Therapy Thresholds

• Number of therapy visits projected on the OASIS at the start of the episode is confirmed by therapy visits entered on final episode claim

• Three Thresholds 

 – 6 Visits

 – 14 Visits

 – 20 Visits

• Claims will be recoded based on actual number of therapy services provided

Supply Groups

• Supplies bundled into HH PPS payment

 – Routine supplies: used in small quantities for patients during usual course of home care 

 – Non-routine: needed to treat patient’s specific illness or injury according to plan of care 

• Non-routine supplies grouped based on if supplies were (or were not) provided and further scaled down into severity levels

Consolidated Billing

• HHA must bill for all home health services which includes: 

– Nursing and therapy services 

– Routine and non-routine medical supplies 

– HH aide services 

– Medical social services 

• All home health services paid on a cost basis included in PPS rate 

• Payment made to primary HHA regardless of whether or not items or services were furnished by the HHA