Keane Care

Changes due for Medicare "likelihood of improvement"
The New York Times reported significant changes in determining eligibility for Medicare payment of SNF patients in a copywritten article published October 22, 2012.

The article states that as part of a proposed settlement of a class-action lawsuit, the administration will discontinue its requirement that beneficiaries show a likelihood of medication or functional improvement.

Use the link below to read the full article.

New York Times article

Changes needed for MDS 3.0 FY2013
CMS made a number of small changes to MDS 3.0 effective October 1, 2012. Labelled MDS 3.0 Data Submission Specifications (V1.11.0), it involves updates to several State-required items in Section S as well as some minor corrections.

CMS notes that "Although the MDS 3.0 RAI Manual will be posted later this Fall, this does not affect the implementation of the data submission specifications."

Note to NTT DATA clients: Updates with these changes have already been released, be sure they have been installed for MDS 3.0 assessments effective October 1, 2013.

Manual Medical Review of Therapy Claims: More information
CMS has posted the slides from the September 5 Open Door Forum on Manual Medical Review of Therapy Claims. The review is required when a resident's Part B therapy exceeds a $3700 threshold. Use the link below to view the slides.

The recent Medlearn Matters article (link below) provides details on
- required contents of a request
- phase-in schedule for providers

From the article: "All requests for therapy services above $3,700 provided by speech language therapists, physical therapists, occupational therapists, and physicians must be approved in advance.

"This includes services in these settings: Part B Skilled Nursing Facilities (SNFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), rehabilitation agencies (Outpatient Rehabilitation Facilities (ORFs), private practices, home health agencies (TOB 34X), and hospital outpatient departments."

Slides from Open Door Forum

Medlearn Matters 8036

QMs on Nursing Home Compare, 802/672 Forms, RAI Manual Changes
CMS officials reported the following during the SNF Open Door Forum Call of August 23, 2012.

The new Quality Measures are now available on CMS' Nursing Home Compare Website. Two new anti-psychotic measures were added. The Quality Measures are calculated based on MDS 3.0 data submitted to CMS. Providers receive a preview of their QMs a month before posting.

CMS-672/802 Surveyor forms: Revised forms and instructions were sent to vendors. Those forms and instructions are not official; they currently are going thru an internal review. An official Survey and Certification instructional memo will be sent when the revised 802/672 are finalized. Officials during the call reported that no release date has been set.

Changes to the RAI Manual are scheduled for release in October 2012.

CMS' Nursing Home Compare Website

New Cap Above Therapy Caps
Between October 1 and December 31, 2012, therapy services, even with KX exceptions, above a $3700 threshold must receive an exception. Thresholds are similar to the $1880 therapy caps in that there are two -- $3700 for PT and SLP combined, and another of $3700 for OT.

Exception requests for therapy above $3700 will be manually medically reviewed by Medicare Administrative Contractors (MAC). MACs will have 10 days to review the request. If a MAC fails to make a decision in that time, the request is automatically approved. If a claim is denied, the MAC must explain why and give providers a chance to resubmit.

CMS is sending providers instructions by US Mail before September 1, 2012. MACs will post detailed instructions on their Websites before September 1, 2012 on how to submit a request for an exception to the threshold.

The process will be phased in, with providers divided into 3 groups, starting October 1, 2012. Providers are assigned to Phase I (October 1 - December 31, 2012), Phase II (November 1 - December 31, 2012), or Phase III (December 1-31, 2012). To see which phase you are in, see the list on CMS' Website (if you are not assigned a 1 or 2, you're a 3). Link below.

Use the link below to read CMS' Therapy Cap Fact Sheet.

Therapy Provider Phase Information

CMS' Tehrapy Cap Fact Sheet

Confirming the Transition to 5010: Claims and Remittance Advice
The deadline for submitting Medicare electronic claims in the ASC X12 Version 5010 format was June 29, 2012. Effective August 1, 2012, if you had not converted from the 4010A1 format of the electronic remittance advice, the Medicare system will have automatically converted it to the X12 Version 5010 format.

