Home Health Outlier Reconciliation Fix Successfully Implemented

Error in the Calculation Now Fixed.

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 had been incorrect. For most HHAs, once a fix was in place, the adjustment would result in the correction of an underpayment; however for a few, the adjustments would result in the collection of any overpayment not offset by other underpayment amounts. Change Request (CR) 7395 was implemented and identified the corrections that would need to be made.

A successful fix to the HH outlier issues was installed and run on Friday, July 20, 2012. Now that the fix is in place, 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. The bill type on these adjustments will be 32I or 33I. If you have not already received these adjustments they should be completed in the next week.