The Clinician???s Role in Medicare Prospective Payment

Abstract

Pamela Teenier, BSN, RN, MBA, CHCE, is Director of Medicare Operations, Gentiva Health Services, Corpus Christi, TX. Address for correspondence: 13806 Doubloon Street, Corpus Christi, TX 78418. Editor’s Note: Under Medicare’s Prospective Payment System (PPS) today’s clinician is expected to manage both clinical and financial aspects of a patient care episode. This is the second in a series of articles to teach clinicians three important PPS elements that affect a home health agency’s ability to successfully manage in the PPS environment; Case Mix Weight (CMW), Adjustments, and Visits per Episode. The first article (see August 2004 HHN) laid the foundation by outlining definitions of the basic elements tying in the importance they play in PPS reimbursement. This month’s column focuses on evaluating the CMW element and creating a plan to improve assessments and overall reimbursement. Subsequent columns in the series will discuss each of the terms in depth, presenting an analysis of the concept and opportunities for you to apply them to patient situations.