Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, August 17, 2015

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Revisions to State Operations Manual (SOM) Chapter 2, The Certification Process and Appendix W, Survey Protocol, Regulations and Interpretive Guidelines for Critical Access Hospitals (CAH) and Swing-Beds in CAHs
On July 31, CMS released a change request making revisions to portions of Chapter 2, section 2256 and Appendix W to reflect the revised regulation at 42 CFR 485.610(b)(5), concerning loss of rural status due to adoption of the latest Office of Management and Budget metropolitan statistical area delineations. Additional revisions are needed to clarify existing guidance related to requirements concerning CAH location requirements relative to other CAHs or hospitals.
 
Effective date: July 31, 2015
Implementation date: July 31, 2015

View Transmittal R143SOMA.

Procedures for processing under tolerance Part a 935, Part A-Other, Part A and B Healthcare Professional Shortage Area (HPSA), and Part A-Provider Recovery Audit Contractor (RAC) identified debts in the Healthcare Integrated General Ledger Accounting System (HIGLAS)
On July 31, CMS released a change request will provide instructions for the HIGLAS to automate the current manual process to manually process and aggregate Part A 935 under tolerance debts.

Effective date: March 1, 2016
Implementation date: April 4, 2016

View Transmittal R1523OTN.

Provider Reimbursement Manual
-Part 2, Provider Cost Reporting Forms and Instructions, Chapter 43, Form CMS-1984-14
On July 31, CMS released a transmittal updates Chapter 43, Hospice Cost Report, (Form CMS-1984-14) to clarify and correct the cost reporting forms and instructions.

Electronic specification effective date: The electronic reporting specifications are effective for cost reporting periods beginning on or after October 1, 2014.

View Transmittal R2P243.

Quarterly Listing of Program Issuances-April through June 2015
On August 3, CMS posted a quarterly notice in the Federal Register providing only the specific updates that have occurred in the three-month period from April through June 2015 along with a hyperlink to the full listing that is available on the CMS website or the appropriate data registries that are used as resources.

View the notice in the Federal Register.

Advisory Panel on Hospital Outpatient Payment agend
a
On August 3, CMS posted the agenda for the August 24 meeting of the Advisory Panel on Hospital Outpatient Payment.

View the agenda.

PPS and consolidated billing for SNFs for FY 2016, SNF Value-Based Purchasing (VBP) Program, SNF Quality Reporting program, and staffing data collection
On August 4, CMS posted a final rule in the Federal Register updating the payment rates used under the PPS for SNFs for FY 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF VBP Program. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The provisions of this final rule are effective on October 1, 2015 with the exception of provisions in § 483.75(u) which are effective on July 1, 2016.

View the rule in the Federal Register.

Correction to CY 2016 Home Health PPS rate update
On August 4, CMS posted a correction in the Federal Register correcting technical errors in the proposed rule that appeared in the July 10, 2015 Federal Register, ‘‘Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements.’’ Comments on this proposed rule published continue to be accepted until September 4, 2015.

View the notice in the Federal Register.
Leave a comment.

Inpatient psychiatric facilities (IPF) PPS-Update for FY beginning October 1, 2015 (FY 2016)
On August 5, CMS posted a final rule in the Federal Register updating the PPS rates for Medicare inpatient hospital services provided by IPFs (freestanding IPFs and psychiatric units of an acute care hospital or critical access hospital). These changes are applicable to IPF discharges occurring during FY 2016 (i.e., October 1, 2015 through September 30, 2016). This final rule also implements new quality measures and reporting requirements under the IPF quality reporting program. This final rule also reminds IPFs of the October 1, 2015 implementation of the ICD–10–CM, and updates providers on the status of IPF PPS refinements.

View the final rule in the Federal Register.
View the fact sheet.

Inpatient rehabilitation facility (IRF) PPS for FY 2016
On August 6, CMS posted a final rule in the Federal Register updating the prospective payment rates for inpatient IRFs for FY 2016 as required by the statute. This final rule also finalizes policy changes, including the adoption of an IRF-specific market basket that reflects the cost structures of only IRF providers, a one-year phase-in of the revised wage index changes, a three-year phase-out of the rural adjustment for certain IRFs, and revisions and updates to the quality reporting program. This rule is effective October 1, 2015.

View the final rule in the Federal Register.
View the fact sheet.

FY 2016 hospice wage index and payment rate update, and quality reporting requirements
On August 6, CMS posted a final rule in the Federal Register updating the hospice payment rates and the wage index for FY 2016 (October 1, 2015 through September 30, 2016), including implementing the last year of the phase-out of the wage index budget neutrality adjustment factor (BNAF). Effective on January 1, 2016, this rule also finalizes CMS’ proposals to differentiate payments for routine home care based on the beneficiary’s length of stay and implement a service intensity add-on (SIA) payment for services provided in the last seven days of a beneficiary’s life, if certain criteria are met.

View the final rule in the Federal Register.
View the fact sheet.

Medicare contractors' payments to providers for hospital outpatient dental services in Kentucky and Ohio did not comply with Medicare requirements
On August 6, the OIG posted a report stating that Medicare contractor payments to providers in Jurisdiction 15 (Kentucky and Ohio) for hospital outpatient dental services did not comply with Medicare requirements. Of the 100 dental services in the stratified random sample, 97 did not comply with Medicare requirements. Using the sample results, OIG estimated that Medicare contractors improperly paid providers at least $1.7 million for dental services provided during the period January 1, 2011, through December 31, 2013.

View the report.

Medicare Compliance Review of Mary Hitchcock Memorial Hospital for 2009 through 2012
On August 6, the OIG posted a report stating Mary Hitchcock Memorial Hospital complied with Medicare billing requirements for 190 of the 445 inpatient and outpatient services reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 255 services, resulting in net overpayments of $771,000. These errors occurred primarily because the hospital did not have adequate controls to prevent the incorrect billing of Medicare services within the selected risk areas that contained errors. On the basis of the statistical and judgmental sample results, OIG estimated that the hospital received net overpayments of at least $1.4 million.

View the report.

Membership and meeting announcement for the Advisory Panel on Clinical Diagnostic Laboratory Tests
On August 7, CMS posted a notice in the Federal Register announcing 15 membership appointments to the Advisory Panel on Clinical Diagnostic Laboratory Tests (the Panel). The purpose of the Panel is to advise on issues related to clinical diagnostic laboratory tests. The membership appointments are for three years. This notice also announces the first meeting date of the Panel on Wednesday, August 26, 2015.

View the notice in the Federal Register.
Register for the meeting.



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