Home Health Prospective Payment System: CMS Expects Home Care Spending To Decrease

Why This Topic Matters

Even small changes in home health PPS policy can affect agency-level reimbursement, compliance obligations, and planning for the coming payment year. The article helps readers understand the policy context behind CMS’s finalized update and the types of operational factors that may influence payments.

Article Sections

1. Home health PPS final rule overview

   Introduces the finalized Medicare home health payment update for 2013 and places it in the context of the proposed rule and prior year changes.

2. Payment update factors and spending impact

   Summarizes the major components CMS says influenced the overall payment update and the expected direction of national home health spending.

3. Case-mix adjustment and coding concerns

   Discusses CMS’s rationale for the case-mix-related adjustment and the industry response to concerns about coding patterns and future methodology changes.

4. Outlier policy changes

   Reviews CMS’s revision to the outlier methodology and the reasons given for the updated payment calculation approach.

5. Looking ahead to sequestration and rebasing

   Notes additional payment pressures and anticipated future PPS policy changes discussed near the end of the article.