Home Health & Hospice

Insider’s scoop | Calculating the episode

Homecare Insider, June 6, 2016

Editor’s note: This week’s Insider’s scoop/Inside story is from The How-To Guide to Home Health Billing, Second Edition. Accurate, compliant practices are a must to ensure you receive the payment you’ve earned. This second edition updates many critical elements involved in billing, enabling your agency to provide the best training possible to billing professionals and other staff. Click here for more information.

The clinical assessment for home health is known as the OASIS. This assessment is completed at the time of admission. Each question on the OASIS associated with payment has a weight value. The completion of the OASIS assessment calculates the case mix weight to provide the Home Health Resource Group (HHRG) score. The HHRG code is comprised of the following:

  • Clinical domain
  • Functional domain
  • Service domain
  • Nonroutine supply (NRS)

The HHRG code is combined with the episode timing question (M0110) and the total number of therapy services (M2200) provided in the episode to calculate the billing HIPPS code. The HIPPS code is an alphanumeric five-digit code.

The NRS points are calculated from several OASIS questions. The NRS adds additional reimbursement to the base episodic amount depending on the score. There are six NRS levels. The fifth character of the HIPPS code represents the NRS score. If there is supply charges included on the claim, the last character will be alpha (S-X). If there are no supply charges on the claim, the code will be numeric (1-6). The episode is reimbursed the additional payment regardless of whether there are supply charges on the claim.