Industry Insights

Home Health Rural Add-On Payment Extended for 2018

April 2018
Author:  Elizabeth Wilson

Elizabeth Wilson

Managing Consultant

Consulting

Health Care

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)

Springfield
417.865.8701

On November 7, 2017, the Centers for Medicare & Medicaid Services (CMS) released the Medicare final rule updating the home health (HH) prospective payment system for calendar-year 2018. This rule didn’t include provisions to extend the 3 percent rural add-on payment that applied to episodes and visits ending before January 1, 2018.

Recent Developments

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 (the Act), which contained several updates to various policies and payment provisions, including an extension for the 3 percent HH rural add-on payment to episodes and visits ending before January 1, 2019. On March 20, 2018, CMS released Change Request 10531, which outlined multiple provisions of the Act—all with a January 1, 2018, effective date and April 2, 2018, implementation date.

What to Expect

CMS will release a revised HH pricer reflecting the 3 percent rural add-on payment for 2018 with an April 2, 2018, implementation date. Once the revised HH pricer is in place, Medicare Administrative Contractors (MAC) will begin reprocessing affected claims as soon as possible. MACs will have up to six months to ensure all reprocessing actions have been initiated.

Claims to be automatically reprocessed will contain the following criteria:

  • Type of Bill 32X
  • Claim through dates on or after January 1, 2018
  • Value code 61 amounts in the range 999XX
  • Claim receipt dates prior to the installation of the revised HH pricer

Download your updated 2018 payment schedule for all rural areas here.

For more information, contact Elizabeth or your trusted BKD advisor.

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