|
|
 |
Hot Off the Press!
from Keane Care
Keane Care brings you the latest news on Long-Term Care regulatory developments and what they mean to you, including HIPAA, MDS, and more.
July 27, 2010
Exclusions from Part A Consolidated Billing
CMS has released a refresher on SNF Part A Consolidated Billing. SNFs are responsible for including on the Part A bill that it submits to its Medicare intermediary almost all of the services that a resident receives duing a Medicare-covered stay except for a small number of expensive services. The article (link below) lists thsoe services with background information. July 23, 2010
FY 2011 Medicare Part A SNF Payment
CMS has published a notice of SNF Medicare Part A Prospective Payment rates for FY 2011 that includes a market basket increase of 1.7 percent. The daily payment amounts for each RUG group are also included. Two sets of rates are given--one calculated with the RUG-IV grouper and one with the Hybrid RUG-III grouper. RUG-IV rates will be paid beginning October 1, 2010 and continue until the Hybrid grouper software is available. At that time CMS will begin using the Hybrid software and re-process claims submitted since October 1, 2010. The hybrid grouper software will be used until October 1, 2011 when RUG-IV is officially implemented. July 22, 2010
Survey Process Changes to be Announced
At the Open Door Forum of June 22, CMS officials announced that a Survey and Certification letter will be released later this month outlining new survey guidelines that are not driven by Quality Measures. The Quality Measures currently used are calculated for MDS 2.0 data. Although officials didn't announce when the MDS 3.0 Quality Measures would be available for surveys. The QMs are scheduled for use on the Nursing Home Compare Website in April/May 2012. CMS-672/802 forms Officials reported that they will be releasing a mock-up of the new 672/802 forms next week that will show changes due to MDS 3.0. The CMS-672/802 forms are requested by surveyors when they arrive onsite and are completed using MDS data. CMS announced that they are working on a crosswalk that shows how the items in the 672/802 forms are calculated. Keane Care will add the 672/802 forms to our MDS 3.0 software after the crosswalk is available.
July 13, 2010
MDS 3.0 RAI Manual Revisions and Training Materials
CMS; MDS 3.0 Training Materials Website now includes: MDS 3.0 RAI Manual revisions, including instructions for all the MDS 3.0 sections in Chapter 3. Most of the changes are minor and involve wording clarifications. Changes to the instructions for Section I may be the most significant, since they include changes in look-back periods. MDS 3.0 Training Slides V1.00 July 12, 2010 - The slides were used at CMS' in-person training sessions and are available in PowerPoint or PDF for each MDS 3.0 section. Also revised are Chapters 1 and 2, Appendices B, C, D, E and G MDS 3.0 Instructor Guides V1.00 July 12, 2010 - Use these guides if you are conducting training using CMS' training slides. The guides outline a narrative to accompany the slides including objectives, intent, importance, and how to conduct an assessment. Guides are available to facilitate MDS 3.0 training on Chapter 3, all MDS 3.0 sections. Video on Interviewing Vulnerable Elders June 14, 2010 (temporarily pulled from Website MDS 3.0 ADL Flowchart V1.02 June 14, 2010 - An updated version of the ADL Decision Flowchart Download all at CMS' new MDS 3.0 Training Materials Webiste (link below). The second MDS National Train-the-Trainer Conference is scheduled for August 9-13, 2010 at the Las Vegas Hilton in Las Vegas, NV. Registration has closed.
June 24, 2010
ICD-10 Facts
The next big date to add to your regulatory to-do list: October 1, 2013 and the change from ICD-9-CM to ICD-10 for diagnosis coding. ICD-10 facts are outlined in MedLearn Matters SE1019 (link below) and summarized here:
The MedLearn Matters article includes examples of how ICD codes are changing. More information about ICD-10 is posted on CMS' Website (link below).
MLN Matters Special Edition Article #SE1019
June 17, 2010
Clarification of Use of ABN/Denal Letters
CMS has clarified that SNFs may use either the Skilled Nursing Facility Advance Beneficiary Notice or Notices of Noncoverage (Denial Letters) for items and services expected to be denied under Medicare Part A. Use the link below to read the article. May 7, 2010
Update on MDS 3.0 and RUG-IV
CMS has reached a decision about how to implement the one-year delay for RUG-IV. MDS 3.0 will be implemented October 1, 2010 as scheduled. The Healthcare Reform Act (Patient Protection and Affordable Care Act - PPAC) delayed the implementation of RUG-IV for one year, except for the MDS 3.0 items on concurrent therapy and look-backs for special treatments in MDS 3.0 Section O. CMS officials at the May 3-4 AANAC conference said they have decided to pay claims using the RUG-IV Grouper after October 1, 2010 until they have created the new hybrid RUG-III Grouper. Once this new grouper is available the MACs and FIs will automatically reprocess the claims using the new RUG III hybrid Grouper. In response to a question, CMS officials said the delay of RUG-IV should not affect state Medicaid payment.
