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Home health agencies suffering for taking on outlier patients should be able to secure correct payment for them again.
"A system fix was implemented and claims are now processing correctly," Home Health & Hospice Medicare Administrative Contractor Palmetto GBA reports on its website. Since 2010, the Medicare claims system had been incorrectly calculating the 10 percent outlier cap on HHA payments for many agencies.
The fix was implemented July 20, HHH MAC NHIC says in an e-mail message to providers. Now "all HH PPS claims with dates of service January 1, 2010 and after, where the outlier limitation may have been applied in error will be reprocessed and adjustments will be automatically created."
"These adjustments will process to the provider’s remittance as any other adjustment would," NHIC explains. "The bill type on these adjustments will be 32I or 33I."
Most HHAs that see an outlier adjustment will receive an underpayment correction, NHIC adds. But a few will see recoupment of outlier-related overpayments.
"It should take about one to two weeks for most of the adjustments to finalize," NHIC estimates.
This fix should be a big relief to agencies severely impacted by the miscalculation. Previously, "the only relief available to home health agencies was the offer of accelerated payment requests," notes the National Association for Home Care & Hospice in its member newsletter. "However, CMS limited accelerated payment awards to 70 percent of the total amount of an agency’s outlier underpayment. In addition, the accelerated payment process is burdensome, and approval was limited to those agencies that have proof of cash flow problems."