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Home Health & Hospice Week

Industry Notes:

Beware Adjustments To Outlier Claims

Published on Wed Apr 06, 2011

If you need to submit an adjustment for a claim that includes an outlier payment, don't count on holding onto those outlier funds. "It is appropriate for no outlier payments to be made on adjustments when the home health agency is beyond their annual 10 percent outlier limitation for the calendar year at the time the adjustments are initiated," regional home health intermediary Cahaba GBA says on its website. "This is true even if the HHA was below this limitation when the original claim processed creating the initial outlier payment."
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