Other announcements included: April 27, 2010
Removal of Value Codes for Therapy Billing - Oct. 1, 2010
CMS advises that the requirement has been removed for providers to report the total number of therapy visits using these value codes: 50 for physicial therapy, 51 for occupational therapy, 52 for speech therapy, and 53 for cardiac rehab. Effective October 1, 2010, providers are no longer required to submit any of the value codes when billing for therapy services. April 13, 2010
CMS Posts MDS 3.0 Q&A
CMS has posted questions and answers from its March 2010 training sessions in Baltimore. Many of the answers refer to the RAI manual. Several questions were about the timing of the Assessment Reference Date. April 2, 2010
Medicare Bills Must be Submitted within a Year
The law signed March 23, 2010 aimed at curbing fraud, waste, and abuse in the Medicare program calls for Medicare claims to be submitted within one calendar year after the date of service. Claims with dates of service prior to October 1, 2009 must follow the earlier rules. Claims with dates of service October 1, 2009, thru December 31, 2009, must be submitted by December 31, 2010.
March 31, 2010
Healthcare Reform and RUG-IV & Therapy Caps
The Healthcare Reform bill includes two important changes for LTC according to the National Association for the Support of Long Term Care:
March 12, 2010
Five Star Rating System -- Update re MDS 3.0
CMS' Five Star Rating system awards all SNFs with an overall rating of 1 thru 5 stars on its Nursing Home Compare Website (link below). The ratings were calculated using survey data, staffing information, and Quality Measures. In response to a question at the March 11, 2010 SNF Open Door Forum, CMS officials announced that the Quality Measures system will "close" in September due to MDS 3.0 implementation. A year of data will be collected before the Quality Measures are recalculated and released. The officials didn't have an answer for a question about the impact of that on the Five Star system. Nursing Home Compare is generally updated on the 3rd Thursday of the month. CMS will post preview reports for providers that they can access from their MDS State Welcome pages. To access the previews, select the CASPER Reporting link located at the bottom of the login page. Then click on the Folders button and access the report in your "st LTC facid" folder. A help desk will be available for that week at 1-800-839-9290; open from 9 to 5 EST. The help desk will close for the quarter on July 30, 2009.
Nursing Home Compare Website
March 4, 2010
Good News re Therapy Caps
The Therapy Cap Exclusions were extended to March 31, 2010, retroactive to January 1, 2010 as part of the healthcare legislation signed today. The exceptions process exempts most beneficiaries in LTC settings from the caps. A message from CMS on March 4, states that "some therapy providers have been holding claims for services furnished on or after January 1, 2010, for patients who exceeded the cap but qualified for an exception under previous law. These providers may submit those claims to Medicare effective immediately. "Therapy providers, who submitted claims which were denied, for services furnished on or after January 1, 2010, for patients who exceeded the cap but whose services now qualify for an exception, should contact their Medicare contractor to request that their claim be adjusted to add the KX modifier and ensure the appropriate exception applies." The amount of the caps for outpatient therapy under Medicare Part B for calendar year 2010 is $1860. The caps are $1860 per year for physical therapy and speech language pathology combined and $1860 for occupational therapy services.
February 10, 2010
CMS MDS 3.0 Training
CMS is holding two training conferences on MDS 3.0. One is for state RAI Coordinators and surveyor representatives on March 15-19. The other is a Train-the-Trainer conference for people responsible for training others on MDS coding on April 13-15 in Baltimore. Attendees will be selected from those who register. Registration opens February 22 and information on how to register will be posted then (use the link below). CMS will be sharing video and print files of conference presentations after the April conference. January 28, 2010
Full MDS 3.0 RAI Manual now available
CMS posted the remaining chapters of the MDS 3.0 RAI Manual today. Chapter 2 addresses timing and scheduling of MDS assessments. Chapter 4 includes information about the Care Area Assessment (CAA) process, Care Area Triggers (CATS, formerly RAPS), and the process for care plan development. Appendix C includes resources that SNFs may choose to use in assessing care areas triggered by MDS 3.0 assessment responses. Download the documents from the Website link below. Our free MDS 3.0 white paper is a good summary of the changes between MDS 2.0 and 3.0. Download it with link below.
