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Set up Post-Refinement PPS parameters

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Enter the values in this window as dictated by CMS.

  1. Go to Administration>Configuration>PPS>Post-Refinement PPS Parameters.
  2. To add a new set of the post-refinement PPS parameters, click the Add New tab.
  3. Enter the start date for the new set of the PPS parameters.
  4. Enter the Urban and Rural values in the following sections:
  • National Standard PPS Rate
  • Non-Routine Supplies Factor
  • LUPA Episode Add-On Amount (applies to PPS parameters prior to January 1, 2014). Important: The Urban and Rural amounts can be the same and must be entered in both fields regardless of the area your agency serves.
  1. Enter the LUPA Episode Add-On Factor for the SN, PT, and ST disciplines.
  2. Enter the Rural Add-On Percentages for each CBSA/County category:
  • High utilization
  • Low population density
  • All other
  1. Enter the RAP (Request for Anticipated Payment) portion for the episode for the initial and subsequent episodes.
  2. Enter the fixed dollar loss.
  3. Enter the Outlier Sharing Ratio.
  4. Enter the Labor Portion of the Prospective Payment Rate.
  5. Enter the LUPA (Low Utilization Payment Adjustment) visit threshold.
  6. Save your changes.