Home Health & Hospice

Payment for therapy episodes reduced

Homecare Insider, November 21, 2011

Let’s take a closer look at the case-mix weight adjustments featured in the 2012 Home Health Prospective Payment System Final Rule.

Because of the evolving patterns of therapy, payments impacted by therapy have been significantly revised. Payment for higher-therapy episodes is reduced, while payment for lower-therapy episodes is increased. The removal of the two hypertension codes is finalized, and the codes to be removed from the case-mix model are benign essential hypertension (401.1) and unspecified essential hypertension (401.9). Those diagnoses will no longer be associated with additional points from the four-equation model. The Centers for Medicare and Medicaid Services is not removing hypertension completely from the case-mix system—only those two codes. 

The case-mix model has five steps:
  • Step 1: First and second episodes, 0-13 therapy visits
  • Step 2: First and second episodes, 14-19 therapy visits
  • Step 3: Third episodes and beyond, 14-19 therapy visits
  • Step 4: Third episodes and beyond, 0-13 therapy visits
  • Step 5: All episodes with 20+ therapy visits

The revision is intended to reduce the incentive to provide more therapy than is clinically indicated, better align payment with costs, and redistribute dollars from high therapy payment groups to other case-mix groups.