CMS MDS 3.0 Website
December 3, 2009
F441 Tag Guidelines Revised - Infection Control
Transmittal 55 was released December 2, 2009 to replace Transmittal 54 that revised the guidelines for Tag F441 on Infection Control. Use the link below to read the revised guidelines. October 3, 2009
MDS 3.0 specifications released
CMS has released specifications for MDS 3.0 including the assessment forms, the new start-of-therapy OMRA, and a document that identifies the items required for each type of assessment and the QIs, QMs, CATs, RUG-IV, and RUG-III. Use the link below. The publishing of the RAI manual has been delayed to November for chapters 1, 2, 3, 5, and 6. Chapter 4, with the Care Area Assessments, will be posted in December 2009.
September 17, 2009
RUG-IV System Summarized
RUG-IV is scheduled to arrive with MDS 3.0 in October 2010. Based on the STRIVE time study, CMS has changed the RUG system for Medicare Part A payment to SNFs to adjust for changes in incentives, patient population, and industry practices since RUG-III was implemented. CMS states in the Final Rule of July 31, 2009 that it will continue to pay the same total amount, but the amount paid per RUG will shift. Under RUG-IV many fewer patients will qualify for Rehab Plus Extensive Services RUGs, the highest-paid category. To compensate for fewer dollars paid through those RUGs, the Final Rule states that CMS will pay significantly more for the complex medical groups, including Extensive Care, Special Care, and Clinically Complex. For a summary of the changes to the RUG categories and how patients qualify for them, see the Keane Care White Paper (link below). September 16, 2009
5010 Format for Medicare Payment/Advice
CMS has announced a new HIPAA electronic transaction format for Medicare payment, 835 version 5010. The format will have a long transition period: starting in March 2009 and continuing until the January 1, 2012 compliance date. Keane Care clients please note that we have scheduled development of the 5010 format so our clients can be ready to test when CMS is, or shortly thereafter. For more on the new format, see the Medlearn Matters (link below). September 10, 2009
MDS Coding for Flu Vaccine
CMS has announced that the MDS for the 2009-2010 flu season should be coded only for Seasonal Influenza vaccine -- not for the H1N1 vaccine. CMS recommends that SNFs frequently check the CDC Influenza Website (link below) for the most up-to-date and accurate information. August 27, 2009
MIP Joins RAC -- Medicaid and Medicare Audits
The Medicare Recovery Audit Contractor program is charged to look for Medicare over and under-payment to providers. It is a permanent program that went into effect March 1, 2009 following a demonstration in CA, FL, NY, MA, SC, and AZ that resulted in over $900 million in overpayments being returned to the Medicare Trust Fund and nearly $38 million in underpayments returned to healthcare providers. For full information visit CMS' RAC Website (link below). The Medicaid Integrity Group at CMS has launched a preliminary Program, MIP, using the Medicaid claims data it receives for research. The program is conducting audits in 17 states now and will be operational nationwide by December 31, 2009. MIP issues final audit reports to states and it is the states' responsibility to initiate action as necessary. Use the link below to CMS' Website.
