Attention All Home Health Billers: We have updated the Medicare PPS Final Billing Audit and PPS
Revenue Report to more accurately reflect when a HIPPS code and calculated
reimbursement amount has changed due to the new CMS therapy grouping steps for
2015. For episodes that begin in 2014 and end in 2015 (cross-over
episodes), the RAP is calculated using the 2014 HIPPS/Case Mix Weight. When the
Final is processed in 2015, although the HIPPS reported to Medicare must be the
same as the RAP, the HIPPS needs to be recalculated using the 2015 case mix
scoring to post the correct revenue. Previously these recalculations were labeled as ‘Therapy
Upgrades” on the Final Billing Audit and PPS Revenue report. This
has been changed to display as “Regulatory Upgrades” on the Billing Audit and any change in revenue as a result of
the group step change will be included in the “Rate-Adj” figure of the PPS
Revenue report. If any cross-over episodes were previously billed and posted as
a Therapy Upgrade when they should not have been, un-bill and repost the Final
audit to reflect the changes. Do not resubmit the Final claim to Medicare
as this step is for HAS reporting purposes only.
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