The Medicare Prospective Payment System (PPS) for home health agencies (HHAs) utilizes a case-mix classification system to adjust payments based on patient characteristics and resource needs. This system is known as Home Health Resource Groups (HHRGs). Under the original HH PPS, a patient was assigned to an HHRG for a 60-day episode of care, which determined the reimbursement rate. Although CMS implemented the Patient-Driven Groupings Model (PDGM) in 2020, which uses a more refined case-mix methodology for 30-day periods, HHRG is the specific term among the choices that is historically and fundamentally associated with the home health PPS case-mix system.

B. case-mix groups (CMGs). This classification is used for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) to determine reimbursement.

C. diagnosis-related groups (DRGs). This system is used to classify hospital cases for reimbursement under the Inpatient Prospective Payment System (IPPS) for acute care hospitals.

D. resource utilization groups (RUGs). This was the case-mix methodology used for the Skilled Nursing Facility (SNF) PPS, which has since been replaced by the Patient-Driven Payment Model (PDPM).

1. Sayles

N. B.

& Trawick

M. A. (Eds.). (2023). Health Information Management Technology: An Applied Approach (7th ed.). AHIMA Press. In Chapter 10

"Reimbursement Methodologies

" the text specifies the use of HHRGs for the Home Health PPS

DRGs for the Inpatient PPS

CMGs for the Inpatient Rehabilitation PPS

and RUGs for the Skilled Nursing Facility PPS.

2. Centers for Medicare & Medicaid Services (CMS). (n.d.). Home Health Prospective Payment System. CMS.gov. The "Overview" section details the establishment of the HH PPS and its reliance on a case-mix system

which it identifies as HHRGs

to adjust payments for 60-day episodes of care prior to the 2020 implementation of the PDGM.

3. University of Illinois Chicago

Department of Biomedical and Health Information Sciences. (n.d.). BHIS 410: Healthcare Revenue Cycle and Reimbursement. Course Syllabus. The course materials outline the various Medicare prospective payment systems

explicitly linking HHRGs to Home Health

DRGs to Acute Inpatient

CMGs to Inpatient Rehabilitation

and RUGs to Skilled Nursing Facilities.