change is here: a new era for medicare home health pps€¦ · medicare claims oasis assessments...
TRANSCRIPT
Change is Here: A New Era for Medicare
Home Health PPS
September 20, 2007
Presented for Missouri Alliance for Home Care
Presented by Mark P. Sharp, CPA [email protected]
BKD Health Care Group 901 E. St. Louis Street
P.O. Box 1190 Springfield, MO 65801-1190
417 865-8701 Fax 417 865-0682
www.bkd.com
Beyond Your NumbersCPAs & Advisors
Change is Here: A New Era for Medicare Home Health PPS
Presented by
Mark P. Sharp, CPAPartnerBKD Health Care GroupSpringfield, Missouri
Beyond Your Numbers
Presentation Overview
Why prospective payment system (PPS) refinementsWhat are the PPS refinementsHow to plan for the PPS refinements
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Beyond Your Numbers
Resources
PowerPoint handoutSummary of the PPS refinements (exhibit 1)Key tables from Federal Register (exhibit 2)Missouri PPS rates by HHRG, NRS & LUPA (exhibit 3)
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Beyond Your Numbers
Background
Purpose of PPSResearch of PPS effectiveness
Abt Associates, Inc.PPS designed for 34% accuracyAchieved 21% accuracy
Refinements deemed necessary
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Beyond Your Numbers
Refinement Research
Abt Associates, Inc.Medicare claimsOASIS assessmentsMedicare cost reports
Significant changes from proposed to finalProposed rule based on 2003 dataFinal rule based on 2005 data
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Beyond Your Numbers
Research Findings
“Later” episodes (3rd+) Require more resourcesRelationship of case-mix variables differed
Dual eligibility & caregiver status not good predictors of resource utilizationAdministrative difficulties & lack of predictive value of M0175
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Beyond Your Numbers
Research Findings
Therapy thresholdResponsible for a marked shift in therapy servicesTherapy resources cannot be effectively predicted on any indicators other than utilizationPayment gradations would be effectiveUsing visits just as accurate as minutes
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Research Findings
More predictive indicatorsExpanded primary & secondary diagnosesInteractions of diagnosesManifestation codesAdditional clinical conditions & co-morbidities
With refinements, estimate 45% accuracy
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Beyond Your Numbers
Refinement Time Line
Proposed rule released April 27, 2007Final rule issued on August 22, 2007Published in August 29, 2007, Federal RegisterEffective for episodes ending on or after January 1, 2008
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Beyond Your Numbers
Refinement Elements
New case-mix modelNew base ratesUnbundling of non-routine medical supply paymentsChanges to payment adjustments
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Beyond Your Numbers
New Case-Mix Model
Four equation model#1 - Early episodes (1st & 2nd) with fewer than 14 therapy visits#2 - Early episodes (1st & 2nd) with 14 or more therapy visits#3 - Later episodes (3rd+) with fewer than 14 therapy visits#4 - Later episodes (3rd+) with 14 or more therapy visits
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Beyond Your Numbers
Early vs Later Episodes
Every episode countsOwn agencyOther agencyPEPLUPA
The end of all episodes (except a PEP) is day 60Must be a break in service in excess of 60 days to bounce back to an early episode
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Beyond Your Numbers
New Case-Mix Scoring
Four equation modelSample: Primary diagnosis = diabetes
• Different points for each equation• See Table 2a for logic
81125Points for Diabetes as primary diagnosis
4321Equation #14+0-1314+0-13Therapy Visits
3rd+1st or 2ndEpisode Number
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Beyond Your Numbers
New Case-Mix Scoring
Different points for each equation based on data relationshipsSample: Primary diagnosis = dysphagia, & M0250 = 3 (enteral therapy at home)
0060Primary diagnosis = dysphagia & M0250 = 3
4321Equation Number14+0-1314+0-13Therapy Visits
3rd+1st or 2ndEpisode Number
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Beyond Your Numbers
New Case-Mix Scoring
Utilizes 22 OASIS itemsRetain three domains/dimensions
ClinicalFunctionalService utilization
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Beyond Your Numbers
Clinical Dimension
M0230/ M0240/ M0246 – DiagnosesM0250 – Therapy at homeM0390 – VisionM0420 – PainM0450 & M0460 – Pressure ulcersM0476 – Stasis ulcersM0488 – Surgical woundsM0490 – Dyspnea
M0540 – Bowel incontinenceM0550 – OstomyM0650 & M0660 – Dressing (new)M0670 – Bathing (new)M0680 – Toileting (new)M0690 – Transferring (new)M0700 – Ambulation (new)M0800 – Injectable drugs (new)
Consists of
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Beyond Your Numbers
Clinical Dimension
EliminatedM0245 – Payment diagnosesM0440 – Skin lesions/open wounds
M0530 – Urinary incontinenceM0610 – Behaviors
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Beyond Your Numbers
Clinical Dimension
Blindness and low visionBlood disordersCancer & selected benign neoplasmsDiabetesDysphagiaGait abnormalityGastrointestinal disordersHeart diseaseHypertension
Neuro – brain and paralysis, peripheral, stroke & MSOrtho – leg & other disordersPsych – affective/other psychoses, degenerative & other PulmonarySkin – traumatic wounds, burns, post-op, ulcers & otherTracheostomy careUrostomy/Cystostomy care
Expanded diagnoses (table 2b)
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Beyond Your Numbers
Functional Dimension
Components unchangedM0650 or M0660 – DressingM0670 – BathingM0680 – ToiletingM0690 – TransferringM0700 – Ambulation
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Beyond Your Numbers
Service Utilization Dimension
M0175 eliminated from case-mix considerationThree therapy thresholds
6, 14 & 20 visitsGraduated payment increases
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Beyond Your Numbers
Case-Mix Scoring
Variation in scoring across four equationsClinical dimension
• Combinations of co-existing diagnoses• Combination of diagnoses & clinical or functional
OASIS itemsFunctional dimension
• Functional OASIS items onlyService utilization dimension
• Therapy utilization only
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Beyond Your Numbers
Case-Mix Grouping
11 to 1311 to 13S5
1010S418 to 197 to 918 to 197 to 9S3
16 to 17616 to 176S2
20+14 to 150 to 514 to 150 to 5S1Service Utilization (number of therapy visits)
8+9+10+8+7+F378976F2
0 to 60 to 70 to 80 to 60 to 5F1Functional (sum of points)
15+17+6+15+9+C3
8 to 149 to 163 to 57 to 145 to 8C20 to 70 to 80 to 20 to 60 to 4C1Clinical (sum
of points)
(2 or 4)4321Equation
20+ therapy14-19 therapy0-13 therapy14-19 therapy0-13 therapyDimension
All Episodes3rd+ Episodes1st & 2nd Episodes
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Beyond Your Numbers
Case-mix Grouping
Results in 153 HHRGsCase-mix weights range from .05827 to 3.4872Billing/HIPPS codes yet to be released
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Beyond Your Numbers
Base Rates
2007 rate = $2,339.00New rates
Episodes beginning in 2007 & ending in 2008• $2,337.06
Episodes beginning in 2008• $2,270.32
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Beyond Your Numbers
Base Rates
Market basket adjustment3.0% increaseRebased to FY2003 dataAt risk for Congress eliminationCompare to
• Hospital = 3.3%• SNF = 3.3%
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Beyond Your Numbers
Base Rates
Case-mix “creep” adjustmentAdministrative adjustmentAssess increases due to
• Change in patient characteristics, or• Creep due to scoring improvements
Per CMS, mostly creep from 2000 to 20052.75% reduction in 2008, 2009 & 20102.71% reduction in 2011 (proposed)
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Beyond Your Numbers
Wage Index
Continue to use hospital wage indexPre-floorPre-classified
Labor portion subject to wage indexIncreased from 76.775 to 77.082
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Beyond Your Numbers
Episode Adjustments
Low-utilization payment adjustment (LUPA) episodes
Maintain four or fewer visitsIdentified increased costs for first visitAdd-on of $87.93
• For LUPA-only episodes (no subsequent episodes)• For initial episodes• Add-on is wage-index adjusted
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Beyond Your Numbers
Episode Adjustments
Significant change in condition (SCIC) adjustments eliminated
Difficult in applicationNegative financial impacts foundOnly 2.1% of episodesAdjustment to base rate for elimination
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Beyond Your Numbers
Episode Adjustments
Partial episode payment (PEP) adjustments retainedOutlier episodes retained
Revised standards• Fixed dollar loss ratio increased to 0.89 from 0.67• 80% loss sharing
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Beyond Your Numbers
Non-Routine Supplies
Patient characteristics determine additional payment (tables 10a and 10b)
42 skin conditions• 19 primary & other diagnoses categories• Pressure ulcers, stasis ulcers & surgical wounds
7 other clinical factors• Ostomies, IV/infusion, urinary catheters & bowell
incontinence
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Beyond Your Numbers
Non-Routine Supplies
NRS payment amount added to case-mix & wage-index adjusted rate
Reduction in base episode rates
Six severity levelsNo supply payment for LUPA episodes
320.3749-985
139.8415-273
551.0099+6
207.7628-484
51.001-142
$ 14.1201PaymentPoints
Severity Level
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Beyond Your Numbers
Sample Rate Computation
Standard rate $2,270.32Case-mix index (C2F1S3 – early episode with 0-13 therapy) 1.2107Case-mix adjusted $2,748.68 Case-mix adjusted $2,748.68Labor portion .77082 $2,118.74Wage index (KC, Mo) 0.9504 Labor portion $2,013.65
(table 5)
(addendum A or B)
Continued…
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Beyond Your Numbers
Sample Rate Computation
Labor portion $2,013.65 Case-mix adjusted $2,748.68Non-labor portion .22918 629.94 Non-routine supplies (level 2) 51.00 Case-mix, wage-index adjusted & supply inclusive PPS rate $2,694.59
(table 9)
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Beyond Your Numbers
OASIS Changes
AddM0110 – Early or later episode
• CMS default = earlyM0246 – Case-mix diagnosesM0826 – Expected therapy visits
• Will adjust therapy up or down based on actual visits reported on final claim
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Beyond Your Numbers
OASIS Changes
DeleteM0245 – Payment diagnosesM0825 – Therapy threshold
Retain M0175But not used for case mix
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Beyond Your Numbers
Quality Improvement
2% reduction for failure to report OASISJuly 2006 through June 2007Compare to claims data
Add measures to Home Health CompareEmergent care for wound infectionsImprovement in status of surgical wounds
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Beyond Your Numbers
Financial Impact
Estimated net increase of $20 million$430M increase for market basket increase$410M decrease for case-mix creep adjustment
Winners?Non-profits, provider-based, North
Losers?Proprietary, freestanding, South
VERY agency-specific
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Beyond Your Numbers
Adapting to the Refinements
Be involved in the industryStudy new rules & regulationsEngage a knowledgeable advisory teamPerform impact assessmentsAssess current coding accuracy
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Beyond Your Numbers
Adapting to the Refinements
Solidify IT vendor interfaceEvaluate potential changes in care planning practicesBlend clinical & financial staff in planning operational changesConservative 2008 budget
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Beyond Your Numbers
How to Contact Me…
Mark Sharp, CPABKD Health Care Group
[email protected] 865-8701
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Beyond Your Numbers
Thank you!
