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2008 REFINEMENTS to the Medicare Home Health Prospective Payment System

Teenier, Pamela RN, MBA, CHCE, HCS-D

doi: 10.1097/01.NHH.0000313351.08852.9f

On January 1, 2008, Centers for Medicare and Medicaid Services (CMS) implemented refinements to the Prospective Payment System (PPS). This is the first change to the way CMS reimburses Medicare patients receiving home health services since the inception of PPS in 2000. The calculation for the exact episode payment has changed significantly, but from a clinical management perspective, the focus must be on ensuring that both the Outcome and Assessment Information Set (OASIS) assessment and the International Classification of Diseases (ICD)-9 CM coding are completed accurately—the same things all clinicians should be doing currently! This article will describe the structural, payment adjustment, and base rate changes for Medicare home care reimbursement that were implemented by CMS on January 1, 2008.

Pamela Teenier, RN, MBA, CHCE, HCS-D, is Assistant Vice President of Medicare Operations, Gentiva Health Services, Corpus Christi, TX.

Address for correspondence: Pamela Teenier, RN, MBA, CHCE, Gentiva Health Services, 13806 Doubloon Street, Corpus Christi, TX 78418 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.