Late last week CMS published the rule that sets the 2014 Medicare home health payment rates. The final rule is a slight improvement over the proposed rule (a net reduction of 1.05% instead of the proposed 1.5%) that was issued last June. The change from proposed to final is due modifications of the case-mix recalibration, updated visit utilization data and modification in the calculation of the 3.5% annual rebasing adjustment cap. The base episode rate will increase $9.07 per episode, case mix weights increase an average of .39% and LUPA and non-routine supplies (NRS) will decrease slightly from the proposed rule.
The rule also removes 170 ICD-9-CM diagnosis codes from the list of case mix codes and resets case-mix weights to get to an average of 1.0. The eliminated codes include those that are considered too acute and therefore inappropriate for home health care or conditions which would not require home health intervention.
CMS will be adding two claims based measures to home health compare for public reporting in CY2015. The measures are based on hospital readmissions within the first 30 days of receiving home health services and visits to a hospital’s emergency department without readmission within the first 30 days of home health services.
ICD-10-CM changes were also included in the final rule. The draft list of ICD-10-CM case mix codes was included in the final rule with the exception of two changes. The list no longer includes codes with initial encounter extensions and CMS has eliminated unspecified codes when a more specific diagnosis can be identified via clinical assessment.
The expected date for posting of the ICD-10-CM home health grouper remains July 1, 2014.
Since there will no longer be a need for conditions to be reported in the payment diagnosis field with the implementation of ICD-10-CM, CMS will be retiring Appendix D (also known as Attachment D). All necessary guidance can be found in the ICD-10-CM coding guidelines.
The final rule is available at https://www.federalregister.gov/public-inspection.
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