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EXHIBIT 1
Summary of the PPS Refinements
Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
National 60- Day Episode Payment RatesPayment Rates
Episodes beginning in 2006 and ending Episodes beginning in 2007 and endingin 2007 in 2008
Urban Urban or 2,291.68$ 1
Rural Rural or 2,291.68$ 1
Episodes beginning and ending in 2007 Episodes beginning and ending in 2008
Urban Urban or 2,226.24$ 1
Rural Rural or 2,226.24$ 1
1 reduced payment rates for agenciesthat do not transmit OASIS datato the state
Wage Adjustment
Labor portion 76.775% Labor portion 77.082%Nonlabor portion 23.225% Nonlabor portion 22.918%
Episode Payment AdjustmentsLow Utilization Payment Adjustments (LUPA)
Per-visit payment paid on all episodes billed Per-visit payment paid on all episodes billedwith four or fewer visits with four or fewer visits
Additional $87.93 base amount paid for LUPA episodes when:
Episode is the only episode billed, orEpisode is the first episode in a series
2,339.00$ 2,455.95$
2,339.00$
2,337.06$ 2,337.06$
2,270.32$ 2,270.32$ 2,339.00$
BKD Health Care Group, All Rights Reserved 1 of 9
Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Episode Payment Adjustments (continued)Significant Change in Condition (SCIC)
SCIC adjustmend billed when patient Adjustment is elimintedexperiences an unexpected change incondition and other clinical and billing criteriaare met
Outliers
Fixed dollar loss ratio of 0.67 Fixed dollar loss ratio of 0.89
Case-Mix ModelPayment Categories
80 HHRGs and case-mix weights 153 HHRGs and case-mix weights
Case-Mix Scoring
Case-mix weights range from 0.5265 to Case-mix weights range from 0.5827 to2.8113 3.4872
Single equation model: Multiple equation model:
All episodes given equal weight Equation 1: regardless of whether the episode wasthe first or subsequent in a series of First or second episodes with 0 to 13episodes total therapy visits
Equation 2:
First or second episodes with 14 or moretotal therapy visits
Equation 3:
Third or later episodes with 0 to 13total therapy visits
Equation 4:
Third or later episodes with 14 or moretotal therapy visits
BKD Health Care Group, All Rights Reserved 2 of 9
Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Case-Mix Model (continued)Episode Timing
No tracking or payment for episode sequence New OASIS item M0110 to track early (first oror timing second episodes) or late (third or later)
episodes which determines the equation thatwill be applied to the episode for paymentpurposes
Clinical Dimension
OASIS Questions OASIS Questions
15 questions with payment value: 20 questions with payment value:
M0230/M0245 M0476 M0230/M0240/M0246 M0540M0240a M0488 M0250 M0550M0250 M0490 M0390 M0650M0390 M0530 M0420 M0660M0420 M0540 M0450 M0670M0440 M0550 M0460 M0680M0450 M0610 M0476 M0690M0460 M0488 M0700
M0490 M0800
Dimension Codes Dimension Codes
C0 = A 0 to 7 points (minimum) Equation 1 (HHRG Group 1)C1 = B 8 to 19 points (low)C2 = C 20 to 40 points (moderate) C1 = A2 0 to 4 clinical pointsC3 = D 41 or more points (high) C2 = B2 5 to 8 clinical points
C3 = C2 9 or more clinical points
BKD Health Care Group, All Rights Reserved 3 of 9
Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Case-Mix Model (continued)Clinical Dimension (continued)
Equation 2 (HHRG Group 2)
C1 = A2 0 to 6 clinical pointsC2 = B2 7 to 14 clinical pointsC3 = C2 15 or more clinical points
Equation 3 (HHRG Group 3)
C1 = A2 0 to 2 clinical pointsC2 = B2 3 to 5 clinical pointsC3 = C2 6 or more clinical points
Equation 4 (HHRG Group 4)
C1 = A2 0 to 8 clinical pointsC2 = B2 9 to 16 clinical pointsC3 = C2 17 or more clinical points
Equations 2 & 4 (HHRG Group 5)
C1 = A2 0 to 7 clinical pointsC2 = B2 8 to 14 clinical pointsC3 = C2 15 or more clinical points
Functional Dimension
OASIS Questions OASIS Questions
6 questions with payment value: 6 questions with payment value:
M0650 M0680 M0650 M0680M0660 M0690 M0660 M0690M0670 M0700 M0670 M0700
BKD Health Care Group, All Rights Reserved 4 of 9
Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Case-Mix Model (continued)Functional Dimension (continued)
Dimension Codes Dimension Codes
F0 = E 0 to 2 points (minimum) Equation 1 (HHRG Group 1)F1 = F 3 to 15 points (low)F2 = G 16 to 23 points (moderate) F1 = F2 0 to 5 functional pointsF3 = H 24 to 29 points (high) F2 = G2 6 functional pointsF4 = I 30 or more points (maximum) F3 = H2 7 or more functional points
Equation 2 (HHRG Group 2)
F1 = F2 0 to 6 functional pointsF2 = G2 7 functional pointsF3 = H2 8 or more functional points
Equation 3 (HHRG Group 3)
F1 = F2 0 to 8 functional pointsF2 = G2 9 functional pointsF3 = H2 10 or more functional points
Equation 4 (HHRG Group 4)
F1 = F2 0 to 7 functional pointsF2 = G2 8 functional pointsF3 = H2 9 or more functional points
Equations 2 & 4 (HHRG Group 5)
F1 = F2 0 to 6 functional pointsF2 = G2 7 functional pointsF3 = H2 8 or more functional points
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Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Case-Mix Model (continued)Service Utilization Dimension
OASIS Questions OASIS Questions
2 questions with payment value: 1 question with payment value
M0175 M0825 M0826
Dimension Codes Dimension Codes
Single therapy threshold of 10 total therapy Multiple therapy thresholds at 6, 14 and visits 20 visits (M0826)
S0 = J 0 to 2 points (minimum) and Equation 1 (HHRG Group 1)less than 10 total therapy visits
S1 = K 3 points (low) and less than S1 = K2 0 to 5 total therapy visits10 total therapy visits S2 = L2 6 total therapy visits
S2 = L 4 to 6 points (moderate) and S3 = M2 7 to 9 total therapy visits10 or more total therapy visits S4 = N2 10 total therapy visits
S3 = M 7 points (high) and 10 or more S5 = P2 11 to 13 total therapy visitstotal therapy visits
Equation 2 (HHRG Group 2)
S1 = K2 14 to 15 total therapy visitsS2 = L2 16 to 17 total therapy visitsS3 = M2 18 to 19 total therapy visits
Equation 3 (HHRG Group 3)
S1 = K2 0 to 5 total therapy visitsS2 = L2 6 total therapy visitsS3 = M2 7 to 9 total therapy visitsS4 = N2 10 total therapy visitsS5 = P2 11 to 13 total therapy visits
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Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Case-Mix Model (continued)Service Utilization Dimension (continued)
Equation 4 (HHRG Group 4)
S1 = K2 14 to 15 total therapy visitsS2 = L2 16 to 17 total therapy visitsS3 = M2 18 to 19 total therapy visits
Equations 2 & 4 (HHRG Group 5)
S1 = K2 20 or more total therapy visits
Nonroutine Medical Supplies
Nonroutine medical supplies factored into Additional episode payment made accordingnational standard rates but no extra payment to six patient severity levels:in addition to standard episode payment Additional
Severity StandardLevel HIPPS2 Points Payment
1 S 0 14.12$ 2 T 1 to 14 51.00$ 3 U 15 to 27 139.84$ 4 V 28 to 48 207.76$ 5 W 49 to 98 320.37$ 6 ? 99 or more 551.00$
Billing Codes2
HIPPS Codes
Five character alpha-numeric code, i.e., HAEJ1 Five character alpha-numeric code, i.e., 1AFKS
Position 1 H Home health Position 1 1 - 5 HHRG groupPosition 2 A - D Clinical domain score Position 2 A - C Clinical domain scorePosition 3 E - I Functional domain score Position 3 F - H Functional domain scorePosition 4 J - M Service utilization Position 4 K - N, P Service utilization
domain score domain scorePosition 5 1 - 8 Validity score Position 5 S - W Nonroutine supplies
severity level
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Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Billing Codes2 (continued)OASIS Matching Key
18 character numeric code, i.e., 18 character alpha-numeric code, i.e.,200701012007010000 07JK08AA41GBMDCDLG
Positions 1 - 8 M0030: Start of care Positions 1 - 2 M0030: Start of caredate year (2 digit code)
Positions 9 - 16 M0090: Assessment Positions 3 - 4 M0030: Start of caredate month and day (2
Positions 17 - 18 M0100: Reason for character alpha code)assessment Positions 5 - 6 M0090: Assessment
year (2 digit code)Positions 7 - 8 M0090: Assessment
month and day (2character alpha code)
Position 9 M00100: Reason forassessment (1 digitcode)
Position 10 M0110: Episode timing(1 digit code)
Position 11 Clinical domain pointsunder equation 1 (alphacode)
Position 12 Functional domainpoints under equation 1(alpha code)
Position 13 Clinical domain pointsunder equation 2 (alphacode)
Position 14 Functional domainpoints under equation 2(alpha code)
Position 15 Clinical domain pointsunder equation 3 (alphacode)
Position 16 Functional domainpoints under equation 3(alpha code)
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Medicare Home Health ProgramPPS Refinements Summary of Key ChangesEffective January 1, 2008
Current PPS Rules New PPS Rules1
Billing Codes2 (continued)OASIS Matching Key (continued)
Position 17 Clinical domain pointsunder equation 4 (alphacode)
Position 18 Functional domainpoints under equation 4(alpha code)
Publicly Reported Outcomes
10 publicly reported outcome measures 12 publicly reported outcome measurestracked using OASIS data and posted on tracked using OASIS data and posted onthe CMS home health compare website the CMS home health compare website
2 new measures include:
Emergent care for wound infections, deteriorating wound status, and
Improvement in status of surgical wound
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
1All new rules are effective January 1, 2008, and are based on the proposed rules in the Federal Register, dated May 4, 2007, and the final rules published in the Centers for Medicare and Medicaid Services (CMS) document CMS-1541-FC.
2All new HIPPS codes and other billing code information is based on proposed data and has not yet been finalized by CMS.
BKD Health Care Group, All Rights Reserved 9 of 9
EXHIBIT 2
Key Tables from the Federal Register
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49853 Federal Register / Vol. 72, No. 167 / Wednesday, August 29, 2007 / Rules and Regulations
TABLE 10A.—NRS CASE-MIX ADJUSTMENT VARIABLES AND SCORES
Item Description Score
SELECTED SKIN CONDITIONS
1 ....................................... Primary diagnosis = Anal fissure, fistula and abscess ................................................................................. 15 2 ....................................... Other diagnosis = Anal fissure, fistula and abscess ..................................................................................... 13 3 ....................................... Primary diagnosis = Cellulitis and abscess ................................................................................................... 14 4 ....................................... Other diagnosis = Cellulitis and abscess ...................................................................................................... 8 5 ....................................... Primary or other diagnosis = Diabetic ulcers ................................................................................................ 20 6 ....................................... Primary diagnosis = Gangrene ...................................................................................................................... 11 7 ....................................... Other diagnosis = Gangrene ......................................................................................................................... 8 8 ....................................... Primary diagnosis = Malignant neoplasms of skin ........................................................................................ 15 9 ....................................... Other diagnosis = Malignant neoplasms of skin ........................................................................................... 4 10 ..................................... Primary or Other diagnosis = Non-pressure and non-stasis ulcers .............................................................. 13 11 ..................................... Primary diagnosis = Other infections of skin and subcutaneous tissue ....................................................... 16 12 ..................................... Other diagnosis = Other infections of skin and subcutaneous tissue .......................................................... 7 13 ..................................... Primary diagnosis = Post-operative Complications ....................................................................................... 23 14 ..................................... Other diagnosis = Post-operative Complications .......................................................................................... 15 15 ..................................... Primary diagnosis = Traumatic Wounds and Burns ..................................................................................... 19 16 ..................................... Other diagnosis = Traumatic Wounds and Burns ......................................................................................... 8 17 ..................................... Primary or other diagnosis = V code, Cystostomy care ............................................................................... 16 18 ..................................... Primary or other diagnosis = V code, Tracheostomy care ........................................................................... 23 19 ..................................... Primary or other diagnosis = V code, Urostomy care ................................................................................... 24 20 ..................................... OASIS M0450 = 1 or 2 pressure ulcers, stage 1 ......................................................................................... 4 21 ..................................... OASIS M0450 = 3+ pressure ulcers, stage 1 ............................................................................................... 6 22 ..................................... OASIS M0450 = 1 pressure ulcer, stage 2 ................................................................................................... 14 23 ..................................... OASIS M0450 = 2 pressure ulcers, stage 2 ................................................................................................. 22 24 ..................................... OASIS M0450 = 3 pressure ulcers, stage 2 ................................................................................................. 29 25 ..................................... OASIS M0450 = 4+ pressure ulcers, stage 2 ............................................................................................... 35 26 ..................................... OASIS M0450 = 1 pressure ulcer, stage 3 ................................................................................................... 29 27 ..................................... OASIS M0450 = 2 pressure ulcers, stage 3 ................................................................................................. 41 28 ..................................... OASIS M0450 = 3 pressure ulcers, stage 3 ................................................................................................. 46 29 ..................................... OASIS M0450 = 4+ pressure ulcers, stage 3 ............................................................................................... 58 30 ..................................... OASIS M0450 = 1 pressure ulcer, stage 4 ................................................................................................... 48 31 ..................................... OASIS M0450 = 2 pressure ulcers, stage 4 ................................................................................................. 67 32 ..................................... OASIS M0450 = 3+ pressure ulcers, stage 4 ............................................................................................... 75 33 ..................................... OASIS M0450e = 1 (unobserved pressure ulcer(s)) .................................................................................... 17 34 ..................................... OASIS M0470 = 2 (2 stasis ulcers) .............................................................................................................. 6 35 ..................................... OASIS M0470 = 3 (3 stasis ulcers) .............................................................................................................. 12 36 ..................................... OASIS M0470 = 4 (4+ stasis ulcers) ............................................................................................................ 21 37 ..................................... OASIS M0474 = 1 (unobservable stasis ulcers) ........................................................................................... 9 38 ..................................... OASIS M0476 = 1 (status of most problematic stasis ulcer: fully granulating) ............................................ 6 39 ..................................... OASIS M0476 = 2 (status of most problematic stasis ulcer: early/partial granulation) ................................ 25 40 ..................................... OASIS M0476 = 3 (status of most problematic stasis ulcer: not healing) .................................................... 36 41 ..................................... OASIS M0488 = 2 (status of most problematic surgical wound: early/partial granulation) .......................... 4 42 ..................................... OASIS M0488 = 3 (status of most problematic surgical wound: not healing) .............................................. 14
OTHER CLINICAL FACTORS
43 ..................................... OASIS M0550 = 1 (ostomy not related to inpt stay/no regimen change) .................................................... 27 44 ..................................... OASIS M0550 = 2 (ostomy related to inpt stay/regimen change) ................................................................ 45 45 ..................................... Any ‘Selected Skin Conditions’ (rows 1–42 above) AND M0550 = 1 (ostomy not related to inpt stay/no
regimen change).14
46 ..................................... Any ‘Selected Skin Conditions’ (rows 1–42 above) AND M0550 = 2 (ostomy related to inpt stay/ regimen change).
11
47 ..................................... OASIS M0250 (Therapy at home) =1 (IV/Infusion) ....................................................................................... 5 48 ..................................... OASIS M0520 = 2 (patient requires urinary catheter) .................................................................................. 9 49 ..................................... OASIS M0540 = 4 or 5 (bowel incontinence, daily or >daily) ....................................................................... 10
Note: Points are additive, however points may not be given for the same line item in the table more than once. Points are not assigned for a secondary diagnosis if points are already assigned for a primary diagnosis
from the same diagnosis/condition group. See Table 12b for definitions of diagnosis/ condition groups.
