KEANE CARE PRESS RELEASES AND ANNOUNCEMENTS

2009 SNF Medicare Rates Proposed

Press Release

CMS announced a 0.3 percent decrease in 2009 payment to SNFs on May 1. The proposed rates included a 03.1 percent market basket increase that was offset by a 03.3 percent reduction due to an error in forecasting use of new RUG groups created in 2006.

Volunteers Needed for Post-Acute Care Payment Reform Demonstration

Overview of the Initiative

CMS has been directed to develop a post-acute assessment tool to gather standardized data to evaluate the care that Medicare beneficiaries receive after being discharged from a hospital and how CMS pays for that care.

Providers in the study include acute care hospitals and providers that may treat patients after leaving the hospital, specifically skilled nursing, home health agencies, LTC hospitals, and inpatient rehabilitation facilities. Called the CARE (Continuity Assessment Record and Evaluation) Tool, it was tested during summer 2007 in five Chicago provider settings. A demonstration in Boston is underway.

This spring volunteers will be selected within a two-hour radius of the following cities: Dallas, TX; Lakeland/Tampa, FL; Lincoln, NE: Louisville, KY: Rapid City, SD; Rochester, NY: San Francisco/Bay Area, CA, and Seattle/Tacoma, WA. Data collection in those sites will continue through summer 2009, followed by an analysis phase. A report to Congress is due June 2011.

In response to a question at the SNF Open Door Forum of April 15, 2008 about whether the CARE tool will take the place of the MDS, a CMS official said that in the demonstration, volunteer sites will do both assessments. She said the goal is to have an integrated assessment instrument rather than providers in different settings completing different assessments.

If you would be interested in learning more about the demonstration or are interested in participating, contact Barbara Gage, Ph.D., Principal Investigator at RTI, by emailing PAT-COMMENTS@RTI.org.

No-Pay Billing Clarification

Medlearn Matters 5840

CMS has released Medlearn Matters MM5840 (link above) with clarification on when no-pay bills are required, including for beneficiaries covered by Medicare Advantage plans. The contents were included in Change Request memo 5840 released December 14, 2007.

Medicare Learning Catalog

Medicare Learning NetWork Catalog
Revised Spell of Illness Quick Reference Chart

CMS has posted a catalog of informational publications. Most materials can be downloaded from the online catalog by clicking on "downloadable" or on the publications title. (A link to catalog is above.) Examples of publications:

- Quick Reference for Billing Medicare for Immunizations
- Medicare Appeals Process
- Hospice Payment System Fact Sheet
- Implementation of the UB-O4
- SNF PPS Fact Sheet
- Web-based training courses such as SNF Consolidated Billing and Understanding the Remittance Advice
- A section of articles on the NPI
The Spell of Illness chart was recently revised and is available thru the link above.

National Provider Identifier Update

CMS NPI Website
Medlearn Matters SE0725

CMS announced a schedule for NPI implementation at the December 13 SNF Open Door Forum:

January 1, 2008 - all institutional claims (837I and UB-04) must use the NPI in the fields for billing and pay to. Bills without NPIs in those fields will be rejected, although outdated (legacy) identifiers may be used in addition to NPIs.

March 1, 2008 - Part B claims (837P and CMS-1500) must use the NPI (with or without an outdated identifier) in these fields: billing, pay to, and rendering provider.

May 23, 2008 - the contingency plan is lifted and no legacy identifiers may be used on HIPAA electronic transactions, paper claims, and remittance advice. This also includes all secondary provider fields on the 837P and 837I.

Medlearn Matters SE0725 covers how to correct rejected claims and common errors. Use the link above to read it.

MDS 3.0 Information Available

MDS 3.0 draft, introduction, and timeline released
Postings from Open Door Forum

At the special MDS 3.0 Open Door Forum on January 28, the project's lead researcher reported that testers of the revised assessment form found it took less time to complete and were positive overall.

Feedback from nurses who tested the draft:
- 85 percent rated MDS 3.0 as likely to help identify unrecognized problems
- 81 percent rated it more relevant than MDS 2.0
- 85 percent rated MDS 3.0 questions more clearly worded

Materials on the Open Door Forum Website include a draft form and the PowerPoint from the Forum (use link above).