Note to NTT DATA software clients: All of our Billing software clients had the updated software well before the deadlines. If they had a 4010 version, they have the 5010 version for claims and remittance advice for Medicare MACs/FIs as well as most Medicaid intermediaries. If you have any questions regarding the transition to 5010 processing please contact an NTT DATA Product Support Representative.

Medicare Payment Increase for FY2013
CMS released the SNF PPS rates for FY2013 (beginning October 1, 2012) in its final rule released on July 31, 2012. It states that "we estimate the overall estimated payments for SNFs in FY 2013 are projected to increase by $670 million, or 1.8 percent, compared with those in FY 2012.

"We estimate that in FY 2013 under RUG-IV, SNFs in urban and rural areas would experience, on average, a 1.9 and 1.5 percent increase, respectively, in estimated payments compared with FY 2012."

Use the link below to reach the final rule. This year the final rule did not include regulatory changes.

Final Rule July 2012

Redesigned Nursing Home Compare Website Launched
CMS aunched its updated Nursing Home Compare Website on July 19, 2012. The Website is designed to give consumers information such as staffing, enforcement actions and each facility's results on quality measures.

New in this update are:

Quality Measures based on MDS 3.0 data with the addition of measures on anti-psychotic medication use (for short-and long-term stays)

Detailed Inspection Reports

Ownership information

Physical Therapist staffing levels

The links below will take you to the Survey & Certfication letter about the changes and to CMS' Nursing Home Compare Website.

Survey and cert Letter 12-37-NH

Nursing Home Compare Website

New Addresses for Survey & Cert Websites
From the Survey & Certification -Nursing Homes Website you can reach these topics from left navigation bar

Evaluation of Quality Indicator Survey

Special Focus Facility List

State Operations Manual Chapter 7

Survey & Certification - General Information

Contact Information

CMS National Background Check Program

NH Quality Assurance & Performance Improvement

Survey & Certification Letters - listed as Policy & Memos to States and Regions

Survey & Cert - Nursing Homes page

Survey & Cert - General Information

SNF PPS payment and MDS 3.0 policies
CMS has published a memo to answer questions and clarify some SNF PPS payment and MDS 3.0 policies. The clarifications include examples and cover these topics:

1. When assessments are not combined properly

2. The term "used for payment"

3. Unscheduled PPS assessments: setting the ARD for them

4. Early COT assessments: the penalty

5. Late unscheduled assessments: the penalty

6. Missed unscheduled PPS assessments

7. How early, late, and missed unscheduled assessments may create a "compounding effect" with other assessment requirements

8. Inactivating assessments

9. Interview items on unscheduled PPS assessments

10. EOT OMRA: completion requirements

Open the memo with the link below.

SNF PPS Clarification Memo

New Survey Data and CMS-672/802 forms
In the SNF Open Door Forum call of March 1, 2012 CMS officials said that surveyors will begin to use the revised Quality Measures that are now available (use link below).

Drafts of the revised CMS-672/802 forms used by surveyors onsite have been released and are being cleared for use. CMS did not specify an implementation date. The revised forms will address the new QMs that are based on MDS 3.0 data, except surveyors will not use the measures on immunizations.

Officials added that the surveys will use national, rather than state-by-state data. As a result, facilities performance will be compared with others in the country rather than their state.

CMS noted that Appendix P of the State Operations Manual will be updated. The changes addresses the 802 form (roster sample matrix for the traditional survey) and the 672 (census). These were released to facility programmers on Feb. 22 and the changes are pending.

Quality Measures Specs version 5.0

Therapy Cap Extensions Extended til Dec. 31
The President has signed legislation to continue the Therapy Cap exceptions process through December 31, 2012. The caps are on therapy provided under Part B to residents not in a covered Part A stay and to nonresidents who receive outpatient rehab services from the SNF.

Providers may continue to submit claims with the KX modifier to indicate the services were medically necessary and so excepted from the caps.

The new law includes changes related to therapy delivered in a hospital outpatient department that will impact the annual therapy cap in 2012. CMS will issue more on that in the future.

For information about the exception process, use the link below to a section of the Medicare Claims Processing Manual.

Medicare Claims Processing Manual

RAI Manual Changes - April 2012
CMS has released the revised RAI Manual to accompany the MDS 3.0 changes that go into effect April 1, 2012. Many small changes were made to the form, with significant changes made to resident interviews for unplanned discharges and asking residents about returning to the community.