Please see Medicare Home Health Diagnosis Coding guidance at http://
www.cms.hhs.gov/HomeHealthPPS/ 03_coding&billing.asp for definitions of primary and secondary diagnoses.
TABLE 10B.—ICD–9–CM DIAGNOSES INCLUDED IN THE DIAGNOSTIC CATEGORIES FOR THE NONROUTINE SUPPLIES (NRS) CASE-MIX ADJUSTMENT MODEL
Diagnostic Category ICD–9–CM Code* Manifestation Short Description of ICD–9–CM Code
Anal fissure, fistula and abscess .. 565 .................... ........................... ANAL FISSURE AND FISTULA.
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TABLE 10B.—ICD–9–CM DIAGNOSES INCLUDED IN THE DIAGNOSTIC CATEGORIES FOR THE NONROUTINE SUPPLIES (NRS) CASE-MIX ADJUSTMENT MODEL—Continued
Diagnostic Category ICD–9–CM Code* Manifestation Short Description of ICD–9–CM Code
566 .................... ........................... ABSCESS OF ANAL AND RECTAL REGIONS. Cellulitis and abscess .................... 681.00 ............... ........................... FINGER—CELLULITIS AND ABSCESS, UNSPECIFIED.
681.01 ............... ........................... FELON. 681.10 ............... ........................... TOE—CELLULITIS AND ABSCESS, UNSPECIFIED. 681.9 ................. ........................... CELLULITIS AND ABSCESS OF UNSPECIFIED DIGIT. 682 .................... ........................... OTHER CELLULITIS AND ABSCESS.
Diabetic Ulcers .............................. 250.8x & 707.10–707.9.
........................... (PRIMARY OR FIRST OTHER DIAGNOSIS = 250.8x AND PRI-MARY OR FIRST OTHER DIAGNOSIS = 707.10- 707.9).
Gangrene ....................................... 440.24 ............... ........................... ATHERSCLER-ART EXTREM W/GANGRENE. 785.4 ................. M ...................... GANGRENE.
Malignant neoplasms of skin ......... 172 .................... ........................... MALIGNANT MELANOMA OF SKIN. 173 .................... ........................... OTHER MALIGNANT NEOPLASM OF SKIN.
Non-pressure and non-stasis ul-cers (other than diabetic).
440.23 ............... ........................... ATHEROSCLER-ART EXTREM W/ULCERATION.
447.2 ................. ........................... RUPTURE OF ARTERY. 447.8 ................. ........................... OTHER SPECIFIED DISORDERS OF ARTERIES AND
ARTERIOLES. 707.10 ............... ........................... ULCER OF LOWER LIMB, UNSPECIFIED. 707.11 ............... ........................... ULCER OF THIGH. 707.12 ............... ........................... ULCER OF CALF. 707.13 ............... ........................... ULCER OF ANKLE. 707.14 ............... ........................... ULCER OF HEEL AND MIDFOOT. 707.15 ............... ........................... ULCER OF OTHER PART OF FOOT. 707.19 ............... ........................... ULCER OF OTHER PART OF LOWER LIMB. 707.8 ................. ........................... CHRONIC ULCER OTHER SPECIFIED SITE. 707.9 ................. ........................... CHRONIC ULCER OF UNSPECIFIED SITE.
Other infections of skin and sub-cutaneous tissue.
680 .................... ........................... CARBUNCLE AND FURUNCLE.
683 .................... ........................... ACUTE LYMPHADENITIS. 685 .................... ........................... PILONIDAL CYST. 686 .................... ........................... OTH LOCAL INF SKIN&SUBCUT TISSUE.
Post-operative Complications ........ 998.11 ............... ........................... HEMORRHAGE COMPLICATING A PROCEDURE. 998.12 ............... ........................... HEMATOMA COMPLICATING A PROCEDURE. 998.13 ............... ........................... SEROMA COMPLICATING A PROCEDURE. 998.2 ................. ........................... ACC PUNCT/LACERATION DURING PROC NEC. 998.4 ................. ........................... FB ACC LEFT DURING PROC NEC. 998.6 ................. ........................... PERSISTENT POSTOPERATIVE FIST NEC. 998.83 ............... ........................... NON-HEALING SURGICAL WOUND NEC.
Traumatic wounds, burns and post-operative complications.
870 .................... ........................... OPEN WOUND OF OCULAR ADNEXA.
872 .................... ........................... OPEN WOUND OF EAR. 873 .................... ........................... OTHER OPEN WOUND OF HEAD. 874 .................... ........................... OPEN WOUND OF NECK. 875 .................... ........................... OPEN WOUND OF CHEST. 876 .................... ........................... OPEN WOUND OF BACK. 877 .................... ........................... OPEN WOUND OF BUTTOCK. 878 .................... ........................... OPEN WND GNT ORGN INCL TRAUMAT AMP. 879 .................... ........................... OPEN WOUND OTH&UNSPEC SITE NO LIMBS. 880 .................... ........................... OPEN WOUND OF SHOULDER&UPPER ARM. 881 .................... ........................... OPEN WOUND OF ELBOW, FOREARM&WRIST. 882 .................... ........................... OPEN WOUND HAND EXCEPT FINGER ALONE. 883 .................... ........................... OPEN WOUND OF FINGER. 884 .................... ........................... MX&UNSPEC OPEN WOUND UPPER LIMB. 885 .................... ........................... TRAUMATIC AMPUTATION OF THUMB. 886 .................... ........................... TRAUMATIC AMPUTATION OTHER FINGER. 887 .................... ........................... TRAUMATIC AMPUTATION OF ARM&HAND. 890 .................... ........................... OPEN WOUND OF HIP AND THIGH. 891 .................... ........................... OPEN WOUND OF KNEE, LEG, AND ANKLE. 892 .................... ........................... OPEN WOUND OF FOOT EXCEPT TOE ALONE. 893 .................... ........................... OPEN WOUND OF TOE. 894 .................... ........................... MX&UNSPEC OPEN WOUND LOWER LIMB. 895 .................... ........................... TRAUMATIC AMPUTATION OF TOE. 896 .................... ........................... TRAUMATIC AMPUTATION OF FOOT. 897 .................... ........................... TRAUMATIC AMPUTATION OF LEG. 941 except
941.0x and 941.1x.
........................... BURN OF FACE, HEAD, AND NECK.
942 except 942.0x and 942.1x.
........................... BURN OF TRUNK.
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TABLE 10B.—ICD–9–CM DIAGNOSES INCLUDED IN THE DIAGNOSTIC CATEGORIES FOR THE NONROUTINE SUPPLIES (NRS) CASE-MIX ADJUSTMENT MODEL—Continued
Diagnostic Category ICD–9–CM Code* Manifestation Short Description of ICD–9–CM Code
943 except 943.0x and 943.1x.
........................... BURN OF UPPER LIMB, EXCEPT WRIST AND HAND.
944 except 944.0x and 944.1x.
........................... BURN OF WRIST(S) AND HAND(S).
945 except 945.0x and 945.1x.
........................... BURN OF LOWER LIMB(S).
946.2 ................. ........................... BURNS OF MULTIPLE SPECIFIED SITES, BLISTERS, EPI-DERMAL LOSS [SECOND DEGREE].
946.3 ................. ........................... BURNS OF MULTIPLE SPECIFIED SITES, FULL-THICKNESS SKIN LOSS [THIRD DEGREE NOS].
946.4 ................. ........................... BURNS OF MULTIPLE SPECIFIED SITES, DEEP NECROSIS OF UNDERLYING TISSUES [DEEP THIRD DEGREE] WITHOUT MENTION OF LOSS OF A BODY PART.
946.5 ................. ........................... BURNS OF MULTIPLE SPECIFIED SITES, DEEP NECROSIS OF UNDERLYING TISSUES [DEEP THIRD DEGREE] WITH LOSS OF A BODY PART.
998.31 ............... ........................... DISRUPTION OF INTERNAL OPERATION WOUND. 998.32 ............... ........................... DISRUPTION OF EXTERNAL OPERATION WOUND. 998.51 ............... ........................... INFECTED POSTOPERATIVE SEROMA. 998.59 ............... ........................... OTHER POSTOPERATIVE INFECTION.
V-code, Cystostomy Care ............. V55.5 ................. ........................... CYSTOSTOMY—CARE. V-code, Tracheostomy Care ......... V55.0 ................. ........................... TRACHEOSTOMY—CARE. V-code, Urostomy Care ................. V55.6 ................. ........................... OTHER ARTIFICIAL OPENING OF URINARY TRACT-
NEPHROSTOMY, URETEROSTOMY, URETHROSTOMY.
To ensure that NRS costs are being reported, claims that do not report NRS costs, unless explicitly noted by the HHA that NRS was not provided, will be returned to the provider (RTP). For episodes in which NRS was provided, the provider will need to resubmit the claim with NRS reported. For episodes in which NRS was not provided, the HHA will need to explicitly note that fact on the claim. We will allow a grace period, which will be determined and communicated in instructions from CMS. This will improve data on NRS, in the home health setting, providing us with better data with which to analyze and evaluate payment to HHAs for NRS in the future. We will monitor the accuracy of the 6-severity group methodology for payment of NRS. We will continue to monitor the accuracy and completeness of the reporting of NRS costs. Finally, we will explore alternative methods for accounting for NRS costs and payments in the future.
D. The Outlier Policy
As noted in section II, of this final rule with comment period, outlier payments are made for episodes for which the estimated cost exceeds a threshold amount and are intended to address home health episodes that incur unusually high costs due to patient health care needs. Section 1895(b)(5) of the Act requires that the estimated total
outlier payments are no more than 5 percent of total estimated HH PPS payments. For a full description of our outlier policy, we refer to the CY 2008 HH PPS proposed rule (72 FR 25434– 25435).
The wage adjusted fixed dollar loss (FDL) amount represents the amount of loss that an agency must bear before an episode becomes eligible for outlier payments. The loss sharing ratio is 0.80. As noted in the proposed rule, when the HH PPS system was implemented, we chose a value of 0.80 for the loss-sharing ratio and an FDL ratio of 1.13. In the October 2004 final rule, we revised the FDL ratio to 0.70, based on analysis of CY 2003 HH PPS data. We believed this updated FDL ratio of 0.70 preserved a reasonable degree of cost sharing, allowed a greater number of episodes to qualify for outlier payments, and yet did not result in a projected target percentage of estimated outlier payments of more than 5 percent.
Our CY 2006 update to the HH PPS rates, which was based upon CY 2004 HH claims data, again revised the FDL ratio from 0.70 to 0.65 to allow even more home health episodes to qualify for outlier payments and to better meet the estimated 5 percent target of outlier payments as a percentage of total HH PPS payments. In our CY 2007 update, we again changed the FDL ratio from 0.65 to 0.67 to better meet the 5 percent
target of outlier payments to total HH PPS payments, and based the change on analysis of CY 2005 HH claims.
In the proposed rule (72 FR 25434), we stated that preliminary analysis showed that outlier payments, as a percentage of total HH PPS payments, have increased on a yearly basis. With outlier payments having increased in recent years, and given the unknown effects that the proposed refinements may have on outliers, we proposed to maintain the FDL ratio at 0.67. We believed that this would continue to meet the statutory requirement of having an outlier payment outlay that does not exceed 5 percent of total HH PPS payments, while still providing for an adequate number of episodes to qualify for outlier payments. We stated in the proposed rule that we would rely on the latest data and best analysis available at the time to estimate outlier payments and update the FDL ratio in the final rule if appropriate.
Comment: A commenter supported our proposed outlier policy but does not understand why it needs to be capped at 5 percent.
Response: The statute, at section 1895(b)(5) of the Act, limits estimated outlier payments to no more than 5 percent of the total estimated HH PPS payments during a given year.
