tci Medicare Compliance & Reimbursement - 2013 Issue 15

Home Health Reimbursement: 170 Revenue-Generating Diagnosis Codes Pruned

Watch how your plan of care is defined. Including diagnosis codes in the case mix point system leads to overpayments, says the Centers for Medicare & Medicaid Services (CMS). To remedy the situation, CMS suggests dropping a wide variety of case mix codes. CMS’ “clinical staff along with clinical and coding staff from Abt Associates (our support contractor) and 3M (our HH PPS grouper maintenance contractor), recently completed a thorough review of the ICD-9-CM codes included in our HH PPS Grouper,” CMS explains in the home health prospective payment system proposed rule published in the July 3...

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