Rehab Therapy Caps Exclusions Extended

Medlearn Matters 5871

The Medicare bill signed into Law by the President on December 31 extends the exclusions to the Therapy Caps through June 30, 2008. The cap for 2008 is $1810. See the Medlearn Matters article for more info (link above).

SNF Consolidated Billing training

CMS Web-based training courses

CMS' Web-based training course on SNF Consolidated Billing is available for download (use link above). It's under Medicare Payment Policy.

The course is free of charge and a test score of 70 percent or higher, is approved for 1 CEU by the American Academy of Professional Coders.

End of Survey Revisit Fees

Revisit User Fee Program Website

The 2008 appropriations act did not grant CMS the authority to continue charging fees for conducting revisit surveys of healthcare facilities cited for deficiencies on initial certification, recertification, or substantiated complaint surveys.

The program was established as part of the 2007 appropriations law and went into effect September 19, 2007. The fee assessed to SNFs for offsite revisit survey was $168 and $2072 for onsite surveys.

RAI Manual Revisions

January 2008 RAI Manual Revisions

CMS has released changes to the Resident Assessment Instrument Manual including clarifications of instructions for MDS 2.0 Sections I2j, I3, K2a, K3, L1e, M4, and M5. Use the link above to download the table of changes and replacement pages.

For updates to the MDS RAI Coordinators and/or RAI Automation Coordinators in CA, IA, MA, MO, NE, NV, NM, ND, PA, SD, TX, UT, WV, and WY download the full RAI User's Manual (zip 3.9 MG) and open Appendix B (use link above).

2008 Rates for Medicare Deductible and Coinsurance

Medlearn Matters MM5830

The Medicare Part A SNF Coinsurance rate for 2008 is $128 per day for each benefit period. The 2008 rate is effective January 1, 2008 and replaces the 2007 rate of $124.

The 2008 Medicare Part B Deductible rate is $135 a year and the coinsurance is 20 percent. For more information see Medlearn Matters MM5830 (link above).

Benefits Exhaust and No-Pay Billing, including for Medicare Advantage plans

Change Request 5840

CMS is including the following clarifications to Chapter 6, SNF Inpatient Part A Billing, of the claims processing manual, effective March 17, 2008.

CMS does not require SNF providers to submit no payment bills for non-skilled beneficiary admissions. No-pay bills are only required for beneficiaries who have previously received skilled care and subsequently dropped to non-skilled care and continue to reside in the Medicare-certified care of the SNP; and

No payment bills may span both Medicare and Provider's fiscal year-end dates; and

No payment bills are not required for beneficiaries who are in current Medicare Advantage (MA) plans and no longer require skilled care while still under the plan.

CR5840 includes clarification of more points concerning no-pay billing. Use the link above to read the full document.

Billing for Medicare Advantage (MA) Plans

Change Request 5653
Change Request 5513

CMS clarified billing rules for Medicare Advantage plans in CR 5653. Implementation of this change was recently delayed to March 3, 2008.

The document specifies that facilities must submit claims for beneficiaries enrolled in MA (Medicare Advantage) plans and receiving skilled care in order to take benefit days from the beneficiary and/or update the beneficiarys spell of illness information in Medicare Systems.

Submit the claim using bill type 18X or 21X and include a HIPPS code (use default code AAA00 if no assessment was done), room and board charges and condition code 04 (informational only bill).

Keane Care Clients please note that the RAM SP 10 release will contain programming for this change.

Also delayed to March 3, 2008, is implementation of the Timeliness Standards for Processing Other-Than-Clean Claims as outlined in Change Request 5513 (use link above).

Understanding the Remittance Advice

CMS guide

CMS has posted a resource guide for Medicare Providers on the Remittance Advice (RA). Topics include types of RAs, the purpse of the RA, and types of codes on the RA. Use the link above to download the pdf of the guide.

Clarification re: Ambulance Trip

Medlearn Matters SE0433

Regarding "trips for excluded outpatient services," CMS has clarified that the excusion from SNF consolidated billing applies to the entire ambulance roundtrip and not just the SNF-to-hospital portion. Use the link above to read the article.

NPI List Now Available

CMS National Provider Identifier Web page
NPI Registry

A list of provider NPIs (National Provider Identifier) is now available at the NPI Registry Website. At the Website you can search for individual or organization providers. The list shows providers' NPI, name, business address, taxonomy code, and for individuals, gender and license number. It will be updated monthly.

