American Health Information Management Association (AHIMA) Certification Practice Exam

Which classification system is used for reimbursing home health agencies?

1. MS-DRGs

2. RUGs

3. HHRGs

4. APCs

The correct answer is: HHRGs

Home health agencies use the Home Health Resource Groups (HHRGs) classification system for reimbursement. This system is specifically designed to assign payment levels based on the patient's needs and the services required in a home health setting. The HHRG system incorporates various factors including clinical characteristics and service needs, ensuring that agencies receive appropriate compensation for the care they provide. HHRGs are part of the Patient-Driven Grouping Model (PDGM), which revised how Medicare pays for home health services by focusing on patient characteristics rather than the volume of services rendered. This shift emphasizes the importance of patient-centered care and streamlines payment processes for home health agencies, adjusting reimbursement rates to reflect the complexity of care required. In contrast, the other classification systems mentioned serve different healthcare environments. MS-DRGs (Medicare Severity Diagnosis Related Groups) are used primarily for inpatient hospital reimbursement, RUGs (Resource Utilization Groups) are associated with skilled nursing facilities, and APCs (Ambulatory Payment Classifications) apply to outpatient services. Each of these systems targets specific settings and care modalities, highlighting the unique role that HHRGs play in home health reimbursement.