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Output variables included the unduplicated number of patients served during the year, the HHRG case-mix index based on Medicare patients served, Medicare patients served as percent of all patients, the number of Low Utilization Adjustment Payment (LUPA) episodes, the number of Partial Episode Payment (PEP) episodes, and the QMs.
We calculated the average costs per unduplicated patient, average costs per visit, as well as these costs divided by the agency average HHRG to account for differences in case-mix.
Each HHRG is comprised of three domains or dimensions--clinical, functional, and service.
A patient receiving 10 or more therapy visits during a payment episode is categorized into a high-therapy HHRG.
laptops and notebooks) become smaller and less costly, the ability to use existing technology to support concurrent HHRG assignment and utilization management becomes a reality.
By using software tools to assign the HHRG upon assessment and to compare the expected payment to the ordered services and supplies, agencies can develop prospective win/loss reports and implement utilization management strategies for high cost patients early in the episode.
When changes in a patient's condition dictate, a single episode may be paid under multiple HHRGs.
Using estimates of revenue based on case-mix frequency and national basic reimbursement rates from the Health Care Financing Administration, a probability sample of HHRGs was selected to replace our previous sample of Medicare items.
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