Full information on the NPI is posted on the CMS NPI page (use link above).

New Survey Rules for Paid Feeding Assistants and Accidents

Transmittal 26 - Paid Feeding Assistants
Transmittal 27- Accidents

Surveyor rules regarding Paid Feeding Assistants were released as a new tag, F373. The regulations are included in revisions to Appendix P and PP of the State Operating Manual. The new language is included in Transmittal 26 released August 17, 2007 (use the link above).

Revisions to surveyor guidance regarding accidents was released in Transmittal 27 (link above).

No-Pay Billing Clarification

MLN Matters 5583, Spell of Illness Chart

MM5583 clarifies the use of no-pay billing in certain situations, including when beneficiaries disenroll from Medicare Advantage plans. It also includes CMS' quick reference to assist with determining when Medicare No-Pay bills are required. Use the link above to download it.

Advance Beneficiary Notice - 2nd draft

CMS-R-131

CMS used the comments received on an earlier draft of the Advance Beneficiary Notice (ABN) of Noncoverage to prepare a revised version that is now available (use link above and click on CMS-R-131.)

Formerly, CMS maintained two versions of the ABN, a general and a laboratory specific. CMS is now proposing to combine the two into a single ABN meeting both needs. Other proposed changes are described in the website posting.

Medicare Payments Increase for 2008

CMS today announced that Medicare payments to nursing homes would increase by 3.3 percent for fiscal year 2008, beginning October 1, 2007. The special 128 percent adjustment for residents with HIV/AIDS will continue.

Broadband MDS Transmissions Coming

QTSO/QIES Website

Faster state connections are in the future for facilities due to broadband MDS submissions. AT&T will make broadband available starting in June 2007. Help with broadband connections will be scheduled by state, beginning in June and extending to the end of 2007. Facilities that do not need assistance from AT&T can connect any time after connections are available.

Information on the broadband submission is available at the QTSO/QIES Website (link above). Click on the "MDCN Information" box at top right.

Formerly known as Medicare Provider Number

Survey and Certifcation Letter 07-16

Effective immediately the Medicare/Medicaid Provider Number will be renamed the CMS Certification Number (CCN) to avoid confusion with the NPI (National Provider Identifier).

The CCN will be used in survey and assessment-related activities. The Medicare Provider Number was also known as the Online Survey, Certification, Reporting (OSCAR), Medicare Identification, and provider number.

As of May 23, 2007, the NPI will be the only acceptable provider identifier on HIPAA standard transactions for electronic claims and remittance advice.

Extension for CMS-1500

CMS Website on the 1500

CMS has extended the acceptance period of the Form CMS-1500-(12-90 version) beyond the original April 1, 2007 deadline because some of the new forms available are incorrectly formatted. The acceptance period of the older Form CMS-1500 is extended until the situation is resolved and contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease.

CMS' Website (link above) can help you identify which form is which.

Note to Keane Care Clients: RAM 2.5 sp5 contains the programming to submit the new CMS-1500.

Common Medicare Billing Errors

SE0712

CMS has compiled lists of common Medicare billing errors and billing tips that include background information and references. The document is MLN Matters SE0712 (use the link above).

RAI Manual Revisions - March 2007

RAI Manual update

CMS has posted a set of revisions to the RAI manual that are effective March 1, 2007. The manual is the official instruction book for completing MDS 2.0. This update changes MDS Section W to specify that a dash can be used for a "none of the above" answer in W2b and W3b. It also changes the definition of "Any Scheduled Toileting Plan" for H3a. Use the link above to download all the changes.

Revised Surveyor Guidance re: Unnecessary Medications and more

CMS Survey & Certification General Info page
Transmittal 22 / R22SOMA

Revised guidance for surveyors regarding Unnecessary Drugs, Pharmacy Services, Drug Regimen Review, and Labeling and Storage of Drugs and Biologicals will be effective December 18, 2006.

CMS released revisions to Appendix P and PP in Transmittal 22 dated December 15, 2006, with changes to tags and revisions to all interpretive guidelines for some tags. (Use link above for the 611 page document).

