The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standardized payment), and submitted charges organized by Centers for Medicare and Medicaid Services (CMS) Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Home Health Agency PUF covers calendar year 2013 and contains 100% final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.
The spending and utilization data in the Home Health Agency PUF are aggregated to the following:
a) the identification number for the agency, and
b) the Home Health Resource Group (HHRG).
Medicare makes payment under the home health prospective payment system on the basis of a national standardized 60-day episode payment rate that is adjusted for the applicable case-mix and wage index. The national standardized 60-day episode rate includes the six home health disciplines (skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy, and medical social services). To adjust for case-mix, patients are assigned to one of 153 home health resource groups (HHRG). The clinical severity level, functional severity level, and service utilization are used to place the patient in a particular HHRG. Each HHRG has an associated case-mix weight which is used in calculating the payment for an episode. For episodes with four or fewer visits, Medicare pays national per-visit rates based on the discipline(s) providing the services. An episode consisting of four or fewer visits within a 60-day period receives what is referred to as a low utilization payment adjustment (LUPA). For certain cases that exceed a specific cost threshold, an outlier adjustment may also be available.