- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
- Expanded Home Health Value-Based Purchasing Model
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Notice of Admission Questions and Answers
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Periods with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- 30-Day Home Health Therapy Reassessment Schedule
Expanded Home Health Value-Based Purchasing Model
Overview
The HHVBP Model is an initiative by CMS aimed at improving the quality of care provided by home health agencies while also fostering greater efficiency. It builds on the original HHVBP Model and is designed to incentivize home health providers to deliver higher-quality services through value-based adjustments to their payment structures.
CY 2025 marks the first payment year, with adjustments based on CY 2023 performance. Adjustments range from -5% to 5% and apply to Medicare fee-for-service payments. The payment year corresponds to the claims' 'Through' date, meaning claims extending into CY 2025 will receive updates and adjustments for that year based on CY 2023 performance. Providers should review interim and APRs in the iQIES portal.
How Claim Adjustments Work
Claim value code QV (Medicare-applied code) identifies the dollar amount of the difference between the agency’s HHVBP positive or negative adjusted payment and the payment amount that would have otherwise been made.
Related Content
If you are interested in receiving additional educational information, updates or have questions about the Expanded HHVBP Model, please see the below resources:
- CMS HHVBP Website: Expanded Home Health Value-Based Purchasing Model
- HHVBP Listserv: Subscribe to the HHVBP Model Expansion listserv
- Help Desk: HHVBPquestions@cms.hhs.gov
- APR: Instructions for Accessing HHVBP Model Reports in iQIES
Posted 2/14/2025