CMS' Medicaid Integrity Program Website
August 25, 2009
Reporting HIPAA Breaches
As part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the 2009 Recovery Act, DHHS has issued an interim final rule that requires HIPAA-covered healthcare providers to notify affected individuals and the DHHS Secretary of a breach of protected health information. In some cases, covered entities must notify the media. If business associates breach security, they must notify the covered entity. Comments are requested on the rule that can be read using the link below. August 20, 2009
SNF PPS Fact Sheet
CMS has prepared a fact sheet reviewing how the SNF Medicare Prospective Payment System works, including covered and non-covered services. Use the link below to download it. July 31, 2009
FY 2010 Medicare Part A Payment Rates Finalized
The Final Rule on SNF Medicare Payment for FY 2010 did not change the rate proposed in the Rule published in May 2009. The Rules review how the RUG-III system was refined in 2006 to a 53-RUG system that included higher-paying RUGs for residents receiving therapy plus extensive services. Actual utilization of that system has resulted in higher Medicare payments than projected. To maintain a budget-neutral system CMS will readjust the case-mix weights, resulting in a $1.05 billion (3.3 percent) reduction in payment to SNFs. This reduction, when combined with a 2.2 percent increase in the "market basket" rate, results in an overall 1.1 percent reduction in Medicare payment to SNFs for FY 2010, beginning October 2009. Use the link below to read the Final Rule. July 9, 2009
ICD-10 Myths & Facts
CMS addresses urban legends that are spreading about ICD-10 codes in a fact sheet (link below). One myth is that the October 1, 2013 compliance date should be considered flexible. In response, CMS states that all providers MUST implement ICD-10 on October 1, 2013. June 24, 2009
Changes to Survey Guidance re: Homelike Environment
CMS has revised the Guidance for Surveyors to recommend more focus on creating a "homelike environment" for LTC residents, such as 24-hour access for visitors. It also includes more examples of how to ensure residents' dignity and privacy. Regulatory language is unchanged. Use the link below to read the transmittal. May 1, 2009
LTC Pay for Performance
CMS accepted applications from LTC facilities in Arizona, Mississippi, New York, and Wisconsin that want to participate in the Nursing Home Value-Based Purchasing Demonstration through May 1. The demonstration will run from July 1, 2009 through June 30, 2012. Performance payments will be based on nurse staffing, avoidable hospitalizations, MDS outcomes, and survey deficiencies. Whether payments are made depends on whether the demonstration produces savings for Medicare. More information on the project is posted at the CMS Website (link below). April 22, 2009
New MDS 3.0 Timeline Posted
CMS has posted a new version of its MDS 3.0 Implementation Timeline (link above). The next MDS 3.0 deadline is October 2009 when CMS will publish final MDS 3.0 data specs (RUGs, RAPs, and QM/QIs), data elements (Admission, Quarterly and Discharge MDS forms), and an RAI manual. Train-the-trainer education forums are scheduled for February/March 2010 and October 1, 2010 is implementation of MDS 3.0 including data collection and Medicare PPS payment. April 14, 2009
Care Transitions Project study hospital readmissions
CMS has chosen 14 communities for the Care Transitions Project, a pilot program to reduce hospital readmissions by promoting seamless transitions from the hospital to home, skilled nursing care, or home health care. CMS is taking a local approach, watching hospital return rates and comparing them to CMS' historical rates. Each project is led by their state Quality Improvement Organization (QIO) and will implement system-wide interventions as well as target specific diseases and specific reasons for admission. Use the link below to see the 14 locations. March 12, 2009
ABN Forms and Therapy Caps
As of March 1, 2009, SNFs must use the revised ABN (FORM CMS-R-131) (Advance Beneficiary Notice of Noncoverage) for items/services expected to be denied under Medicare Part B only. CMS issued a revised MedLearn Matters article on therapy caps on March 10, 2009 to clarify ABN language. It states that "Since therapy that exceeds the cap is statutorily excluded from Medicare coverage, the ABN is not required." However, the ABN may be used voluntarily to inform beneficiaries of potential financial liability. (Link below.) During the Open Door Forum call officials reported that an ABN is not needed if a SNF is terminating therapy services because the beneficiary's goals were met. Instead, a Notice of Provider Noncoverage (Form CMS 1-123) should be used. Use the link below for full information. March 6, 2009
MDS 3.0 Postponed
CMS officially announced that implementation of MDS 3.0 is postponed to October 2010. They are currently working to revise the MDS 3.0 timeline and announced that the data specs that were due for release in March 2009 will be released in October 2009. In response to comments received about training, CMS officials pointed out that all the documents posted on their Website (link above) are draft. Looking for a Cliffs Notes version of the draft MDS 3.0? Keane Care has prepared a paper summarizing the MDS 3.0 Final Report from Rand. It describes the changes made in each section, the reasons, and how they did in testing. Open it with the link below.
March 5, 2009
Revised Survey Guidance on Pain effective 3/31/09
Revised guidance for LTC surveyors, including of Pain Management was released as part of Appendix PP of the State Operations Manual in January 2009. The protocols are effective March 31, 2009. The advance copy of this guidance and training materials are to be used to train surveyors. They can be downloaded with the link below. February 20, 2009
Stimulus Law and Long-Term Care
The Stimulus bill increases Medicaid funding for 27 months beginning 10/1/08 through 12/31/10, with an 6.5 percent across-the-board increase to all states for their federal match. An additional bonus structure is funded based on the state's unemployment rate. States that qualify for this increased funding would have to comply with prompt-pay requirements (90 percent of providers' claims must be paid within 30 days of receipt).
