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Home Health & Hospice Week

Reimbursement:

Watch For Outlier Reconciliation In May

Published on Tue Mar 09, 2010

Outlier cap problems resolved, CMS pledges. The road to the 10 percent cap on home health agency outlier payments has been bumpy, but the new limit finally seems on track. Background: In its 2010 HHA rate update final rule, the Centers for Medicare & Medicaid Services imposed a per-agency 10 percent cap on outlier payments effective Jan. 1. The policy came in response to extremely high percentages of outlier billings in hot spots like Miami, Fla. The cap was supposed to start applying immediately, but a claims system problem kept the cap from being imposed on some agencies' payments, a CMS official tells Eli. That problem has now been correctedand the cap should be applying to all agencies' payments, the representative says. Agencies that didn't have their payments limited by the cap were confused, reports Rose Kimball of billing company Med Care Administrative Services in Dallas, Texas. Some HHAs got [...]
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