Comment: Commenters stated that the fixed dollar loss (FDL) ratio should be
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EXHIBIT 3
Missouri PPS Rates by HHRG, NRS & LUPA
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode17860 Columbia, Missouri
Boone CountyHoward County
Rates by HHRG Code1
Equation 1: 1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,186.07$ C2F1S1 0.7335 1,493.02$ C3F1S1 0.9010 1,833.96$ C1F1S2 0.8507 1,731.57 C2F1S2 1.0015 2,038.52 C3F1S2 1.1691 2,379.67 C1F1S3 1.0599 2,157.39 C2F1S3 1.2107 2,464.34 C3F1S3 1.3783 2,805.49 C1F1S4 1.2744 2,594.00 C2F1S4 1.4252 2,900.95 C3F1S4 1.5927 3,241.89 C1F1S5 1.4506 2,952.65 C2F1S5 1.6014 3,259.60 C3F1S5 1.7690 3,600.74 C1F2S1 0.6713 1,366.41 C2F2S1 0.8221 1,673.36 C3F2S1 0.9896 2,014.30 C1F2S2 0.9393 1,911.92 C2F2S2 1.0901 2,218.86 C3F2S2 1.2577 2,560.01 C1F2S3 1.1485 2,337.74 C2F2S3 1.2993 2,644.68 C3F2S3 1.4669 2,985.83 C1F2S4 1.3630 2,774.34 C2F2S4 1.5138 3,081.29 C3F2S4 1.6813 3,422.23 C1F2S5 1.5392 3,132.99 C2F2S5 1.6900 3,439.94 C3F2S5 1.8576 3,781.09 C1F3S1 0.7550 1,536.78 C2F3S1 0.9058 1,843.73 C3F3S1 1.0733 2,184.67 C1F3S2 1.0230 2,082.28 C2F3S2 1.1738 2,389.23 C3F3S2 1.3414 2,730.38 C1F3S3 1.2322 2,508.10 C2F3S3 1.3830 2,815.05 C3F3S3 1.5506 3,156.20 C1F3S4 1.4467 2,944.71 C2F3S4 1.5975 3,251.66 C3F3S4 1.7650 3,592.60 C1F3S5 1.6229 3,303.36 C2F3S5 1.7737 3,610.31 C3F3S5 1.9413 3,951.46
Equation 2: 1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,280.77$ C2F1S1 1.8626 3,791.26$ C3F1S1 2.1524 4,381.14$ C1F1S2 1.7675 3,597.69 C2F1S2 2.0183 4,108.19 C3F1S2 2.3081 4,698.07 C1F1S3 1.9046 3,876.75 C2F1S3 2.1554 4,387.25 C3F1S3 2.4451 4,976.93 C1F2S1 1.7281 3,517.49 C2F2S1 1.9789 4,027.99 C3F2S1 2.2686 4,617.66 C1F2S2 1.8837 3,834.21 C2F2S2 2.1345 4,344.71 C3F2S2 2.4243 4,934.59 C1F2S3 2.0208 4,113.28 C2F2S3 2.2716 4,623.77 C3F2S3 2.5613 5,213.45 C1F3S1 1.8010 3,665.88 C2F3S1 2.0518 4,176.38 C3F3S1 2.3415 4,766.05 C1F3S2 1.9566 3,982.60 C2F3S2 2.2074 4,493.09 C3F3S2 2.4972 5,082.97 C1F3S3 2.0937 4,261.66 C2F3S3 2.3445 4,772.16 C3F3S3 2.6342 5,361.83
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Page 1 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode17860 Columbia, Missouri
Boone CountyHoward County
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Equation 3: 3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,331.81$ C2F1S1 0.7124 1,450.07$ C3F1S1 0.9399 1,913.14$ C1F1S2 1.0041 2,043.81 C2F1S2 1.0622 2,162.08 C3F1S2 1.2897 2,625.14 C1F1S3 1.2065 2,455.79 C2F1S3 1.2646 2,574.05 C3F1S3 1.4922 3,037.33 C1F1S4 1.4277 2,906.04 C2F1S4 1.4858 3,024.30 C3F1S4 1.7134 3,487.57 C1F1S5 1.6024 3,261.64 C2F1S5 1.6605 3,379.90 C3F1S5 1.8880 3,842.97 C1F2S1 0.7882 1,604.36 C2F2S1 0.8463 1,722.62 C3F2S1 1.0738 2,185.69 C1F2S2 1.1380 2,316.36 C2F2S2 1.1962 2,434.83 C3F2S2 1.4237 2,897.90 C1F2S3 1.3405 2,728.55 C2F2S3 1.3986 2,846.81 C3F2S3 1.6261 3,309.88 C1F2S4 1.5167 3,087.20 C2F2S4 1.6198 3,297.05 C3F2S4 1.8473 3,760.12 C1F2S5 1.7364 3,534.39 C2F2S5 1.7945 3,652.65 C3F2S5 2.0220 4,115.72 C1F3S1 0.9151 1,862.66 C2F3S1 0.9732 1,980.92 C3F3S1 1.2007 2,443.99 C1F3S2 1.2649 2,574.66 C2F3S2 1.3230 2,692.93 C3F3S2 1.5506 3,156.20 C1F3S3 1.4674 2,986.85 C2F3S3 1.5255 3,105.11 C3F3S3 1.7530 3,568.18 C1F3S4 1.6886 3,437.09 C2F3S4 1.7467 3,555.35 C3F3S4 1.9742 4,018.42 C1F3S5 1.8632 3,792.49 C2F3S5 1.9213 3,910.75 C3F3S5 2.1489 4,374.02
Equation 4: 3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,568.18$ C2F1S1 2.0276 4,127.12$ C3F1S1 2.3479 4,779.08$ C1F1S2 1.8689 3,804.09 C2F1S2 2.1435 4,363.03 C3F1S2 2.4637 5,014.78 C1F1S3 2.0252 4,122.23 C2F1S3 2.2998 4,681.17 C3F1S3 2.6200 5,332.93 C1F2S1 1.8839 3,834.62 C2F2S1 2.1585 4,393.56 C3F2S1 2.4787 5,045.32 C1F2S2 1.9998 4,070.53 C2F2S2 2.2744 4,629.47 C3F2S2 2.5946 5,281.23 C1F2S3 2.1560 4,388.47 C2F2S3 2.4306 4,947.41 C3F2S3 2.7509 5,599.37 C1F3S1 2.0531 4,179.02 C2F3S1 2.3277 4,737.96 C3F3S1 2.6479 5,389.72 C1F3S2 2.1690 4,414.93 C2F3S2 2.4436 4,973.87 C3F3S2 2.7638 5,625.63 C1F3S3 2.3252 4,732.87 C2F3S3 2.5998 5,291.81 C3F3S3 2.9201 5,943.77
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
HHRG Code
Page 2 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode17860 Columbia, Missouri
Boone CountyHoward County
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Equations 2 and 4: All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,189.43$ C2F1S1 2.7632 5,624.41$ C3F1S1 3.0835 6,276.37$ C1F2S1 2.7390 5,575.15 C2F2S1 2.9527 6,010.13 C3F2S1 3.2730 6,662.09 C1F3S1 2.9532 6,011.15 C2F3S1 3.1669 6,446.13 C3F3S1 3.4872 7,098.09
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 94.06$ Physical therapy 102.84 Occupational therapy 103.53 Speech therapy 111.66 Medical social worker 150.77 Home health aide 42.60
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 78.83$
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
6 551.00 5
34
12
SeverityLevel
Page 3 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode22220 Fayetteville-Springdale-Rogers, Arkansas-Missouri
Benton County, AR McDonald County, MOMadison County, ARWashington County, AR
Rates by HHRG Code1
Equation 1: 1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,194.63$ C2F1S1 0.7335 1,503.80$ C3F1S1 0.9010 1,847.20$ C1F1S2 0.8507 1,744.08 C2F1S2 1.0015 2,053.24 C3F1S2 1.1691 2,396.85 C1F1S3 1.0599 2,172.97 C2F1S3 1.2107 2,482.14 C3F1S3 1.3783 2,825.75 C1F1S4 1.2744 2,612.74 C2F1S4 1.4252 2,921.90 C3F1S4 1.5927 3,265.30 C1F1S5 1.4506 2,973.98 C2F1S5 1.6014 3,283.14 C3F1S5 1.7690 3,626.75 C1F2S1 0.6713 1,376.28 C2F2S1 0.8221 1,685.44 C3F2S1 0.9896 2,028.85 C1F2S2 0.9393 1,925.72 C2F2S2 1.0901 2,234.89 C3F2S2 1.2577 2,578.50 C1F2S3 1.1485 2,354.62 C2F2S3 1.2993 2,663.78 C3F2S3 1.4669 3,007.39 C1F2S4 1.3630 2,794.38 C2F2S4 1.5138 3,103.55 C3F2S4 1.6813 3,446.95 C1F2S5 1.5392 3,155.62 C2F2S5 1.6900 3,464.79 C3F2S5 1.8576 3,808.39 C1F3S1 0.7550 1,547.88 C2F3S1 0.9058 1,857.04 C3F3S1 1.0733 2,200.45 C1F3S2 1.0230 2,097.32 C2F3S2 1.1738 2,406.49 C3F3S2 1.3414 2,750.10 C1F3S3 1.2322 2,526.22 C2F3S3 1.3830 2,835.38 C3F3S3 1.5506 3,178.99 C1F3S4 1.4467 2,965.98 C2F3S4 1.5975 3,275.14 C3F3S4 1.7650 3,618.55 C1F3S5 1.6229 3,327.22 C2F3S5 1.7737 3,636.38 C3F3S5 1.9413 3,979.99
Equation 2: 1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,304.46$ C2F1S1 1.8626 3,818.64$ C3F1S1 2.1524 4,412.78$ C1F1S2 1.7675 3,623.67 C2F1S2 2.0183 4,137.86 C3F1S2 2.3081 4,732.00 C1F1S3 1.9046 3,904.75 C2F1S3 2.1554 4,418.93 C3F1S3 2.4451 5,012.87 C1F2S1 1.7281 3,542.90 C2F2S1 1.9789 4,057.08 C3F2S1 2.2686 4,651.01 C1F2S2 1.8837 3,861.90 C2F2S2 2.1345 4,376.09 C3F2S2 2.4243 4,970.22 C1F2S3 2.0208 4,142.98 C2F2S3 2.2716 4,657.16 C3F2S3 2.5613 5,251.10 C1F3S1 1.8010 3,692.35 C2F3S1 2.0518 4,206.54 C3F3S1 2.3415 4,800.47 C1F3S2 1.9566 4,011.36 C2F3S2 2.2074 4,525.54 C3F3S2 2.4972 5,119.68 C1F3S3 2.0937 4,292.44 C2F3S3 2.3445 4,806.62 C3F3S3 2.6342 5,400.56
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Page 4 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode22220 Fayetteville-Springdale-Rogers, Arkansas-Missouri
Benton County, AR McDonald County, MOMadison County, ARWashington County, AR
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Equation 3: 3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,341.43$ C2F1S1 0.7124 1,460.54$ C3F1S1 0.9399 1,926.95$ C1F1S2 1.0041 2,058.57 C2F1S2 1.0622 2,177.69 C3F1S2 1.2897 2,644.10 C1F1S3 1.2065 2,473.53 C2F1S3 1.2646 2,592.64 C3F1S3 1.4922 3,059.26 C1F1S4 1.4277 2,927.03 C2F1S4 1.4858 3,046.14 C3F1S4 1.7134 3,512.76 C1F1S5 1.6024 3,285.19 C2F1S5 1.6605 3,404.31 C3F1S5 1.8880 3,870.72 C1F2S1 0.7882 1,615.94 C2F2S1 0.8463 1,735.06 C3F2S1 1.0738 2,201.47 C1F2S2 1.1380 2,333.09 C2F2S2 1.1962 2,452.41 C3F2S2 1.4237 2,918.83 C1F2S3 1.3405 2,748.25 C2F2S3 1.3986 2,867.37 C3F2S3 1.6261 3,333.78 C1F2S4 1.5167 3,109.49 C2F2S4 1.6198 3,320.86 C3F2S4 1.8473 3,787.28 C1F2S5 1.7364 3,559.91 C2F2S5 1.7945 3,679.03 C3F2S5 2.0220 4,145.44 C1F3S1 0.9151 1,876.11 C2F3S1 0.9732 1,995.22 C3F3S1 1.2007 2,461.64 C1F3S2 1.2649 2,593.26 C2F3S2 1.3230 2,712.37 C3F3S2 1.5506 3,178.99 C1F3S3 1.4674 3,008.42 C2F3S3 1.5255 3,127.53 C3F3S3 1.7530 3,593.95 C1F3S4 1.6886 3,461.92 C2F3S4 1.7467 3,581.03 C3F3S4 1.9742 4,047.44 C1F3S5 1.8632 3,819.87 C2F3S5 1.9213 3,938.99 C3F3S5 2.1489 4,405.61
Equation 4: 3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,593.95$ C2F1S1 2.0276 4,156.92$ C3F1S1 2.3479 4,813.59$ C1F1S2 1.8689 3,831.56 C2F1S2 2.1435 4,394.54 C3F1S2 2.4637 5,051.00 C1F1S3 2.0252 4,152.00 C2F1S3 2.2998 4,714.98 C3F1S3 2.6200 5,371.44 C1F2S1 1.8839 3,862.31 C2F2S1 2.1585 4,425.29 C3F2S1 2.4787 5,081.75 C1F2S2 1.9998 4,099.93 C2F2S2 2.2744 4,662.90 C3F2S2 2.5946 5,319.37 C1F2S3 2.1560 4,420.16 C2F2S3 2.4306 4,983.14 C3F2S3 2.7509 5,639.81 C1F3S1 2.0531 4,209.20 C2F3S1 2.3277 4,772.18 C3F3S1 2.6479 5,428.64 C1F3S2 2.1690 4,446.82 C2F3S2 2.4436 5,009.79 C3F3S2 2.7638 5,666.26 C1F3S3 2.3252 4,767.05 C2F3S3 2.5998 5,330.03 C3F3S3 2.9201 5,986.70
Case-Mix Rate
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
Page 5 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode22220 Fayetteville-Springdale-Rogers, Arkansas-Missouri
