Palmetto GBA initiates 2021 payment adjustment for home health VBP model
If your agency uses Palmetto GBA to process Medicare claims in the Home Health Value-Based Purchasing (HHVBP) program, your organization could see some positive adjustments to 2021 reimbursement starting in April. The news comes from Palmetto GBA, which identified an underpayment issue to home health providers under the VBP model, and notified affected agencies by letter on March 23. Palmetto GBA reported that claims from Jan. 1, 2021 through March 10, 2021 made to agencies with a VBP adjustment were incorrect. Provider files were updated on March 10 to initiate correct HHVBP payment adjustments on claims moving forward.
Palmetto GBA will adjust claims affected by this issue that were received prior to March 10, 2021, after the April 2021 Quarterly Release to reduce additional adjustments. Upon review of several client scenarios, Simione Healthcare Consultants has determined that there may be adjustments for VBP, as well as adjustments to the 2021 base rate due to incorrect application of the CY2020 HH PPS rates for claims spanning 2020-2021. Headquartered in Columbia, South Carolina, Palmetto GBA is one of the nation’s largest providers of high-volume claims and transaction processing for government administrative and other services.
Simione Healthcare Consultants can help with any questions you may have regarding this issue to support success with financial and revenue cycle operations. For assistance, call 800.949.0388.