Health Information Technology (HIT) Stimulus Funding:
Standards
Loans for LTC to Buy HIT The interest rate shall not exceed the market interest rate and the loan must be fully amortized not later than 10 years after it is awarded. February 16, 2009
RAI Manual Revisions - December 2008
CMS released changes to the RAI Manual effective January 1, 2009, including changes to these pages: 2-27 and 2-37 - clarify that facilities may not be paid even the default rate, for a beneficiary who dies or is discharged shortly after admission if an MDS is not submitted. 2-39 - clarify that early or late assessments with an ARD prior to the discharge date will be paid at the default rate. 3-136 - address UTI coding and the attending physician's involvement. 3-177 and 3-182 regarding Section O-Medications - if information on IV medication additive is not available, do not count in O1 and code P1ac with a dash. 3-215 and 3-216 (MDS Section T1b and c) - language was added about the initial evaluation. The document updated contact information for MDS RAI Coordinators in AK, KS, MN, and PA. And for Automation Coordinators in AK, MN, and OR. February 11, 2009
New HIPAA Privacy Website
The DHHS Office of Civil Rights is charged with enforcing HIPAA Privacy rules. Their new Website includes pages for consumers and pages for providers on the Privacy Rule, Enforcement Rule, Emergecncy Preparedness, and more. Use the link below to reach it. February 9, 2009
Understanding the Remittance Advice
CMS has released a 188-page reference document to help providers understand the Remittance Advice (RA), its uses, and how to interpret RA fields and codes. Download it from the Medicare Learning Network with the link below. February 6, 2009
SNF Web-Based Training Updated
The Web-based training module on SNF consolidated billing and "arrangement agreements" between SNFs and other providers or suppliers was updated October 2008 and can be downloaded from CMS' Medicare Learning Network Website (use link above). Scroll down to the "Related Links Insider CMS" and select "Web-Based Training Modules." January 21, 2009
Final Rules: ICD-10 and Version 5010
The Final Rule on the adoption of the ICD-10 code set for diagnoses was released January 16, 2009. It sets a compliance date of October 1, 2013 for adoption of ICD-10, replacing the ICD-9 code set. Also published was the Final Rule for Version 5010 of the standard for electronic health care transactions, including claims and remittance, that will replace the 4010 standard on January 1, 2012. The 5010 standard will support ICD-10 codes. The HHS press release of January 15, 2009 (use link above) states that ICD-10 and 5010 will facilitate the United States' ongoing transition to an electronic health care environment. It gives an overview of the reasons for moving to the ICD-10 code set, including greater specificity, better support for quality data, more accurate payment, and comparison of US data to international data since most countries use ICD-10. The release also gives details of the benefits of ICD-10. CMS' ICD-10 Fact Sheet is available at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2008.pdf January 15, 2009
Therapy Caps in 2009
The 2009 Therapy Cap limits are $1840 for PT and SLP combined and $1840 for OT, increased from $1810 in 2008. Therapy caps, with the Exceptions process, are in place through December 31, 2009.