Benton County, AR McDonald County, MOMadison County, ARWashington County, AR
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Equations 2 and 4: All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,226.91$ C2F1S1 2.7632 5,665.03$ C3F1S1 3.0835 6,321.70$ C1F2S1 2.7390 5,615.41 C2F2S1 2.9527 6,053.53 C3F2S1 3.2730 6,710.20 C1F3S1 2.9532 6,054.56 C2F3S1 3.1669 6,492.68 C3F3S1 3.4872 7,149.35
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 94.74$ Physical therapy 103.59 Occupational therapy 104.28 Speech therapy 112.46 Medical social worker 151.86 Home health aide 42.90
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 79.40$ 5
34
12
SeverityLevel
6 551.00
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
Page 6 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode27620 Jefferson City, Missouri
Callaway County Osage CountyCole CountyMoniteau County
Rates by HHRG Code1
Equation 1: 1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,167.71$ C2F1S1 0.7335 1,469.91$ C3F1S1 0.9010 1,805.58$ C1F1S2 0.8507 1,704.78 C2F1S2 1.0015 2,006.97 C3F1S2 1.1691 2,342.84 C1F1S3 1.0599 2,124.01 C2F1S3 1.2107 2,426.20 C3F1S3 1.3783 2,762.07 C1F1S4 1.2744 2,553.86 C2F1S4 1.4252 2,856.06 C3F1S4 1.5927 3,191.72 C1F1S5 1.4506 2,906.96 C2F1S5 1.6014 3,209.16 C3F1S5 1.7690 3,545.02 C1F2S1 0.6713 1,345.26 C2F2S1 0.8221 1,647.46 C3F2S1 0.9896 1,983.13 C1F2S2 0.9393 1,882.33 C2F2S2 1.0901 2,184.53 C3F2S2 1.2577 2,520.39 C1F2S3 1.1485 2,301.56 C2F2S3 1.2993 2,603.76 C3F2S3 1.4669 2,939.62 C1F2S4 1.3630 2,731.41 C2F2S4 1.5138 3,033.61 C3F2S4 1.6813 3,369.27 C1F2S5 1.5392 3,084.51 C2F2S5 1.6900 3,386.71 C3F2S5 1.8576 3,722.57 C1F3S1 0.7550 1,513.00 C2F3S1 0.9058 1,815.19 C3F3S1 1.0733 2,150.86 C1F3S2 1.0230 2,050.06 C2F3S2 1.1738 2,352.26 C3F3S2 1.3414 2,688.12 C1F3S3 1.2322 2,469.29 C2F3S3 1.3830 2,771.49 C3F3S3 1.5506 3,107.35 C1F3S4 1.4467 2,899.14 C2F3S4 1.5975 3,201.34 C3F3S4 1.7650 3,537.00 C1F3S5 1.6229 3,252.24 C2F3S5 1.7737 3,554.44 C3F3S5 1.9413 3,890.30
Equation 2: 1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,230.00$ C2F1S1 1.8626 3,732.59$ C3F1S1 2.1524 4,313.34$ C1F1S2 1.7675 3,542.01 C2F1S2 2.0183 4,044.61 C3F1S2 2.3081 4,625.36 C1F1S3 1.9046 3,816.76 C2F1S3 2.1554 4,319.35 C3F1S3 2.4451 4,899.90 C1F2S1 1.7281 3,463.06 C2F2S1 1.9789 3,965.65 C3F2S1 2.2686 4,546.20 C1F2S2 1.8837 3,774.88 C2F2S2 2.1345 4,277.47 C3F2S2 2.4243 4,858.22 C1F2S3 2.0208 4,049.62 C2F2S3 2.2716 4,552.22 C3F2S3 2.5613 5,132.77 C1F3S1 1.8010 3,609.15 C2F3S1 2.0518 4,111.74 C3F3S1 2.3415 4,692.29 C1F3S2 1.9566 3,920.97 C2F3S2 2.2074 4,423.56 C3F3S2 2.4972 5,004.31 C1F3S3 2.0937 4,195.71 C2F3S3 2.3445 4,698.30 C3F3S3 2.6342 5,278.85
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Page 7 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode27620 Jefferson City, Missouri
Callaway County Osage CountyCole CountyMoniteau County
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Equation 3: 3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,311.20$ C2F1S1 0.7124 1,427.63$ C3F1S1 0.9399 1,883.53$ C1F1S2 1.0041 2,012.19 C2F1S2 1.0622 2,128.62 C3F1S2 1.2897 2,584.52 C1F1S3 1.2065 2,417.79 C2F1S3 1.2646 2,534.22 C3F1S3 1.4922 2,990.32 C1F1S4 1.4277 2,861.07 C2F1S4 1.4858 2,977.50 C3F1S4 1.7134 3,433.60 C1F1S5 1.6024 3,211.16 C2F1S5 1.6605 3,327.59 C3F1S5 1.8880 3,783.49 C1F2S1 0.7882 1,579.53 C2F2S1 0.8463 1,695.96 C3F2S1 1.0738 2,151.86 C1F2S2 1.1380 2,280.52 C2F2S2 1.1962 2,397.15 C3F2S2 1.4237 2,853.05 C1F2S3 1.3405 2,686.32 C2F2S3 1.3986 2,802.75 C3F2S3 1.6261 3,258.65 C1F2S4 1.5167 3,039.42 C2F2S4 1.6198 3,246.03 C3F2S4 1.8473 3,701.93 C1F2S5 1.7364 3,479.69 C2F2S5 1.7945 3,596.12 C3F2S5 2.0220 4,052.02 C1F3S1 0.9151 1,833.83 C2F3S1 0.9732 1,950.26 C3F3S1 1.2007 2,406.17 C1F3S2 1.2649 2,534.82 C2F3S2 1.3230 2,651.25 C3F3S2 1.5506 3,107.35 C1F3S3 1.4674 2,940.62 C2F3S3 1.5255 3,057.05 C3F3S3 1.7530 3,512.96 C1F3S4 1.6886 3,383.90 C2F3S4 1.7467 3,500.33 C3F3S4 1.9742 3,956.24 C1F3S5 1.8632 3,733.79 C2F3S5 1.9213 3,850.23 C3F3S5 2.1489 4,306.33
Equation 4: 3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,512.96$ C2F1S1 2.0276 4,063.25$ C3F1S1 2.3479 4,705.12$ C1F1S2 1.8689 3,745.22 C2F1S2 2.1435 4,295.51 C3F1S2 2.4637 4,937.18 C1F1S3 2.0252 4,058.44 C2F1S3 2.2998 4,608.73 C3F1S3 2.6200 5,250.40 C1F2S1 1.8839 3,775.28 C2F2S1 2.1585 4,325.57 C3F2S1 2.4787 4,967.24 C1F2S2 1.9998 4,007.54 C2F2S2 2.2744 4,557.83 C3F2S2 2.5946 5,199.50 C1F2S3 2.1560 4,320.56 C2F2S3 2.4306 4,870.85 C3F2S3 2.7509 5,512.72 C1F3S1 2.0531 4,114.35 C2F3S1 2.3277 4,664.64 C3F3S1 2.6479 5,306.31 C1F3S2 2.1690 4,346.61 C2F3S2 2.4436 4,896.90 C3F3S2 2.7638 5,538.57 C1F3S3 2.3252 4,659.63 C2F3S3 2.5998 5,209.92 C3F3S3 2.9201 5,851.79
Case-Mix Rate
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
Page 8 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode27620 Jefferson City, Missouri
Callaway County Osage CountyCole CountyMoniteau County
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Equations 2 and 4: All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,109.12$ C2F1S1 2.7632 5,537.37$ C3F1S1 3.0835 6,179.24$ C1F2S1 2.7390 5,488.87 C2F2S1 2.9527 5,917.12 C3F2S1 3.2730 6,558.99 C1F3S1 2.9532 5,918.12 C2F3S1 3.1669 6,346.37 C3F3S1 3.4872 6,988.24
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 92.60$ Physical therapy 101.25 Occupational therapy 101.93 Speech therapy 109.93 Medical social worker 148.44 Home health aide 41.94
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 77.61$ 5
34
12
SeverityLevel
6 551.00
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
Page 9 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode27900 Joplin, Missouri
Jasper CountyNewton County
Rates by HHRG Code1
Equation 1: 1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,215.95$ C2F1S1 0.7335 1,530.63$ C3F1S1 0.9010 1,880.16$ C1F1S2 0.8507 1,775.19 C2F1S2 1.0015 2,089.87 C3F1S2 1.1691 2,439.61 C1F1S3 1.0599 2,211.74 C2F1S3 1.2107 2,526.42 C3F1S3 1.3783 2,876.16 C1F1S4 1.2744 2,659.35 C2F1S4 1.4252 2,974.03 C3F1S4 1.5927 3,323.56 C1F1S5 1.4506 3,027.03 C2F1S5 1.6014 3,341.71 C3F1S5 1.7690 3,691.45 C1F2S1 0.6713 1,400.83 C2F2S1 0.8221 1,715.51 C3F2S1 0.9896 2,065.04 C1F2S2 0.9393 1,960.08 C2F2S2 1.0901 2,274.76 C3F2S2 1.2577 2,624.50 C1F2S3 1.1485 2,396.63 C2F2S3 1.2993 2,711.31 C3F2S3 1.4669 3,061.04 C1F2S4 1.3630 2,844.23 C2F2S4 1.5138 3,158.91 C3F2S4 1.6813 3,508.44 C1F2S5 1.5392 3,211.92 C2F2S5 1.6900 3,526.60 C3F2S5 1.8576 3,876.34 C1F3S1 0.7550 1,575.49 C2F3S1 0.9058 1,890.17 C3F3S1 1.0733 2,239.70 C1F3S2 1.0230 2,134.74 C2F3S2 1.1738 2,449.42 C3F3S2 1.3414 2,799.16 C1F3S3 1.2322 2,571.29 C2F3S3 1.3830 2,885.97 C3F3S3 1.5506 3,235.71 C1F3S4 1.4467 3,018.89 C2F3S4 1.5975 3,333.57 C3F3S4 1.7650 3,683.10 C1F3S5 1.6229 3,386.58 C2F3S5 1.7737 3,701.26 C3F3S5 1.9413 4,051.00
Equation 2: 1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,363.41$ C2F1S1 1.8626 3,886.77$ C3F1S1 2.1524 4,491.51$ C1F1S2 1.7675 3,688.32 C2F1S2 2.0183 4,211.68 C3F1S2 2.3081 4,816.41 C1F1S3 1.9046 3,974.41 C2F1S3 2.1554 4,497.77 C3F1S3 2.4451 5,102.30 C1F2S1 1.7281 3,606.10 C2F2S1 1.9789 4,129.46 C3F2S1 2.2686 4,733.99 C1F2S2 1.8837 3,930.80 C2F2S2 2.1345 4,454.16 C3F2S2 2.4243 5,058.89 C1F2S3 2.0208 4,216.89 C2F2S3 2.2716 4,740.25 C3F2S3 2.5613 5,344.78 C1F3S1 1.8010 3,758.23 C2F3S1 2.0518 4,281.58 C3F3S1 2.3415 4,886.11 C1F3S2 1.9566 4,082.92 C2F3S2 2.2074 4,606.28 C3F3S2 2.4972 5,211.02 C1F3S3 2.0937 4,369.02 C2F3S3 2.3445 4,892.37 C3F3S3 2.6342 5,496.90
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Page 10 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode27900 Joplin, Missouri
Jasper CountyNewton County
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Equation 3: 3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,365.36$ C2F1S1 0.7124 1,486.60$ C3F1S1 0.9399 1,961.33$ C1F1S2 1.0041 2,095.30 C2F1S2 1.0622 2,216.54 C3F1S2 1.2897 2,691.27 C1F1S3 1.2065 2,517.66 C2F1S3 1.2646 2,638.90 C3F1S3 1.4922 3,113.84 C1F1S4 1.4277 2,979.24 C2F1S4 1.4858 3,100.48 C3F1S4 1.7134 3,575.43 C1F1S5 1.6024 3,343.80 C2F1S5 1.6605 3,465.04 C3F1S5 1.8880 3,939.77 C1F2S1 0.7882 1,644.77 C2F2S1 0.8463 1,766.01 C3F2S1 1.0738 2,240.75 C1F2S2 1.1380 2,374.71 C2F2S2 1.1962 2,496.16 C3F2S2 1.4237 2,970.90 C1F2S3 1.3405 2,797.28 C2F2S3 1.3986 2,918.52 C3F2S3 1.6261 3,393.25 C1F2S4 1.5167 3,164.96 C2F2S4 1.6198 3,380.11 C3F2S4 1.8473 3,854.84 C1F2S5 1.7364 3,623.42 C2F2S5 1.7945 3,744.66 C3F2S5 2.0220 4,219.40 C1F3S1 0.9151 1,909.58 C2F3S1 0.9732 2,030.82 C3F3S1 1.2007 2,505.55 C1F3S2 1.2649 2,639.52 C2F3S2 1.3230 2,760.76 C3F3S2 1.5506 3,235.71 C1F3S3 1.4674 3,062.09 C2F3S3 1.5255 3,183.33 C3F3S3 1.7530 3,658.06 C1F3S4 1.6886 3,523.68 C2F3S4 1.7467 3,644.92 C3F3S4 1.9742 4,119.65 C1F3S5 1.8632 3,888.02 C2F3S5 1.9213 4,009.26 C3F3S5 2.1489 4,484.20
Equation 4: 3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,658.06$ C2F1S1 2.0276 4,231.08$ C3F1S1 2.3479 4,899.47$ C1F1S2 1.8689 3,899.92 C2F1S2 2.1435 4,472.94 C3F1S2 2.4637 5,141.11 C1F1S3 2.0252 4,226.07 C2F1S3 2.2998 4,799.09 C3F1S3 2.6200 5,467.27 C1F2S1 1.8839 3,931.22 C2F2S1 2.1585 4,504.24 C3F2S1 2.4787 5,172.41 C1F2S2 1.9998 4,173.07 C2F2S2 2.2744 4,746.09 C3F2S2 2.5946 5,414.27 C1F2S3 2.1560 4,499.02 C2F2S3 2.4306 5,072.04 C3F2S3 2.7509 5,740.42 C1F3S1 2.0531 4,284.29 C2F3S1 2.3277 4,857.31 C3F3S1 2.6479 5,525.49 C1F3S2 2.1690 4,526.15 C2F3S2 2.4436 5,099.17 C3F3S2 2.7638 5,767.34 C1F3S3 2.3252 4,852.10 C2F3S3 2.5998 5,425.12 C3F3S3 2.9201 6,093.50
