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Due to an error in the calculation of the Home Health Prospective Payment System (HH PPS) 10% outlier limitation, the outlier payment has been calculated incorrectly since Jan. 1, 2010.
According to the Center for Medicare and Medicaid Services (CMS) MLN Matters article number MM7395, all home health agencies (HHA) that bill Regional Home Health Intermediaries (RHHI) for services provided to Medicare beneficiaries are affected.
Beginning Jan. 3, 2012, CMS will adjust all claims with outlier payments paid or withheld for dates of service since Jan. 1, 2010 by reprocessing all HH PPS claims with outlier limitations applied in error.
Reprocessing of claims will begin Jan. 3, 2012, and CMS expects most claims will result in an underpayment, although there may be some cases where CMS will be collecting an overpayment.
Specifically, effective for claims with dates of service on or after Jan. 1, 2010, Medicare systems will:
For official CMS instructions issued to your RHHI, you can download CR7395.