The annual total of national atypical payments for Home Care near Allentown PA services will not exceed 2 or 5 percent of the estimated total of home health care payments. Additional payments will be made to the 30-day combined adjusted case period and to the associated payments to beneficiaries who incur unusually high costs. These atypical payments will be made during periods of care in which the charged cost exceeds a minimum amount for each group of cases. The amount of the atypical payment will be proportional to the amount of the imputed costs that exceed the threshold. Atypical costs will be charged to each period of care by applying the standard amounts per visit to the number of disciplinary visits (specialized nursing visits or physical therapy, speech-language pathology, occupational therapy or home health care services) reported in the claims. The annual total of national atypical payments for Home Care near Allentown PA services will not exceed 2 or 5 percent of the estimated total of home health care payments. Additional payments will be made to the 30-day combined adjusted case period and to the associated payments to beneficiaries who incur unusually high costs. These atypical payments will be made during periods of care in which the charged cost exceeds a minimum amount for each group of cases. The amount of the atypical payment will be proportional to the amount of the imputed costs that exceed the threshold. Atypical costs will be charged to each period of care by applying the standard amounts per visit to the number of disciplinary visits (specialized nursing visits or physical therapy, speech-language pathology, occupational therapy or home health care services) reported in the claims.
The annual total of national atypical payments for home health services will not exceed 2.5 percent of the estimated total of payments under the PPS for home care. In this blog, we'll discuss the concept of recertification evaluations, how they affect reimbursement rates, and how home health care providers can deal with the complexities of this process to ensure adequate funding for their services. On June 30, 2025, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule to update the rates of the Home Health Care Prospective Payment System (HH PPS) for calendar year (CY) 2026. This proposed standard updates HHA's Medicare payment rates, Home Health Care Quality Reporting Program (HHQRP) requirements, home health care value-based purchasing (HHVBP) model requirements, and other Medicare policies. For home health care providers, recertification serves to evaluate both the patient's health status and the quality of the care they receive.
The Centers for Medicare and Medicaid Services (CMS) sets the rules for recertification, which must be done at least every 60 days for Medicare beneficiaries receiving home health care. Recertification evaluations play an important role in determining whether they are still eligible for home health care services, affecting both funding and in the reimbursement of suppliers. The care plan must be signed and dated by a physician or authorized professional, as described, who meets the certification and recertification requirements of 42 CFR 424.22 and before submitting the request for each 30-day period of services to obtain the final percentage payment. Authorized professionals, in addition to doctors, can certify and recertify beneficiary requirements, request home health services, and establish and review the care plan.
Medicare is a major payer of home health services, and the recertification process plays a critical role in determining eligibility to continue receiving reimbursement. This poses a significant challenge for providers, as they could lose funding for ongoing patient care if they cannot justify the medical need for services through appropriate recertification. Recertification by a doctor is required at least every 60 days when continuous home health care is needed after an initial 60-day episode. For people with a home health care plan, basic HH PPS payment rates include payment for all services (nursing, therapy, home health aides, and medical social services) and routine and non-routine medical supplies, with the exception of certain injectable osteoporosis medications, DME, and the provision of negative pressure wound therapy (NPWT) with a disposable device.
This makes the evaluation of recertification a key opportunity for providers to ensure that they receive adequate reimbursement for the services they provide. Recertification is a process that is carried out periodically during a patient's care to determine if they continue to meet the eligibility criteria for receiving home health services.