Quality Measures for Immunizations

User's Manual Supplement
Nursing Home Compare Website

The immunization Quality Measures (QM) are now reported on CMS' Nursing Home Compare Website. There are two separate QMs, one for influenza and one for pneumococcal vaccination and are calculated from October 1 thru March 31. The two are shown separately by patient population: Chronic Care and Post-Acute (short stay). The QMs are calculated as a percentage of residents receiving vaccination using MDS Section W data.

Residents who have received the vaccine in or outside the facility (W2a=1 or W2b=2) are included. Residents are excluded from the denominator if they are not in the facility, not eligible, declined, or the facility was unable to obtain the vaccine.

Residents are included in the pneumococcal QM percentage when they have an up-to-date vaccination (W3a =1), residents are excluded if not eligible or declined the vaccination. Complete information on the new QMs is posted in a User's Manual Supplement (link above).

New Fiscal Intermediary Contract Awarded

Press release
Medlearn Matters 0642

The first award for a new Medicare Administrative Contractor (MAC) was made to Noridian Administrative Services (NAS). Beginning no later than March 2007 NAS will serve as the first point of contact for processing and payment of Medicare A/B claims for providers in the states of AZ, MT, ND, SD, UT, and WY.

Contracts for MACs will replace current fiscal intermediary contracts nationwide on a schedule extending to October 2011. Key objectives for MACs are enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and cost savings resulting from efficiencies and innovation.

More MAC contracts will be awarded on the following schedule: J4 - CO, OK, NM, TX J5 - IW, KS, MO, NE J12 - DE, DC, MD, NJ, PA J1 - CA, HI, NV J2 - AK, ID, OR, WA J7 - AR, LA, MS J13 - CT, NY

Nursing Home Clinical Standards & STRIVE time studies

Sharing Innovations in Quality
STRIVE time study project

As referenced in the Open Door Forum call of July 18, clinical standards and guidelines useful to surveyors and to professionals in the nursing home setting are now posted on the Sharing Innovations in Quality Website (use link above).

The STRIVE project is underway and will be extended into other states between now and January 2008. For full information on this time study intended to update the Medicare PPS program, use the link above to the QIES Website and click on STRIVE in the left nav bar.

Paid Feeding Assistant Regulations

Transmittal 19 - CMS Manual System

The State Operations Manual, 483.35(h), states that a facility may use a paid feeding assistant if the feeding assistant has completed a state-approved training course, and the use of feeding assistants is consistent with state law.

Feeding assistants must work under the supervision of an RN or LPN. In an emergency they must call a supervisory nurse for help.

Residents selected for this assistance must not have complicated feeding problems such as difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings. Selection must also be based on the charge nurse's assessment and the resident's latest care plan.

Immunizations: Regulatory language

Transmittal 19 - CMS Manual System

As stated in 483.25(n), LTC facilities must develop policies and procedures that ensure that each resident is educated about the benefits and side effects, offer influenza immunization annually (between October 1 and March 31), as well as lifetime immunization against pneumococcal disease, unless medically contraindicated or refused. An exception is that a second pneumococcal immunization may be given after 5 years.

The rule also requires that facilities document:

• That the resident or representative was provided education
• Whether the resident received the immunizations or did not, due to medical contraindications or refusal

Posting Nurse Staffing F tag

Transmittal 19 - CMS Manual System

The update to Appendix PP of the State Operations Manual regarding LTC facilities contains information on the F356 tag regarding posting nursing staffing information. It also includes regulatory language on Paid Feeding Assistance and Immunizations (Influenza and Pneumococcal). (See the next items)

A format wasn't specified for posting staffing information, only that it be clear/readable and posted in a prominent place. The posting must be daily at the beginning of each shift and include:

• facility name
• current date
• total number and actual hours worked by these staff directly responsible for resident care per shift: RNs, LPN or Licensed vocational nurses, and Certified nurse aides
• resident census

The data must be maintained for a minimum of 18 months, or as required by State law, whichever is greater. For the full language use the link above.

SNF Consolidated Billing Website

SNF Consolidated Billing Website
Medlearn Matters MM4297

CMS' Website on Consolidated Billing for payment of SNFs for Medicare Part A beneficiaries includes frequently asked questions and related links. Medlearn Matters MM4297 outlines the contents. Reach them with the links above.