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.Article Limit Reached
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content