The pms5 HHRG Grouper

The pms5 HHRG Grouper with Pricer

Sample for patient from Miami-Dade County Florida (MSA 5000) Factor 1.0234 FY 2001
Total Prospective Payment Worksheet

  Home Health Resource Group (HHRG) C3F3S3

    a) HHRG Factor 2.6437

    b) Standardized PPS Case Mix Adjusted for FY 2001 $ 2115.30

    c) Calculated Case Mix Adjustment Amount $ 5592.22

    d) Standard Labor Factor 0.77668

    e) Calculated Labor Amount $ 4343.37

    f) Wage Index Factor 1.0234

    g) Final Calculated Labor Amount $ 4445.00

    h) Standard Non-Labor Factor 0.22332

    i) Calculated Non-Labor Amount   $ 1248.85

TOTAL Prospective Payment Amount   $ 5693.85

The HIPPS Code: HDHM2 is also calculated based on the HHRG using the grouper

HHRG stands for Home Health Resource Group. The HHRG is the basis for calculating PPS reimbursement. Every patient is assigned an HHRG based on the estimates of the resources required to manage his or her case. This is determined by the OASIS data collected at the start of care.

There are several factors that influence the HHRG. These include the patient's Clinical Severity, Functional Status and Service Utilization scores.

Here is the HHRG calculated for a patient by the pms5 Haven Bridge and by the pms5 UFO desktop. Once the OASIS data has been collected, the calculation process is automatic - in the home or in the office. No manual or redundant data entry or manipulation is required.

Using the UFO or the pms5 Haven Bridge there are a number of reports that can be run prior to sending the RAP (request for anticipated payment), here is a sample.