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Home care agencies may now visit the Centers for Medicare and Medicaid Services (CMS) web site to download the PC version of the Medicare PPS Pricer software that is used to calculate home health prospective payment system (PPS) payments on all home health claims.
The PPS Pricer makes all reimbursement calculations applicable under PPS, including percentage payments on requests for anticipated payments, claim payments for full episodes of care, and all payment adjustments, including low utilization payment adjustments, partial episode payment adjustments, significant change in condition adjustments, and outlier payments.
The software allows agencies to predict and validate payment amounts for their claims, using the same software used by regional home health intermediaries’ systems. To download, users must have an IBM PC or clone with a hard disk drive for Microsoft Windows 95 or newer with at least 8MB RAM. The software is available at: www.hcfa.gov/medicare/nm75ght/priceint.htm.