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Home Health & Hospice Week

Prospective Payment System:

Case Mix Changes Take Effect On M0090 Date

Published on Wed Nov 09, 2011

The 2.3 percent cut will hit a bit later. Don't expect to have an episode's worth of lag time when switching over to the new prospective payment system case mix grouper. The date you complete the OASIS assessment determines whether you'll receive this year's or next year's PPS payment. The date you enter in M0090 will set whether the 2011 or 2012 PPS grouper applies to your payment, the National Association for Home Care & Hospice points out in its member newsletter. Under the new PPS case mix system, home health agencies' payments will decrease for high-therapy episodes and increase for no- or low-therapy episodes, among other changes. (See Eli's HCW, Vol. XX, No. 39, p. 306 for more case mix change details.) The new case mix system also eliminates 401.1 (Benign essential hypertension) and 401.9 (Unspecified essential hypertension) as case mix codes, points out coding expert Lisa Selman-Holman on [...]
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