Services

PPS Impact Analysis

PPS 2008 Regulatory Changes

CMS recently released their Home Health Prospective Payment System and Rate Update (CMS-1541-P). These proposed regulations present the most significant changes in Medicare’s payment structure since the inception of PPS, and they are slated to go into effect on January 1, 2008. This means that home health agencies have to act now to understand the impact and create a smooth transition into a new era of Medicare PPS.

The new payment methodologies are sure to have a range of both positive and negative effects on your reimbursement, depending on multiple factors unique to your organization. To determine the financial impact, a significant sample of your Medicare claims will need to be re-priced according to the new calculations.

Agencies that take a proactive approach have the luxury of enough time to:

• Assess the financial impact of the new regulations

• Discuss potential negative effects with senior leadership

• Develop an action plan to offset any negative impact

• Adjust operations to create a smooth transition

• Protect the financial health of your organization

Impact Analysis

Conducting a comprehensive Impact Analysis is the first step in a strong, proactive response to the proposed changes. McBee Associates can help you forecast the financial effects your agency can expect under the new PPS regulations by repricing a representative sample of your Medicare claims according to the new regulations. Armed with this valuable information, you’ll be able to anticipate the coming changes and adjust your operations to compensate for negative effects before they impact your financial health.

Strategic Discussions with Senior Leadership

Your success depends on senior management understanding the financial and operational impact of the new payment system on your agency. The McBee Associates’ findings report provides the detailed information you need to thoroughly explain all aspects of the new PPS regulations and how they will affect your agency. This enables you to work with senior leadership to develop strategies that can head off any negative effects long before they impact your operations.

Adjusting Operations to Offset Negative Financial Impacts

The only way to offset negative financial effects is through improving your existing operations. McBee Associates provides several operational improvement services that can increase profitability while helping you deliver high-quality care.

• An Operational Assessment is the starting point for many agencies seeking to compensate for negative financial effects of the new regulations. The assessment focuses on the OASIS process, episode management, scheduling, coding issues, and documentation flow.

• An OASIS Accuracy Audit identifies weaknesses in your OASIS process and provides recommendations for improvement. Implementing these process improvements can help ensure that your organization is prepared for the new PPS regulations.

• Diagnosis Coding will play a significantly larger role in the new PPS reimbursement model. McBee Associates’ certified coders can provide a coding review and staff training to address any problems identified during the review.

• OASIS Training provides your clinical staff members with the knowledge and understanding necessary to accurately complete the OASIS according to CMS guidelines. Proper training can improve scoring accuracy and help ensure full reimbursement for the care you provide.

• Episode Management improvements are another way to offset the effects of PPS changes. Implementing continuous, proactive episode reviews enables staff to deliver more appropriate care, ensures appropriate utilization of visits and disciplines, and, most importantly, addresses problems as they arise, instead of after the fact. This can reduce per-episode costs, lead to more appropriate patient care, and ensure more accurate reimbursement, which can increase your profits.