Entry By: Eileen Bach, PT, M.Ed, DPT
CMS has released the final PPS rules for home health care. Link and brief summary posted here.
The 2012 CMS Home Care PPS rules can be found at: www.ofr.gov/OFRUpload/OFRData/2011-28416_PI.pdf.
Medicare Program; Home Health Prospective Payment System Rate Update for Calendar
Year 2012
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule.
SUMMARY: This final rule sets forth updates to the home health prospective payment system
(HH PPS) rates, including: the national standardized 60-day episode rates; the national per-visit
rates; and the low utilization payment amount (LUPA) under the Medicare PPS for home health
agencies effective January 1, 2012. This rule applies a 1.4 percent update factor to the episode
rates, which reflects a 1 percent reduction applied to the 2.4 percent market basket update factor,
as mandated by the Affordable Care Act. This rule also updates the wage index used under the
HH PPS, and further reduces home health payments to account for continued nominal growth in
case-mix which is unrelated to changes in patient health status. This rule removes two
hypertension codes from the HH PPS case-mix system, thereby requiring recalibration of the
case-mix weights. In addition, the rule implements two structural changes designed to decrease
incentives to upcode and provide unneeded therapy services. Finally, this rule incorporates
additional flexibility regarding face-to-face encounters with providers related to home health
care.
EFFECTIVE DATE: These regulations are effective on January 1, 2012.
I have a PT telling me that a Sup therapist(ST) can do a reassessment for the 11th visit, then an asst. can do a visit on the 12th then another Sup therapist(PT) can do the reassessment on the 13th. My understanding is that both sup therapist has to have the assessments done before asst can go back out. So the visits may fall on 11/12 or 12/13 so if its falls where the ST did assessment for the 11th visit then the PT has to do assessment on 12th. Correct (before asst can go back out)?
Thanks,
Joy
Joy, in your scenario, you did not indicate if PT was the only rehab discipline providing care. I will assume that is the case.
IF PT is the only care provider from Rehab disciplines, then your scenario is fine because the PT must make the 13th visit. I am not clear in your example as to why the supervising PT made an assessment visit on the 11th visit and then another PT returns to complete another re-assessment on the 13th visit – that certainly sounds inefficient OR perhaps there are state based PT:PTA rules that need to be followed.
IF on the other hand, there are 2 or 3 Rehab disciplines caring for the patient, then each therapist (not assistant such as PTA or COTA) must complete the re-assessment by the 13th visit. So if only 2 -PT and OT – the PT could re-assess on visit 11, the PTA provide care on visit 12 and the OT re-assess on visit 13.
The final rules for 2013 are out now and there is some additional clarification when there are multiple disciplines and when a re-assessment is late.
Best wishes,
Eileen Bach
Will Medicare pay for a PT/OT visit on a day the pt sees an MD for the same condition?
Kate, a quick answer is yes because Medicare home care is part A Medicare and is paid via a prospective payment system, not a fee per visit. The MD visit would be part B Medicare. The PT and OT visits in the home are based on physician orders and it is reasonable for medical follow-up with the MD to occur during a home health episode of care.
Hope this helps – let me know if there was more to your question.
Best wishes,
Eileen
Hi Melinda, the agency is correct. The 13/19 combined visit re-assessments are done each cert period. So the combined therapy (PT, OT, SLP) visits start counting from the beginnning of each cert period. The 30 day reassessment is the re-assessment that goes across cert periods.
So in your example, PT (the only therapy discipline) for 6 weeks and then recertified; if the PT was 2x a week, the 30 day assessment would have been due by the end of the 4th week of PT but since with 1 therapy the 13 visit re-assessment must be done ON the 13th visit, the cert period ends with 12 PT visits. The recert takes place and visit count for PT starts again (assuming plan is still 2 x wk) BUT the 30 day re-assessment would be due in about 2 weeks – you would be tracking the day the last 30 day re-assessment was done in the previous cert period.
Hope the example helps and best wishes in the field,
Eileen
I recently attended your Home Health Care Seminar in Houston. In regards to the new rules for the 13/19 visits; if a patient has been on home health for 6 weeks and gets a PT order and the cert periods ends while the patient has visits left… the patient is re-certed…Does the count for the visits re-start? The answer the agency gave is :once the new cert starts the first therapy visit will be the first visit. Is this correct?