How are the payments for Home Health PPS claims derived?
The payments for Home Health Prospective Payment System (HH PPS) claims are based on payment groups. These payment groups, also known as Home Health Resource Groups (HHRGs), are derived from beneficiary assessment data reported by home health agencies (HHAs) on the Outcomes and Assessment Information Set (OASIS). Each HHRG has an associated weight value that increases or decreases Medicare’s payment for an episode of care, and this payment is relative to a national standard per episode amount. The HHRGs are reported to Medicare on HH PPS claims using the health insurance PPS (HIPPS) code set.
