Allegheny Messages

All of the final 2012 PPS rate changes per the November 8, 2011 Federal Register are now available with the current update, 4897, along with the CBSA wage index factors for 2012. We had sent out the proposed changes earlier in October and found that we had made a few mistakes. Diagnosis codes 4011 and 4019 for Hypertension NOS will no longer score clinical points as of January 1, 2012. We mistakenly made the date October 1, 2011. This has been corrected. Secondly, OASIS assessments where the episode ends in 2012 were scoring with the new point structures. It should have only been assessments beginning in 2012. This also has been corrected. We had 3 or4 support calls stating that the state was calculating a different HIPPS code than what our software was calculating which helped us find the reasons for the differences.

The possible clinical and functional points that are used to determine HIPPS codes for the 5 different scoring equations have also changed for 2012. The possible points had not changed since the 5 scoring equations were put into effect. In addition for 2012, the amounts paid for the levels of therapy now fluctuate based upon the clinical and functional scores. In the past the amounts were constants dollar amount based solely on the number of therapy visits. The nature of these changes required considerable more programming effort than in the past few years. Thanks you for your patience.