Home Health Case Mix Grouper Software Package

Home Health Case Mix Grouper Software Package

The Home Health Prospective Payment System (HH PPS) Grouper (HHRG V3413) is available for download.  HHRG V3413 contains numerous changes to the previous grouping logic and is a required update for OASIS submissions with assessment completion date on or after January 1, 2013.

The changes contained within V3413 include:

1. A select range of neoplasm codes in the series 173.xx have been added to diagnosis group 3 and non-routine supply group 5 retroactive to October 1, 2011.  Additional Guidance will be issued through your Medicare Administrative Contractor on the process for claim submission if a provider elects to adjust a previously submitted claim.
2. The scoring of Diagnosis codes submitted within payment diagnosis fields when calculating HIPPS codes has been revised. For assessments with completion dates on or after January 1, 2013   scoring of codes reported in the payment diagnosis field will be restricted to a defined list available within the HHRG grouper tables.
3. Attribution of additional points to select codes that appear in the primary position has been revised to permit more codes to act “as if” primary when immediately preceded by a designated aftercare code (v-code) or etiology.
4. Date validation has been enhanced to restrict M0090 dates to valid date submissions within a calendar year.
5. Data validity flags have been reintroduced for a wider array of processing outcomes to the HHRG following a partial removal under V3312.
6. The HHRG expiration date has been specified within the release as December 31, 2013. While this is not intended to signal that there will be no Oct 1, 2013 update, it will require action to update the HHRG for assessment completion dates on or after Jan 1, 2014.

Providers can find additional information surrounding the payment diagnosis field logic within the V3413 documentation in a PDF file titled “Medicare Home Health Prospective Payment System Patient Classification Algorithm Home Health Resource Grouper (HHRG) Overview.”  In addition, responses to comments surrounding many of the changes are provided within the Federal Register: http://www.gpo.gov/fdsys/pkg/FR-2012-11-08/pdf/2012-26904.pdf.

CMS is Soliciting Beta Site Testers

Thank you for your interest in participating in the beta testing of the Home Health Grouper for the CMS Home Health Prospective Payment System.

The Beta Process

Approximately fifteen (15) business days prior to each general release, you will be provided with a beta test package. This will be distributed to a designated recipient of your choice via a downloadable web “drop box” hosted by 3M. The designated recipient will be required to supply a contact e-mail address.

During the annual release cycle intermediate version changes may be made available to beta testers for review. There is no requirement to test these versions in order to retain beta site status however the requirement for confidentiality surrounding intermediate versions is essential.

Expectations

Upon receipt of the beta package, you will be expected to:

• Test the application by running several hundred assessments through the software; there should be adequate representation of all documented changes implemented for the update
• Analyze the output from the HH Grouper in the return buffers for a reduced sample of assessments, specifically:

          - From the reduced sample select 5-10 records from each of the 5 Grouping Steps

          - Manually confirm that the grouper output (HIPPS codes and validation Flags) match the manual calculations

• Complete testing and report on your findings within 10-days of having the beta release made available.

Communication

During beta testing communication needs to be immediate and direct.

• The designated contact will be expected to communicate with 3M if any problems are identified in the installation or application testing, or if any questions or comments arise during the beta testing.
• 3M Contact names, e-mail addresses and phone numbers will be provided to beta test designees with each distribution of the web drop box.
• At the conclusion of testing, a summary of the testing results is requested.

Confidentiality

Software and information will be released to you for HH Grouper beta testing before being released by CMS to the general public.  With the exception of your designated contact at 3M, this material may not be discussed with, or distributed to anyone outside of your organization. To prevent unauthorized release, access to this information within your organization should be limited to individuals who are directly involved in the beta testing.

To enroll as a beta site, vendors will be required to e-mail us at:  grouperemail@mmm.com

We will respond to the e-mail requesting additional contact information.