Outlier-Issue

Home Health Outlier Corrections Expected Soon

Tests are Underway by CMS.

In the Home Care and Hospice Financial Managers Association (HHFMA) call with the experts Wednesday, Bill Dombi with the National Association of Home Care mentioned that tests are underway by CMS on the latest iteration of a fix that will hopefully permanently resolve the Outlier miscalculation issue.

For those not familiar with the issue, due to an error in the calculation of the Home Health Prospective Payment System (HH PPS) 10 percent outlier limitation, the basic calculation of the outlier limitation since January 1, 2010, has been incorrect. For most HHAs, the adjustment once the fix is in place will result in the correction of an underpayment; however for a few, the adjustments will result in the collection of any overpayment not offset by other underpayment amounts.

As mentioned in Wednesday’s HHFMA call even agencies with small numbers of outliers could still have been adversely affected and only providers with no Outliers were not impacted. If this latest iteration does not work, NAHC plans to request CMS give providers a manual work around.

HEALTHCAREfirst will provide more information as it becomes available.

June 22, 2012

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