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Medicare home health payments to remain flat


By Jessica Zigmond
Posted: November 2, 2012 - 6:45 pm ET
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Home health agencies can expect Medicare payments to drop by 0.01% next year, decreasing total payments in this segment by about $10 million from 2012 payments, the CMS announced.

The so-called market basket—which adjusts for inflation—called for a 1.3% payment increase to home health providers next year. Then the CMS applied an updated wage index that resulted in a 0.37% decrease, as well as a 1.32% decrease in the case-mix adjustment and an update to the fixed-dollar loss ratio used in outlier payments that led to an increase of 0.38%. Taken together, these adjustments result in a total decrease of 0.01% for 2013 payments, a CMS spokeswoman explained in an e-mail.

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In a nearly 300-page final rule (PDF) released Friday, the agency also established new survey and certification requirements for home health agencies, specifying definitions for types of surveys, surveyor qualifications and the opportunity for informal dispute resolution.

The rule also gives those agencies that are not compliant with the federal health and safety standards known as Medicare's conditions of participation a chance to change their performance, either through directed plans of correction or directed in-service training. And it allows the CMS to impose alternative sanctions—besides termination—for agencies that do not maintain or achieve compliance with those standards.


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