decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
HHA Model Compliance Plan / Prospective payment system
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Article Overview
This article discusses the move to a prospective payment system for home health services under the Balanced Budget Act of 1997 and the compliance issues home health agencies should anticipate. It is aimed at providers, compliance staff, and revenue cycle professionals who need a general understanding of reimbursement model changes and the associated fraud, abuse, and waste risk areas.
Why This Topic Matters
Changes in payment methodology can affect billing, documentation, and internal compliance efforts for home health agencies. Understanding the broad risks associated with a prospective payment system helps organizations prepare policies and procedures before implementation.
What You Will Learn
- How a prospective payment system changes the reimbursement framework for home health services.
- Why reimbursement model changes can create new compliance risk areas.
- What kinds of organizational planning may be needed for home health agencies when payment methodology changes.
- The general types of fraud, abuse, and waste concerns discussed in connection with prospective payment.
Who Should Read This
- Home health agencies
- Compliance officers
- Billing and reimbursement staff
- Revenue cycle professionals
- Healthcare administrators
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