December 24, 2008
HIPAA Privacy Fact Sheets
To clarify how the HIPAA Privacy Rule works with a providers' policies and procedures and to help providers update their policies for exchange of electronic health information, the Office of Civil Rights has released a series of fact sheets that give an overview and frequently asked questions. The topics are Correction, Openness and Transparency, Individual Choice, Collection/ Use/Disclosure Limitation, Safeguards, and Accountability. Use the link below to download them. November 13, 2008
When your FI/Carrier Becomes a MAC
"Preparing for a transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) is the title of Medlearn Matters SE0837. It contains detailed recommendations for making a smooth move to a MAC for facilities that haven't already done so. Use the link above to download it. September 22, 2008
2009 Medicare Coinsurance Rates
CMS reports no increase in the 2009 Part B premiums and a rate increase for Part A Coinsurance. Part A SNF Coinsurance rate for 2009 is $133.50 per day, effective January 1, 2009, up from $128. The daily rate is paid for the 21st thru 100th day in a SNF. The Medicare Part B Deductible rate of $135 will continue for 2009 and the 2009 Part B premium rate of $96.40 also will not increase. See the CMS press release for full information (link is above). MDS 2.0 Section W Active Again
MDS Section W2 is active between October 1 and June 30. The coding for W2 has not changed, although the July 2008 RAI Manual update now states that "the current influenza (flu) season begins when this season's flu vaccine is made available to the public." August 13, 2008
MDS Tip Sheets
CMS has posted two MDS Tip Sheets to its MDS 2.0 Website that are intended to clarify MDS coding rationale. So far Tip Sheets are posted for Items K2a/K2b, Height and Weight; and Item H3a, Any Scheduled Toileting Plan. Download them from the above link, scroll down to 2008 MDS Tip Sheets. July 31, 2008
Increase in Medicare Funding for 2009
Medicare payment rates to SNFs will increase by 3.4 percent for 2009 rather than the 0.3 percent increase proposed in May. The increase is due to a 3.4 percent market basket increase that previously was offset by an error in forecasting. Recalibration for the error has been postponed. July 15, 2008
Rehab Therapy Caps Exclusions Restored
The Senate and House of Representatives have overridden the President's veto of the Medicare bill and so restored the exclusions to the therapy caps to December 31, 2009. The exclusions to the Medicare therapy caps for Part B therapy mean that caps do not apply to most nursing home residents for payment under Medicare Part B. CMS had earlier indicated that claims would be held for 10 days beginning Tuesday, July 1, 2008. It is expected that CMS will begin processing claims for services provided on or after July 1 (the date the exclusions were set to expire). Read about the exclusion process in Medlearn Matters SE0826 (use link above). Instructions regarding processing effected claims using VistaKEANE and Keane NetSolutions RAM are available in the RAM Insider blog (password required). Use link above. June 18, 2008
CMS' New Five-Star Rating Program
CMS has announced that a five-star rating system for nursing homes will be available in December 2008 at CMS' Nursing Home Compare Website. Details of the system are expected to be shared at CMS' SNF Open Door Forum of June 24. To read the press release use the link above. May 23, 2008
New MDS Tip Sheet: Toileting Plan
CMS recently released its latest MDS Tip Sheet, on Toileting Plans. Download it, along with others on MDS Sections K5a, G, P7, P8, P1b, and M5c using the link above. National Provider Identifier Deadline Here
The final deadline is here: NPIs must be used in all provider identifier fields for all HIPAA electronic transactions (claims and remittance) and paper claims. Claims will be rejected that include a Medicare legacy identifier in any provider field. Medlearn Matters SE0725 covers how to correct rejected claims and common errors. Use the link above to read it. May 2, 2008
2009 SNF Medicare Rates Proposed
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. April 15, 2008
Volunteers Needed for Post-Acute Care Payment Reform Demonstration
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. April 14, 2008
Care Transitions Project study hospital readmissions
CMS has chosen 14 communities for a pilot program to reduce hospital readmissions by promoting seamless transitions from the hospital to home, skilled nursing care, or home health care. CMS is taking a local approach, watching hospital return rates and comparing them to CMS' historical rates. Each project is led by their state Quality Improvement Organization (QIO) and will implement system-wide interventions as well as target specific diseaes and specific reasons for admission. Use the link above to see the 14 locations. March 17, 2008
No-Pay Billing Clarification
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. January 28, 2008
MDS 3.0 Information Available
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: Materials on the Open Door Forum Website include a draft form and the PowerPoint from the Forum (use link above).
MDS 3.0 draft, introduction, and timeline released
January 15, 2008
SNF Consolidated Billing training
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. January 3, 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). January 2, 2008
Benefits Exhaust and No-Pay Billing, including for Medicare Advantage plans
CMS is including the following clarifications to Chapter 6, SNF Inpatient Part A Billing, of the claims processing manual, effective March 17, 2008. 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
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 beneficiary's 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). December 5, 2007
Understanding the Remittance Advice
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. August 24, 2007
New Survey Rules for Paid Feeding Assistants and 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).
Transmittal 26 - Paid Feeding Assistants
May 28, 2007
Advance Beneficiary Notice - 2nd draft
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. March 9, 2007
Common Medicare Billing Errors
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). November 15, 2006
Quality Measures for Immunizations
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). June 7, 2006
Paid Feeding Assistant Regulations
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. |
|
| Copyright © Keane Care, Inc. All rights reserved. | Back to Top | Home | Contact Us | Careers | Site Map | Privacy Policy |
