Prospective payment system final rule at a glance

Here are some of the major components of the final prospective payment system rule, published in June:

The national standardized base rate: $2,115.30 per episode, up nearly 4% from the proposed rate. There also are increases in the per visit rates for low utilization payment adjustments. Initial payment: 60% at the start of the first 60-day episode of care; 40% at the end. For each successive episode, the split is 50-50. The Health Care Financing Administration will allow use of a verbal order for the initial billing. The request for anticipated payment (RAP) must contain the detail necessary to be equivalent to a plan of care. There is no 14-day waiting period before Medicare will pay on the RAP. Medical supplies are not case-mix adjusted but are included in the base rate. There is no adjustment in the base rate based on the presence or absence of a caregiver in the home. Partial episode payments will be prorated based on the number of days of care.

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