Author Question: List two exceptions to the normal 60-day HHRG-based episode ... (Read 21 times)

Arii_bell · **on:** Jul 12, 2018

List two exceptions to the normal 60-day HHRG-based episode payment.

Question 2

Describe the two-installment payment method for the 60-day episode.

Hikerman221 · **Reply #1 on:** Jul 12, 2018

Answer to Question 1

Any two of the following: (1) Low Utilization Payment Adjustment occurs when a patient receives four or fewer visits in a 60-day episode. (2) Partial Episode Payment (PEP) occurs when a patient is transferred to another agency for care; PEPs also occur if the agency providing care discharges the patient prior to the end of the 60-day episode and then home care is resumed by the same agency before the end of the episode. (3) Outliers occur when the provision of care to a patient results in unusually high costs to the home care agency.

Answer to Question 2

The first installment is made when a Request for Anticipated Payment is submitted to Medicare, and the second installment is made when the final claim is filed.