Do you need help with tracking your outlier payments? The Centers for Medicare & Medicaid Services (CMS) enables home health agencies (HHAs) to track outlier payment and Home Health Prospective Payment System (HH PPS) payment totals via the Direct Data Entry (DDE) Online Remote Terminal Access of the Fiscal Intermediary Standard System (FISS). HHAs can use the Home Health Pymt Totals (Map 1B41) Inquiry screen as a handy tool to ensure that outlier payments comprise no more than 10% of the HHA's total HH PPS payments for the year. When each HH PPS claim is processed, FISS will compare these two amounts and determine whether the 10% has currently been met. *Note: Kinnser strongly recommends that you confirm all results with your Fiscal Intermediary for accuracy.

Follow the instructions below to access the Home Health Pymt Totals screen (Map 1B41) and obtain your agency's payment information:
1) From the FISS Main Menu (Map 1701), type 01 in the Enter Menu Selection field and press Enter.
2) From the Inquiry Menu, type "67" in the Enter Menu Selection field and press Enter. The Home Health Payment Totals Inquiry screen (Map 1B41) appears.
3) From the Home Health Payment Totals Inquiry screen, type your agency's Provider Transaction Access Number (PTAN) (also known as your OSCAR/Legacy provider number) in the Provider field.
5) Tab to the NPI field, type your agency's National Provider Identifier (NPI) and press Enter.

The Home Health Payment Totals Inquiry (Map 1B42) screen displays the total home health payment and outlier totals for up to three years beginning with calendar year 2010 HH PPS payments. The payment information is updated only after HH PPS claims are in FISS status/location (S/LOC) P B9997 (paid). HH PPS claims with "TO" dates on/after January 1, 2010, are included in the data currently available.

To display a list of claims that comprises the outlier and payment totals for a specific year:
6) Type an "S" in the SEL field next to the specific year and press Enter. The Home Health Payment Totals Detail (MAP 1B42) screen appears with individual claim data and the corresponding value code amounts that reflect outlier and total payment amounts.

For more information, review pp.76-79 of the Cahaba GBA Fiscal Intermediary Standard System Reference Guide at https://www.cahabagba.com/rhhi/education/materials/fiss_menu.pdf

Pamela Pruitt has over 20 years experience as an accountant, with a majority in public accounting specializing in health care industry such as physicians, anesthesiologists, dentists, hospitals/clinics, etc. Ms. Pruitt is the Chief Accountant at All Nursing Home Health Services, Inc. in Houston, TX, as well as a Certified QuickBooks Pro Advisor, Certified Public Bookkeeper and Certified Bookkeeper. After hours, she blogs on Jobing.com and runs a business providing services to small businesses such as bookkeeping, accounting, and software setup, among other services. To reach Ms. Pruitt, call (281)617-1180 or visit www.ppruitt.com.