HIPPS groups with the lowest and highest case-mix weights under PDGM

The following 15 HIPPS groups will have the lowest and highest case-mix weights under PDGM, according to the 2019 PPS final rule.

The following 15 HIPPS groups will have the lowest case-mix weights under PDGM, according to the 2019 PPS final rule.

HIPPS

Clinical group and functional level

Timing and admission source

Comorbidity adjustment

Weight

3GA11

MMTA — Surgical aftercare — Low

Late — Community

0

0.4784

3FA11

Behavioral Health — Low

Late — Community

0

0.5015

3JA11

MMTA — GI/GU — Low

Late — Community

0

0.5277

3GA21

MMTA — Surgical aftercare — Low

Late — Community

1

0.5381

3LA11

MMTA — Respiratory …

Calculating Reimbursement Under PDPM

The new Patient Driven Payment Model (PDPM) goes into effect October 1st, 2019. While staff will continue to rely on computer software to convert MDS assessment data to calculate reimbursement rates, it will be vital to fully understand the rate calculation methodology to properly identify opportunities to maximize reimbursement and accurately project revenue.
In this FREE special report, our industry experts are providing the inside scoop on how you can prepare for these significant changes. We’re …

LUPAs remain a complicated area under PDGM

Source: Home Health Line
Despite the fact that payment episodes under the Patient-Driven Groupings Model (PDGM) will last 30 days instead of 60, LUPAs still will occur under the new payment model CMS is creating beginning on or after Jan. 1, 2020.
Unlike with the PPS, where a LUPA involves four or fewer visits during an episode, the threshold for the number of visits needed for an episode to be a LUPA under PDGM will vary.
Thresholds will …