Hhas And 10 Percent Outlier Cap: Minimize The Risk

By Author: Angela MArtin
Total Articles: 206
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There are tough times ahead for home health agencies affected by the 10 percent outlier cap. Here's how you can lessen the policy's impact on your agency:

You need to find out right away if your payments will be limited, recommends Abilene, Texas-based financial consultant Bobby Dusek as the 10 percent per agency cap will start applying immediately in January.

Dusek advises that an agency can look at their total outlier payments as a percentage of their total reimbursement to see if they might have a problem. He stresses that since the cap will affect episodes that have already begun, agencies need to look at their situation now.


If there are chances of exceeding the 10 percent mark for outlier payments, you need to act now to mitigate the financial impact. The National Association for Home Care & Hospice suggests that you can explore alternative treatment ...
... plans with physicians such as using insulin pumps, changing insulin frequency or employing alternative wound therapy.

Your clinicians can explore alternative options like new training approaches to teach self-management or use of assistive devices, NAHC offers. She relates that for low vision patients, Gaboury's clients found a low vision program to enroll them in that taught them to self-administer insulin.

NAHC counsels that your social workers can find other sources of care such as churches or volunteer groups.

If you are not in one of the high-suspicion areas, you can look out for other agencies in your area with room under their outlier caps to take on some of your outlier patients.

Put a stop on outlier patient admission. NAHC says that you should try to limit admission only temporarily.


If you must discharge patients, be sure to adhere to any state rules and your own agency rules for discharge. The trade group adds that you should try to give patients and caregivers advance notice of the possiblity of discharge so that they and their families can work with you on alternatives.

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