Page 205 - CHHA Binder 2.3.20

1/10/2020

Prospective Payment System (PPS)

 The Home Health PPS provides HHAs with payments for two
30-day episode of care for each beneficiary.

 In a 60 day episode of care there must be:
• SOC OASIS with a RECERT OASIS
or
• SOC OASIS with a Discharge OASIS.

 When there is an Interruption in the episode of care:

• A Transfer to inpatient facility is done on the OASIS followed by a ROC
upon patient return home.***

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Case-mix Adjustment

The case-mix adjustment is the Health Insurance Prospective
Payment System(HPPS) in cases with completed OASIS.

 OASIS items describing:
• The patient's condition
• Episode timing (early or late)
• The expected therapy needs (PT, OT, ST).

The HIPPS is used to calculate reimbursement for services.

 There are 432 case-mix groups, available for patient
classification.

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