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
HHRG Code
Page 11 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode27900 Joplin, Missouri
Jasper CountyNewton County
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Equations 2 and 4: All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,320.15$ C2F1S1 2.7632 5,766.09$ C3F1S1 3.0835 6,434.48$ C1F2S1 2.7390 5,715.59 C2F2S1 2.9527 6,161.53 C3F2S1 3.2730 6,829.91 C1F3S1 2.9532 6,162.57 C2F3S1 3.1669 6,608.51 C3F3S1 3.4872 7,276.89
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 96.43$ Physical therapy 105.43 Occupational therapy 106.14 Speech therapy 114.47 Medical social worker 154.57 Home health aide 43.67
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 80.82$
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
6 551.00 5
34
12
SeverityLevel
Page 12 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode28140 Kansas City, Missouri-Kansas
Franklin County, KS Wyandotte County, KS Clinton County, MOJohnson County, KS Bates County, MO Jackson County, MOLeavenworth County, KS Caldwell County, MO Lafayette County, MOLinn County, KS Cass County, MO Platte County, MOMiami County, KS Clay County, MO Ray County, MO
Rates by HHRG Code1
Equation 1: 1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,272.34$ C2F1S1 0.7335 1,601.61$ C3F1S1 0.9010 1,967.35$ C1F1S2 0.8507 1,857.52 C2F1S2 1.0015 2,186.79 C3F1S2 1.1691 2,552.75 C1F1S3 1.0599 2,314.31 C2F1S3 1.2107 2,643.59 C3F1S3 1.3783 3,009.55 C1F1S4 1.2744 2,782.68 C2F1S4 1.4252 3,111.95 C3F1S4 1.5927 3,477.69 C1F1S5 1.4506 3,167.41 C2F1S5 1.6014 3,496.69 C3F1S5 1.7690 3,862.65 C1F2S1 0.6713 1,465.80 C2F2S1 0.8221 1,795.07 C3F2S1 0.9896 2,160.81 C1F2S2 0.9393 2,050.98 C2F2S2 1.0901 2,380.25 C3F2S2 1.2577 2,746.21 C1F2S3 1.1485 2,507.77 C2F2S3 1.2993 2,837.05 C3F2S3 1.4669 3,203.00 C1F2S4 1.3630 2,976.14 C2F2S4 1.5138 3,305.41 C3F2S4 1.6813 3,671.15 C1F2S5 1.5392 3,360.87 C2F2S5 1.6900 3,690.15 C3F2S5 1.8576 4,056.11 C1F3S1 0.7550 1,648.56 C2F3S1 0.9058 1,977.83 C3F3S1 1.0733 2,343.57 C1F3S2 1.0230 2,233.74 C2F3S2 1.1738 2,563.02 C3F3S2 1.3414 2,928.97 C1F3S3 1.2322 2,690.53 C2F3S3 1.3830 3,019.81 C3F3S3 1.5506 3,385.77 C1F3S4 1.4467 3,158.90 C2F3S4 1.5975 3,488.17 C3F3S4 1.7650 3,853.91 C1F3S5 1.6229 3,543.63 C2F3S5 1.7737 3,872.91 C3F3S5 1.9413 4,238.87
Equation 2: 1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,519.40$ C2F1S1 1.8626 4,067.02$ C3F1S1 2.1524 4,699.81$ C1F1S2 1.7675 3,859.37 C2F1S2 2.0183 4,407.00 C3F1S2 2.3081 5,039.78 C1F1S3 1.9046 4,158.73 C2F1S3 2.1554 4,706.36 C3F1S3 2.4451 5,338.92 C1F2S1 1.7281 3,773.34 C2F2S1 1.9789 4,320.97 C3F2S1 2.2686 4,953.53 C1F2S2 1.8837 4,113.10 C2F2S2 2.1345 4,660.72 C3F2S2 2.4243 5,293.51 C1F2S3 2.0208 4,412.46 C2F2S3 2.2716 4,960.08 C3F2S3 2.5613 5,592.65 C1F3S1 1.8010 3,932.52 C2F3S1 2.0518 4,480.15 C3F3S1 2.3415 5,112.71 C1F3S2 1.9566 4,272.27 C2F3S2 2.2074 4,819.90 C3F3S2 2.4972 5,452.69 C1F3S3 2.0937 4,571.63 C2F3S3 2.3445 5,119.26 C3F3S3 2.6342 5,751.83
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Page 13 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode28140 Kansas City, Missouri-Kansas
Franklin County, KS Wyandotte County, KS Clinton County, MOJohnson County, KS Bates County, MO Jackson County, MOLeavenworth County, KS Caldwell County, MO Lafayette County, MOLinn County, KS Cass County, MO Platte County, MOMiami County, KS Clay County, MO Ray County, MO
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Equation 3: 3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,428.68$ C2F1S1 0.7124 1,555.54$ C3F1S1 0.9399 2,052.29$ C1F1S2 1.0041 2,192.47 C2F1S2 1.0622 2,319.33 C3F1S2 1.2897 2,816.09 C1F1S3 1.2065 2,634.42 C2F1S3 1.2646 2,761.28 C3F1S3 1.4922 3,258.25 C1F1S4 1.4277 3,117.41 C2F1S4 1.4858 3,244.27 C3F1S4 1.7134 3,741.24 C1F1S5 1.6024 3,498.87 C2F1S5 1.6605 3,625.73 C3F1S5 1.8880 4,122.49 C1F2S1 0.7882 1,721.05 C2F2S1 0.8463 1,847.91 C3F2S1 1.0738 2,344.66 C1F2S2 1.1380 2,484.85 C2F2S2 1.1962 2,611.93 C3F2S2 1.4237 3,108.68 C1F2S3 1.3405 2,927.01 C2F2S3 1.3986 3,053.87 C3F2S3 1.6261 3,550.62 C1F2S4 1.5167 3,311.74 C2F2S4 1.6198 3,536.87 C3F2S4 1.8473 4,033.62 C1F2S5 1.7364 3,791.46 C2F2S5 1.7945 3,918.33 C3F2S5 2.0220 4,415.08 C1F3S1 0.9151 1,998.14 C2F3S1 0.9732 2,125.00 C3F3S1 1.2007 2,621.75 C1F3S2 1.2649 2,761.93 C2F3S2 1.3230 2,888.80 C3F3S2 1.5506 3,385.77 C1F3S3 1.4674 3,204.10 C2F3S3 1.5255 3,330.96 C3F3S3 1.7530 3,827.71 C1F3S4 1.6886 3,687.09 C2F3S4 1.7467 3,813.95 C3F3S4 1.9742 4,310.70 C1F3S5 1.8632 4,068.33 C2F3S5 1.9213 4,195.20 C3F3S5 2.1489 4,692.17
Equation 4: 3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,827.71$ C2F1S1 2.0276 4,427.30$ C3F1S1 2.3479 5,126.69$ C1F1S2 1.8689 4,080.78 C2F1S2 2.1435 4,680.37 C3F1S2 2.4637 5,379.54 C1F1S3 2.0252 4,422.06 C2F1S3 2.2998 5,021.66 C3F1S3 2.6200 5,720.82 C1F2S1 1.8839 4,113.53 C2F2S1 2.1585 4,713.13 C3F2S1 2.4787 5,412.29 C1F2S2 1.9998 4,366.60 C2F2S2 2.2744 4,966.20 C3F2S2 2.5946 5,665.36 C1F2S3 2.1560 4,707.67 C2F2S3 2.4306 5,307.26 C3F2S3 2.7509 6,006.64 C1F3S1 2.0531 4,482.98 C2F3S1 2.3277 5,082.58 C3F3S1 2.6479 5,781.74 C1F3S2 2.1690 4,736.05 C2F3S2 2.4436 5,335.65 C3F3S2 2.7638 6,034.81 C1F3S3 2.3252 5,077.12 C2F3S3 2.5998 5,676.71 C3F3S3 2.9201 6,376.10
Case-Mix Rate
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
Page 14 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode28140 Kansas City, Missouri-Kansas
Franklin County, KS Wyandotte County, KS Clinton County, MOJohnson County, KS Bates County, MO Jackson County, MOLeavenworth County, KS Caldwell County, MO Lafayette County, MOLinn County, KS Cass County, MO Platte County, MOMiami County, KS Clay County, MO Ray County, MO
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Equations 2 and 4: All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,566.88$ C2F1S1 2.7632 6,033.50$ C3F1S1 3.0835 6,732.88$ C1F2S1 2.7390 5,980.66 C2F2S1 2.9527 6,447.28 C3F2S1 3.2730 7,146.66 C1F3S1 2.9532 6,448.37 C2F3S1 3.1669 6,914.99 C3F3S1 3.4872 7,614.37
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 100.90$ Physical therapy 110.32 Occupational therapy 111.06 Speech therapy 119.78 Medical social worker 161.74 Home health aide 45.69
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 84.57$ 5
34
12
SeverityLevel
6 551.00
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
Page 15 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode41140 St. Joseph, Missouri-Kansas
Doniphan County, KS Dekalb County, MOAndrew County, MOBuchanan County, MO
Rates by HHRG Code1
1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,196.67$ C2F1S1 0.7335 1,506.37$ C3F1S1 0.9010 1,850.36$ C1F1S2 0.8507 1,747.06 C2F1S2 1.0015 2,056.75 C3F1S2 1.1691 2,400.94 C1F1S3 1.0599 2,176.68 C2F1S3 1.2107 2,486.38 C3F1S3 1.3783 2,830.57 C1F1S4 1.2744 2,617.20 C2F1S4 1.4252 2,926.89 C3F1S4 1.5927 3,270.88 C1F1S5 1.4506 2,979.05 C2F1S5 1.6014 3,288.75 C3F1S5 1.7690 3,632.94 C1F2S1 0.6713 1,378.63 C2F2S1 0.8221 1,688.32 C3F2S1 0.9896 2,032.31 C1F2S2 0.9393 1,929.01 C2F2S2 1.0901 2,238.70 C3F2S2 1.2577 2,582.90 C1F2S3 1.1485 2,358.64 C2F2S3 1.2993 2,668.33 C3F2S3 1.4669 3,012.53 C1F2S4 1.3630 2,799.15 C2F2S4 1.5138 3,108.84 C3F2S4 1.6813 3,452.83 C1F2S5 1.5392 3,161.01 C2F2S5 1.6900 3,470.70 C3F2S5 1.8576 3,814.90 C1F3S1 0.7550 1,550.52 C2F3S1 0.9058 1,860.21 C3F3S1 1.0733 2,204.20 C1F3S2 1.0230 2,100.90 C2F3S2 1.1738 2,410.60 C3F3S2 1.3414 2,754.79 C1F3S3 1.2322 2,530.53 C2F3S3 1.3830 2,840.22 C3F3S3 1.5506 3,184.42 C1F3S4 1.4467 2,971.04 C2F3S4 1.5975 3,280.74 C3F3S4 1.7650 3,624.73 C1F3S5 1.6229 3,332.90 C2F3S5 1.7737 3,642.59 C3F3S5 1.9413 3,986.79
1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,310.10$ C2F1S1 1.8626 3,825.16$ C3F1S1 2.1524 4,420.32$ C1F1S2 1.7675 3,629.86 C2F1S2 2.0183 4,144.92 C3F1S2 2.3081 4,740.07 C1F1S3 1.9046 3,911.42 C2F1S3 2.1554 4,426.48 C3F1S3 2.4451 5,021.43 C1F2S1 1.7281 3,548.95 C2F2S1 1.9789 4,064.01 C3F2S1 2.2686 4,658.95 C1F2S2 1.8837 3,868.50 C2F2S2 2.1345 4,383.56 C3F2S2 2.4243 4,978.71 C1F2S3 2.0208 4,150.05 C2F2S3 2.2716 4,665.11 C3F2S3 2.5613 5,260.06 C1F3S1 1.8010 3,698.66 C2F3S1 2.0518 4,213.72 C3F3S1 2.3415 4,808.67 C1F3S2 1.9566 4,018.21 C2F3S2 2.2074 4,533.27 C3F3S2 2.4972 5,128.42 C1F3S3 2.0937 4,299.77 C2F3S3 2.3445 4,814.83 C3F3S3 2.6342 5,409.77
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Page 16 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode41140 St. Joseph, Missouri-Kansas
Doniphan County, KS Dekalb County, MOAndrew County, MOBuchanan County, MO
