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Home Health Agency Claims: Total Performance Score/Payment Adjustment Reports

Thursday, March 5, 2020

In January, we informed you the Defense Health Agency (DHA) is updating the TRICARE manuals to include a Home Health Value-Based Purchasing (HHVBP) Demonstration and Patient-Driven Groupings Model (PDGM) based on the Centers for Medicare & Medicaid Services (CMS) HHVBP and PDGM pricing. The HHVBP offers financial incentives to home health agencies (HHAs) who perform efficient, higher quality care. This model was rolled out by CMS in 2016 to nine states, four of which are in the TRICARE West Region: Arizona, Iowa, Nebraska, and Washington. While we continue to hold claims from all West Region HHAs as described below, providers in the four listed states may submit their calendar year 2020 (CY20) Total Performance Score (TPS) and Payment Adjustment Report (PAR) to us in advance. Although we are prepared to receive CY20 reports, we cannot process held HHA claims until we have direction from DHA to complete the required system updates. 

HHA claims held
We anticipate TRICARE’s HHVBP Demonstration and PDGM reimbursement to be effective retroactive to Jan. 1, 2020. As we await the TRICARE manuals to publish and the pricing updates from DHA, we are holding home health agency claims for new episodes of care that started on or after Jan. 1 (as determined by the “From Date” on the claim) for all West Region states. Due to the complexity of HHA pricing and the expected new billing requirements, we are taking this step to help providers avoid having to resubmit claims.  

TPS/PAR request letters
Upon direction from DHA, and as a courtesy during this initial year of implementation, we will mail letters to home health agencies in the four impacted West Region states who have previously submitted claims to us, requesting CY20 TPS and PAR reports. (Exception: If you have already submitted these to us, you will not get a letter.) If you receive a letter, please submit your reports to us as soon as possible using the “Upload a Document” feature online under secure tools or via postal mail or fax:

TRICARE West PDM Correspondence
PO Box 202106
Florence, SC 29502-2106
Fax: 844-730-1373. 

In future years, we will not mail TPS/PAR request letters. It will be the responsibility of HHAs in Arizona, Iowa, Nebraska, and Washington to submit these reports to us via the website or to the above PO Box or fax number by Dec. 1 each year in order to avoid financial penalty. Should this change, we will provide updated education.