Program_Memos / 2000 / B-00-16

Why This Topic Matters

It helps readers determine whether the article addresses Medicare home health payment policy, physician documentation duties, and the operational shift from cost-based reimbursement to a prospective model.

Article Sections

1. Program Memorandum

   Administrative details about the transmittal, timing, distribution expectations, and implementation notes for the memorandum.

2. Role of the Physician in the Home Health Prospective Payment System

   Background on the proposed home health payment changes and the bulletin’s purpose within the broader regulatory context.

3. I. The Proposed Regulation

   An overview of the proposed national home health payment framework, including the general episode-based structure and related claim-processing context.

4. II. Physician Responsibilities

   A summary of the physician’s role in determining needs and managing the documentation responsibilities associated with home health care.

5. III. HCFA-485

   Information about the certification and recertification form used in home health and plan-of-care processes.

6. A. Home Health Certification

   Discussion of the certification process tied to home health eligibility and ongoing physician involvement.

7. B. Plan of Care Certification

   General guidance on plan-of-care development, documentation, and physician review responsibilities.

8. IV. Payment Approach

   A high-level explanation of how the proposed payment methodology is organized and how episode-based payment is described.

9. A. 60-Day Episode Payment

   Coverage of the basic episode structure, payment timing, and case-mix concepts used in the proposed system.

10. B. Partial Episode Payment (PEP) Adjustment

    A general description of payment handling when a care episode is interrupted by certain events.

11. C. Significant Change in Condition Adjustment (SCIC Adjustment)

    Discussion of how episode payment may be adjusted when a patient’s condition changes during the episode.