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,343.72$ C2F1S1 0.7124 1,463.03$ C3F1S1 0.9399 1,930.24$ C1F1S2 1.0041 2,062.09 C2F1S2 1.0622 2,181.41 C3F1S2 1.2897 2,648.62 C1F1S3 1.2065 2,477.75 C2F1S3 1.2646 2,597.07 C3F1S3 1.4922 3,064.48 C1F1S4 1.4277 2,932.02 C2F1S4 1.4858 3,051.34 C3F1S4 1.7134 3,518.76 C1F1S5 1.6024 3,290.80 C2F1S5 1.6605 3,410.12 C3F1S5 1.8880 3,877.33 C1F2S1 0.7882 1,618.70 C2F2S1 0.8463 1,738.02 C3F2S1 1.0738 2,205.23 C1F2S2 1.1380 2,337.08 C2F2S2 1.1962 2,456.60 C3F2S2 1.4237 2,923.81 C1F2S3 1.3405 2,752.94 C2F2S3 1.3986 2,872.26 C3F2S3 1.6261 3,339.47 C1F2S4 1.5167 3,114.80 C2F2S4 1.6198 3,326.53 C3F2S4 1.8473 3,793.74 C1F2S5 1.7364 3,565.99 C2F2S5 1.7945 3,685.31 C3F2S5 2.0220 4,152.52 C1F3S1 0.9151 1,879.31 C2F3S1 0.9732 1,998.63 C3F3S1 1.2007 2,465.84 C1F3S2 1.2649 2,597.69 C2F3S2 1.3230 2,717.00 C3F3S2 1.5506 3,184.42 C1F3S3 1.4674 3,013.55 C2F3S3 1.5255 3,132.87 C3F3S3 1.7530 3,600.08 C1F3S4 1.6886 3,467.83 C2F3S4 1.7467 3,587.14 C3F3S4 1.9742 4,054.35 C1F3S5 1.8632 3,826.40 C2F3S5 1.9213 3,945.71 C3F3S5 2.1489 4,413.13
3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,600.08$ C2F1S1 2.0276 4,164.02$ C3F1S1 2.3479 4,821.81$ C1F1S2 1.8689 3,838.10 C2F1S2 2.1435 4,402.04 C3F1S2 2.4637 5,059.62 C1F1S3 2.0252 4,159.09 C2F1S3 2.2998 4,723.03 C3F1S3 2.6200 5,380.61 C1F2S1 1.8839 3,868.91 C2F2S1 2.1585 4,432.84 C3F2S1 2.4787 5,090.43 C1F2S2 1.9998 4,106.93 C2F2S2 2.2744 4,670.86 C3F2S2 2.5946 5,328.45 C1F2S3 2.1560 4,427.71 C2F2S3 2.4306 4,991.65 C3F2S3 2.7509 5,649.44 C1F3S1 2.0531 4,216.39 C2F3S1 2.3277 4,780.33 C3F3S1 2.6479 5,437.91 C1F3S2 2.1690 4,454.41 C2F3S2 2.4436 5,018.35 C3F3S2 2.7638 5,675.93 C1F3S3 2.3252 4,775.19 C2F3S3 2.5998 5,339.13 C3F3S3 2.9201 5,996.92
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
HHRG Code
Page 17 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode41140 St. Joseph, Missouri-Kansas
Doniphan County, KS Dekalb County, MOAndrew County, MOBuchanan County, MO
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,235.83$ C2F1S1 2.7632 5,674.70$ C3F1S1 3.0835 6,332.49$ C1F2S1 2.7390 5,625.00 C2F2S1 2.9527 6,063.87 C3F2S1 3.2730 6,721.66 C1F3S1 2.9532 6,064.90 C2F3S1 3.1669 6,503.76 C3F3S1 3.4872 7,161.55
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 94.90$ Physical therapy 103.76 Occupational therapy 104.46 Speech therapy 112.66 Medical social worker 152.12 Home health aide 42.98
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 79.54$
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
6 551.00 5
34
12
SeverityLevel
Page 18 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode41180 St. Louis, Missouri-Illinois
Bond County, IL Monroe County, IL St. Charles County, MOCalhoun County, IL St. Clair County, IL St. Louis County, MOClinton County, IL Crawford County, MO Warren County, MOJersey County, IL Franklin County, MO Washington County, MOMacoupin County, IL Jefferson County, MO St. Louis City, MOMadison County, IL Lincoln County, MO
Rates by HHRG Code1
Equation 1: 1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,223.39$ C2F1S1 0.7335 1,540.00$ C3F1S1 0.9010 1,891.67$ C1F1S2 0.8507 1,786.06 C2F1S2 1.0015 2,102.67 C3F1S2 1.1691 2,454.55 C1F1S3 1.0599 2,225.28 C2F1S3 1.2107 2,541.89 C3F1S3 1.3783 2,893.77 C1F1S4 1.2744 2,675.63 C2F1S4 1.4252 2,992.23 C3F1S4 1.5927 3,343.90 C1F1S5 1.4506 3,045.56 C2F1S5 1.6014 3,362.17 C3F1S5 1.7690 3,714.05 C1F2S1 0.6713 1,409.41 C2F2S1 0.8221 1,726.01 C3F2S1 0.9896 2,077.68 C1F2S2 0.9393 1,972.08 C2F2S2 1.0901 2,288.69 C3F2S2 1.2577 2,640.57 C1F2S3 1.1485 2,411.30 C2F2S3 1.2993 2,727.91 C3F2S3 1.4669 3,079.78 C1F2S4 1.3630 2,861.64 C2F2S4 1.5138 3,178.25 C3F2S4 1.6813 3,529.92 C1F2S5 1.5392 3,231.58 C2F2S5 1.6900 3,548.19 C3F2S5 1.8576 3,900.07 C1F3S1 0.7550 1,585.14 C2F3S1 0.9058 1,901.74 C3F3S1 1.0733 2,253.41 C1F3S2 1.0230 2,147.81 C2F3S2 1.1738 2,464.42 C3F3S2 1.3414 2,816.30 C1F3S3 1.2322 2,587.03 C2F3S3 1.3830 2,903.64 C3F3S3 1.5506 3,255.51 C1F3S4 1.4467 3,037.37 C2F3S4 1.5975 3,353.98 C3F3S4 1.7650 3,705.65 C1F3S5 1.6229 3,407.31 C2F3S5 1.7737 3,723.92 C3F3S5 1.9413 4,075.80
Equation 2: 1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,384.01$ C2F1S1 1.8626 3,910.56$ C3F1S1 2.1524 4,519.01$ C1F1S2 1.7675 3,710.90 C2F1S2 2.0183 4,237.46 C3F1S2 2.3081 4,845.90 C1F1S3 1.9046 3,998.74 C2F1S3 2.1554 4,525.30 C3F1S3 2.4451 5,133.53 C1F2S1 1.7281 3,628.18 C2F2S1 1.9789 4,154.74 C3F2S1 2.2686 4,762.97 C1F2S2 1.8837 3,954.86 C2F2S2 2.1345 4,481.42 C3F2S2 2.4243 5,089.86 C1F2S3 2.0208 4,242.71 C2F2S3 2.2716 4,769.27 C3F2S3 2.5613 5,377.50 C1F3S1 1.8010 3,781.23 C2F3S1 2.0518 4,307.79 C3F3S1 2.3415 4,916.02 C1F3S2 1.9566 4,107.92 C2F3S2 2.2074 4,634.48 C3F3S2 2.4972 5,242.92 C1F3S3 2.0937 4,395.76 C2F3S3 2.3445 4,922.32 C3F3S3 2.6342 5,530.55
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Page 19 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode41180 St. Louis, Missouri-Illinois
Bond County, IL Monroe County, IL St. Charles County, MOCalhoun County, IL St. Clair County, IL St. Louis County, MOClinton County, IL Crawford County, MO Warren County, MOJersey County, IL Franklin County, MO Washington County, MOMacoupin County, IL Jefferson County, MO St. Louis City, MOMadison County, IL Lincoln County, MO
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Equation 3: 3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,373.72$ C2F1S1 0.7124 1,495.70$ C3F1S1 0.9399 1,973.34$ C1F1S2 1.0041 2,108.13 C2F1S2 1.0622 2,230.11 C3F1S2 1.2897 2,707.75 C1F1S3 1.2065 2,533.07 C2F1S3 1.2646 2,655.05 C3F1S3 1.4922 3,132.90 C1F1S4 1.4277 2,997.48 C2F1S4 1.4858 3,119.47 C3F1S4 1.7134 3,597.32 C1F1S5 1.6024 3,364.27 C2F1S5 1.6605 3,486.25 C3F1S5 1.8880 3,963.89 C1F2S1 0.7882 1,654.84 C2F2S1 0.8463 1,776.82 C3F2S1 1.0738 2,254.46 C1F2S2 1.1380 2,389.25 C2F2S2 1.1962 2,511.44 C3F2S2 1.4237 2,989.09 C1F2S3 1.3405 2,814.41 C2F2S3 1.3986 2,936.39 C3F2S3 1.6261 3,414.03 C1F2S4 1.5167 3,184.34 C2F2S4 1.6198 3,400.80 C3F2S4 1.8473 3,878.44 C1F2S5 1.7364 3,645.61 C2F2S5 1.7945 3,767.59 C3F2S5 2.0220 4,245.23 C1F3S1 0.9151 1,921.27 C2F3S1 0.9732 2,043.25 C3F3S1 1.2007 2,520.89 C1F3S2 1.2649 2,655.68 C2F3S2 1.3230 2,777.66 C3F3S2 1.5506 3,255.51 C1F3S3 1.4674 3,080.83 C2F3S3 1.5255 3,202.82 C3F3S3 1.7530 3,680.46 C1F3S4 1.6886 3,545.25 C2F3S4 1.7467 3,667.23 C3F3S4 1.9742 4,144.87 C1F3S5 1.8632 3,911.82 C2F3S5 1.9213 4,033.81 C3F3S5 2.1489 4,511.66
Equation 4: 3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,680.46$ C2F1S1 2.0276 4,256.99$ C3F1S1 2.3479 4,929.46$ C1F1S2 1.8689 3,923.79 C2F1S2 2.1435 4,500.32 C3F1S2 2.4637 5,172.59 C1F1S3 2.0252 4,251.95 C2F1S3 2.2998 4,828.47 C3F1S3 2.6200 5,500.74 C1F2S1 1.8839 3,955.28 C2F2S1 2.1585 4,531.81 C3F2S1 2.4787 5,204.08 C1F2S2 1.9998 4,198.62 C2F2S2 2.2744 4,775.15 C3F2S2 2.5946 5,447.41 C1F2S3 2.1560 4,526.56 C2F2S3 2.4306 5,103.09 C3F2S3 2.7509 5,775.57 C1F3S1 2.0531 4,310.52 C2F3S1 2.3277 4,887.05 C3F3S1 2.6479 5,559.32 C1F3S2 2.1690 4,553.86 C2F3S2 2.4436 5,130.39 C3F3S2 2.7638 5,802.65 C1F3S3 2.3252 4,881.80 C2F3S3 2.5998 5,458.33 C3F3S3 2.9201 6,130.81
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
HHRG Code
Page 20 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode41180 St. Louis, Missouri-Illinois
Bond County, IL Monroe County, IL St. Charles County, MOCalhoun County, IL St. Clair County, IL St. Louis County, MOClinton County, IL Crawford County, MO Warren County, MOJersey County, IL Franklin County, MO Washington County, MOMacoupin County, IL Jefferson County, MO St. Louis City, MOMadison County, IL Lincoln County, MO
Rates by HHRG Code1
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
By HHRG Code, NRS Level and LUPA Category
Equations 2 and 4: All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,352.72$ C2F1S1 2.7632 5,801.39$ C3F1S1 3.0835 6,473.87$ C1F2S1 2.7390 5,750.58 C2F2S1 2.9527 6,199.25 C3F2S1 3.2730 6,871.73 C1F3S1 2.9532 6,200.30 C2F3S1 3.1669 6,648.97 C3F3S1 3.4872 7,321.44
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 97.02$ Physical therapy 106.08 Occupational therapy 106.79 Speech therapy 115.17 Medical social worker 155.52 Home health aide 43.94
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 81.31$
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
6 551.00 5
34
12
SeverityLevel
Page 21 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode44180 Springfield, MO
Christian County, MO Polk County, MODallas County, MO Webster County, MOGreene County, MO
Rates by HHRG Code1
1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,189.84$ C2F1S1 0.7335 1,497.77$ C3F1S1 0.9010 1,839.79$ C1F1S2 0.8507 1,737.08 C2F1S2 1.0015 2,045.01 C3F1S2 1.1691 2,387.24 C1F1S3 1.0599 2,164.26 C2F1S3 1.2107 2,472.18 C3F1S3 1.3783 2,814.41 C1F1S4 1.2744 2,602.25 C2F1S4 1.4252 2,910.18 C3F1S4 1.5927 3,252.20 C1F1S5 1.4506 2,962.04 C2F1S5 1.6014 3,269.97 C3F1S5 1.7690 3,612.20 C1F2S1 0.6713 1,370.76 C2F2S1 0.8221 1,678.68 C3F2S1 0.9896 2,020.71 C1F2S2 0.9393 1,918.00 C2F2S2 1.0901 2,225.92 C3F2S2 1.2577 2,568.15 C1F2S3 1.1485 2,345.17 C2F2S3 1.2993 2,653.10 C3F2S3 1.4669 2,995.33 C1F2S4 1.3630 2,783.17 C2F2S4 1.5138 3,091.09 C3F2S4 1.6813 3,433.12 C1F2S5 1.5392 3,142.96 C2F2S5 1.6900 3,450.89 C3F2S5 1.8576 3,793.12 C1F3S1 0.7550 1,541.67 C2F3S1 0.9058 1,849.59 C3F3S1 1.0733 2,191.62 C1F3S2 1.0230 2,088.91 C2F3S2 1.1738 2,396.83 C3F3S2 1.3414 2,739.06 C1F3S3 1.2322 2,516.08 C2F3S3 1.3830 2,824.01 C3F3S3 1.5506 3,166.24 C1F3S4 1.4467 2,954.08 C2F3S4 1.5975 3,262.01 C3F3S4 1.7650 3,604.03 C1F3S5 1.6229 3,313.87 C2F3S5 1.7737 3,621.80 C3F3S5 1.9413 3,964.03
