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Home Health Reimbursement

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Can someone please explain simply how home health agencies get reimbursed using HRRG scores, number of therapy visits and outliers? I am having difficulty understanding it. Thanks.

KateRN1

Specializes in COS-C, Risk Management. Has 20 years experience.

http://www.cms.gov/HomeHealthPPS/

http://www.cms.gov/ProspMedicareFeeSvcPmtGen/downloads/hippsusesv4.pdf

Scroll down to page 6. Clear as mud?

The short version is that your OASIS generates the HHRG (home health resource group) score based on the information provided by your clinician, separated into clinical, functional, and service domains. That score, combined with the number of total projected therapy visits, along with the episode timing generates the HIPPS (health insurance prospective payment system) code, which determines the payment for the episode. This is why clinicians need to be well versed in how to accurately score OASIS per CMS guidelines.