1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,291.21$ C2F1S1 1.8626 3,803.32$ C3F1S1 2.1524 4,395.08$ C1F1S2 1.7675 3,609.14 C2F1S2 2.0183 4,121.26 C3F1S2 2.3081 4,713.01 C1F1S3 1.9046 3,889.09 C2F1S3 2.1554 4,401.21 C3F1S3 2.4451 4,992.76 C1F2S1 1.7281 3,528.68 C2F2S1 1.9789 4,040.80 C3F2S1 2.2686 4,632.35 C1F2S2 1.8837 3,846.41 C2F2S2 2.1345 4,358.53 C3F2S2 2.4243 4,950.28 C1F2S3 2.0208 4,126.36 C2F2S3 2.2716 4,638.48 C3F2S3 2.5613 5,230.03 C1F3S1 1.8010 3,677.54 C2F3S1 2.0518 4,189.66 C3F3S1 2.3415 4,781.21 C1F3S2 1.9566 3,995.27 C2F3S2 2.2074 4,507.39 C3F3S2 2.4972 5,099.14 C1F3S3 2.0937 4,275.22 C2F3S3 2.3445 4,787.34 C3F3S3 2.6342 5,378.89
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Page 22 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode44180 Springfield, MO
Christian County, MO Polk County, MODallas County, MO Webster County, MOGreene County, MO
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,336.04$ C2F1S1 0.7124 1,454.68$ C3F1S1 0.9399 1,919.22$ C1F1S2 1.0041 2,050.32 C2F1S2 1.0622 2,168.95 C3F1S2 1.2897 2,633.50 C1F1S3 1.2065 2,463.61 C2F1S3 1.2646 2,582.24 C3F1S3 1.4922 3,046.99 C1F1S4 1.4277 2,915.28 C2F1S4 1.4858 3,033.92 C3F1S4 1.7134 3,498.67 C1F1S5 1.6024 3,272.01 C2F1S5 1.6605 3,390.65 C3F1S5 1.8880 3,855.19 C1F2S1 0.7882 1,609.46 C2F2S1 0.8463 1,728.10 C3F2S1 1.0738 2,192.64 C1F2S2 1.1380 2,323.73 C2F2S2 1.1962 2,442.57 C3F2S2 1.4237 2,907.12 C1F2S3 1.3405 2,737.23 C2F2S3 1.3986 2,855.86 C3F2S3 1.6261 3,320.41 C1F2S4 1.5167 3,097.02 C2F2S4 1.6198 3,307.54 C3F2S4 1.8473 3,772.08 C1F2S5 1.7364 3,545.63 C2F2S5 1.7945 3,664.27 C3F2S5 2.0220 4,128.81 C1F3S1 0.9151 1,868.58 C2F3S1 0.9732 1,987.22 C3F3S1 1.2007 2,451.76 C1F3S2 1.2649 2,582.85 C2F3S2 1.3230 2,701.49 C3F3S2 1.5506 3,166.24 C1F3S3 1.4674 2,996.35 C2F3S3 1.5255 3,114.99 C3F3S3 1.7530 3,579.53 C1F3S4 1.6886 3,448.03 C2F3S4 1.7467 3,566.66 C3F3S4 1.9742 4,031.21 C1F3S5 1.8632 3,804.55 C2F3S5 1.9213 3,923.19 C3F3S5 2.1489 4,387.93
3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,579.53$ C2F1S1 2.0276 4,140.25$ C3F1S1 2.3479 4,794.28$ C1F1S2 1.8689 3,816.19 C2F1S2 2.1435 4,376.91 C3F1S2 2.4637 5,030.74 C1F1S3 2.0252 4,135.34 C2F1S3 2.2998 4,696.06 C3F1S3 2.6200 5,349.89 C1F2S1 1.8839 3,846.82 C2F2S1 2.1585 4,407.54 C3F2S1 2.4787 5,061.37 C1F2S2 1.9998 4,083.48 C2F2S2 2.2744 4,644.20 C3F2S2 2.5946 5,298.03 C1F2S3 2.1560 4,402.43 C2F2S3 2.4306 4,963.15 C3F2S3 2.7509 5,617.18 C1F3S1 2.0531 4,192.32 C2F3S1 2.3277 4,753.03 C3F3S1 2.6479 5,406.86 C1F3S2 2.1690 4,428.98 C2F3S2 2.4436 4,989.69 C3F3S2 2.7638 5,643.52 C1F3S3 2.3252 4,747.93 C2F3S3 2.5998 5,308.65 C3F3S3 2.9201 5,962.68
Case-Mix Rate
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
Page 23 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode44180 Springfield, MO
Christian County, MO Polk County, MODallas County, MO Webster County, MOGreene County, MO
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
All Episodes, 20+ Therapy Visits C1F1S1 2.5495 5,205.94$ C2F1S1 2.7632 5,642.30$ C3F1S1 3.0835 6,296.33$ C1F2S1 2.7390 5,592.88 C2F2S1 2.9527 6,029.25 C3F2S1 3.2730 6,683.28 C1F3S1 2.9532 6,030.27 C2F3S1 3.1669 6,466.63 C3F3S1 3.4872 7,120.67
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 94.36$ Physical therapy 103.17 Occupational therapy 103.86 Speech therapy 112.01 Medical social worker 151.25 Home health aide 42.73
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 79.08$ 5
34
12
SeverityLevel
6 551.00
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
Page 24 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode99926 Rural Missouri
Includes all counties not classified elsewhere as urban areas
Rates by HHRG Code1
1st and 2nd Episodes, 0 to 13 Therapy VisitsC1F1S1 0.5827 1,111.83$ C2F1S1 0.7335 1,399.57$ C3F1S1 0.9010 1,719.17$ C1F1S2 0.8507 1,623.19 C2F1S2 1.0015 1,910.93 C3F1S2 1.1691 2,230.72 C1F1S3 1.0599 2,022.36 C2F1S3 1.2107 2,310.10 C3F1S3 1.3783 2,629.89 C1F1S4 1.2744 2,431.64 C2F1S4 1.4252 2,719.38 C3F1S4 1.5927 3,038.98 C1F1S5 1.4506 2,767.84 C2F1S5 1.6014 3,055.58 C3F1S5 1.7690 3,375.37 C1F2S1 0.6713 1,280.89 C2F2S1 0.8221 1,568.62 C3F2S1 0.9896 1,888.22 C1F2S2 0.9393 1,792.25 C2F2S2 1.0901 2,079.99 C3F2S2 1.2577 2,399.78 C1F2S3 1.1485 2,191.42 C2F2S3 1.2993 2,479.15 C3F2S3 1.4669 2,798.95 C1F2S4 1.3630 2,600.70 C2F2S4 1.5138 2,888.43 C3F2S4 1.6813 3,208.04 C1F2S5 1.5392 2,936.90 C2F2S5 1.6900 3,224.64 C3F2S5 1.8576 3,544.43 C1F3S1 0.7550 1,440.59 C2F3S1 0.9058 1,728.33 C3F3S1 1.0733 2,047.93 C1F3S2 1.0230 1,951.95 C2F3S2 1.1738 2,239.69 C3F3S2 1.3414 2,559.48 C1F3S3 1.2322 2,351.12 C2F3S3 1.3830 2,638.86 C3F3S3 1.5506 2,958.65 C1F3S4 1.4467 2,760.40 C2F3S4 1.5975 3,048.14 C3F3S4 1.7650 3,367.74 C1F3S5 1.6229 3,096.60 C2F3S5 1.7737 3,384.34 C3F3S5 1.9413 3,704.13
1st and 2nd Episodes, 14 to 19 Therapy Visits C1F1S1 1.6118 3,075.42$ C2F1S1 1.8626 3,553.97$ C3F1S1 2.1524 4,106.93$ C1F1S2 1.7675 3,372.51 C2F1S2 2.0183 3,851.05 C3F1S2 2.3081 4,404.01 C1F1S3 1.9046 3,634.11 C2F1S3 2.1554 4,112.65 C3F1S3 2.4451 4,665.42 C1F2S1 1.7281 3,297.33 C2F2S1 1.9789 3,775.88 C3F2S1 2.2686 4,328.64 C1F2S2 1.8837 3,594.23 C2F2S2 2.1345 4,072.77 C3F2S2 2.4243 4,625.73 C1F2S3 2.0208 3,855.82 C2F2S3 2.2716 4,334.37 C3F2S3 2.5613 4,887.14 C1F3S1 1.8010 3,436.43 C2F3S1 2.0518 3,914.97 C3F3S1 2.3415 4,467.74 C1F3S2 1.9566 3,733.33 C2F3S2 2.2074 4,211.87 C3F3S2 2.4972 4,764.83 C1F3S3 2.0937 3,994.92 C2F3S3 2.3445 4,473.47 C3F3S3 2.6342 5,026.23
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
Page 25 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode99926 Rural Missouri
Includes all counties not classified elsewhere as urban areas
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
3rd+ Episodes, 0 to 13 Therapy Visits C1F1S1 0.6543 1,248.45$ C2F1S1 0.7124 1,359.31$ C3F1S1 0.9399 1,793.39$ C1F1S2 1.0041 1,915.89 C2F1S2 1.0622 2,026.75 C3F1S2 1.2897 2,460.84 C1F1S3 1.2065 2,302.08 C2F1S3 1.2646 2,412.94 C3F1S3 1.4922 2,847.22 C1F1S4 1.4277 2,724.15 C2F1S4 1.4858 2,835.01 C3F1S4 1.7134 3,269.28 C1F1S5 1.6024 3,057.49 C2F1S5 1.6605 3,168.35 C3F1S5 1.8880 3,602.43 C1F2S1 0.7882 1,503.94 C2F2S1 0.8463 1,614.80 C3F2S1 1.0738 2,048.88 C1F2S2 1.1380 2,171.38 C2F2S2 1.1962 2,282.43 C3F2S2 1.4237 2,716.52 C1F2S3 1.3405 2,557.77 C2F2S3 1.3986 2,668.62 C3F2S3 1.6261 3,102.71 C1F2S4 1.5167 2,893.97 C2F2S4 1.6198 3,090.69 C3F2S4 1.8473 3,524.77 C1F2S5 1.7364 3,313.17 C2F2S5 1.7945 3,424.03 C3F2S5 2.0220 3,858.11 C1F3S1 0.9151 1,746.07 C2F3S1 0.9732 1,856.93 C3F3S1 1.2007 2,291.02 C1F3S2 1.2649 2,413.52 C2F3S2 1.3230 2,524.37 C3F3S2 1.5506 2,958.65 C1F3S3 1.4674 2,799.90 C2F3S3 1.5255 2,910.76 C3F3S3 1.7530 3,344.84 C1F3S4 1.6886 3,221.96 C2F3S4 1.7467 3,332.82 C3F3S4 1.9742 3,766.91 C1F3S5 1.8632 3,555.11 C2F3S5 1.9213 3,665.97 C3F3S5 2.1489 4,100.25
3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S1 1.7530 3,344.84$ C2F1S1 2.0276 3,868.80$ C3F1S1 2.3479 4,479.95$ C1F1S2 1.8689 3,565.99 C2F1S2 2.1435 4,089.94 C3F1S2 2.4637 4,700.91 C1F1S3 2.0252 3,864.22 C2F1S3 2.2998 4,388.18 C3F1S3 2.6200 4,999.14 C1F2S1 1.8839 3,594.61 C2F2S1 2.1585 4,118.57 C3F2S1 2.4787 4,729.53 C1F2S2 1.9998 3,815.76 C2F2S2 2.2744 4,339.71 C3F2S2 2.5946 4,950.67 C1F2S3 2.1560 4,113.80 C2F2S3 2.4306 4,637.75 C3F2S3 2.7509 5,248.91 C1F3S1 2.0531 3,917.46 C2F3S1 2.3277 4,441.41 C3F3S1 2.6479 5,052.37 C1F3S2 2.1690 4,138.60 C2F3S2 2.4436 4,662.56 C3F3S2 2.7638 5,273.52 C1F3S3 2.3252 4,436.64 C2F3S3 2.5998 4,960.60 C3F3S3 2.9201 5,571.75
Case-Mix Rate
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Case-Mix Rate
Case-Mix Weight
HHRG Code
Case-Mix Rate
Page 26 of 27
Medicare Home Health PPS Payment Rates
Effective for Episodes Beginning and Ending in January 2008
Service AreaCBSACode99926 Rural Missouri
Includes all counties not classified elsewhere as urban areas
Rates by HHRG Code1
By HHRG Code, NRS Level and LUPA Category
Payment Amount
Payment Amount
HHRG Code
Case-Mix Weight
HHRG Code
Case-Mix Weight
Payment Amount
HHRG Code
Case-Mix Weight
All Episodes, 20+ Therapy Visits C1F1S1 2.5495 4,864.62$ C2F1S1 2.7632 5,272.37$ C3F1S1 3.0835 5,883.53$ C1F2S1 2.7390 5,226.20 C2F2S1 2.9527 5,633.95 C3F2S1 3.2730 6,245.11 C1F3S1 2.9532 5,634.91 C2F3S1 3.1669 6,042.66 C3F3S1 3.4872 6,653.82
Nonroutine Supply (NRS) LUPA Per-Visit Payment Rates1
Payment Rates1 Skilled nursing 88.17$ Physical therapy 96.41 Occupational therapy 97.05 Speech therapy 104.67 Medical social worker 141.34 Home health aide 39.93
LUPA Episode Add-On Payment Amount1
Initial and LUPA-only episodes 73.90$ 5
34
12
SeverityLevel
6 551.00
1All rates are effective January 1, 2008, and are based on the Federal Register, dated May 4, 2007, and the Centers for Medicare and Medicaid Services document CMS-1541-FC.
BKD Health Care Group provides financial, billing, clinical and operational consulting services for home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or [email protected] with questions regarding this information or browse the BKD website to learn more about our services.
14.12$ 51.00
139.84 207.76 320.37
RatePayment
Page 27 of 27