Use the link below to open the zip file containing revised manual pages.

Note to Keane clients: our update for these changes is in beta release with general release scheduled for the first week in March.

MDS 3.0 Training Materials Website

New Quality Measures Scheduled for Release
CMS staff reported on the new Quality Measures based on MDS 3.0 at the SNF Open Door Forum call on January 19. The MDS 3.0 Quality Measures are on schedule to be released April 19, 2012 on Nursing Home Compare. SNFs scores will be posted as a private preview on the CASPER system by the end of January 2012. The final QMs will be posted in February and a decision about which will be used for 5 Star Ratings will be made by April 2012.

The draft list follows and is made up of 11 Short-Stay QMs and 18 Long-Stay QMs. Briefly, a Short Stay is 100 or fewer cumulative days in facility. A Long Stay is 101 days or more.

Short Stay Quality Measures
Percent of residents:
- on a Scheduled Pain Medication Regimen on Admission who self-report a decrease in pain intensity or frequency
- who self-report moderate to severe pain
- with pressure ulcers that are new or worsened
- were assessed and appropriate given seasonal flu vaccine
- received the seasonal flu vaccine
- were offered and declined seasonal flu vaccine
- did not receive seasonal flu vaccine, due to medical contraindication
- were assessed and appropriately given Pneumococcal vaccine
- received Pneumococcal vaccine
- were offered and declined Pneumococcal vaccine
- did not receive Pneumococcal vaccine due to medical contraindication

Long Stay Quality Measures
Percent of residents:
- experiencing one or more falls with major injury
- who self report moderate to severe pain
- high-risk residents with pressure ulcers
- with a urinary tract infection
- low-risk residents who lose control of their bowel or bladder
- who have/had a catheter inserted and left in their bladder
- who were physically restrained
- whose need for help with activities of daily living has increased
- who lose too much weight
- who have depressive symptoms
- were assessed and appropriately given the seasonal flu vaccine
- received the seasonal flu vaccine
- were offered and declined seasonal flu vaccine
- did not receive seasonal flu vaccine, due to medical contraindication
- were assessed and appropriately given the Pneumococcal vaccine
- received the Pneumococcal vaccine
- were offered and declined Pneumococcal vaccine
- did not receive Pneumococcal vaccine, due to medical contraindication

MDS 3.0 Technical Information

2012 Medicare Deductibles, Coinsurance, and Therapy Caps - Updated
CMS has released the updates for these 2012 rates:

- Inpatient deductible is $1,156.00
- SNF Coinsurance is $144.50 for days 21-100
- Part B Deductible is $140.00

Use the link below to download the CMS MLN Matters article.

Therapy caps for calendar year 2012 will be $1880 ($1880 for PT and Speech therapy combined, and a separate $1880 for Occupational Therapy). The caps are for outpatient therapy under Part B.

In 2005 exceptions to the therapy caps were initiated for medically necessary services. These exceptions apply to much of the therapy provided to SNF patients. The exceptions were extended through CY 2011, and are scheduled to expire on December 31, 2011. The update added December 7 says that if the exceptions are extended, CMS will provide more information.

Activities are underway to encourage legislative action to extend the exceptions.

MedLearn Matters MM7567 Updated 12

MMLN on Therapy Cap Values for CY 2012

5010 Delay in Enforcement
On November 17, 2011, the CMS Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA-covered provider that is not in compliance with the ASC X12 Version 5010 (Version 5010) standards for electronic claims.

The compliance date for use of these new standards remains the same, January 1, 2012 for providers even though enforcement action will not be applied until March 31, 2012. See CMS' statement for more information (link below).

Note to Keane Care Clients: Keane intends to carry out our original schedule, but please check our 5010 Update Report for the release date for your state. Our Update Report is posted on the clients-only section of our Website and is updated regularly. Use link below.

Keane 5010 Progress Report

CMS statement on Enforcement Delay

H@ MDS Login Procedure Changing
CMS is changing how LTC facilities connect to CMSNet to transmit MDS files -- from AT&T to Verizon. It will affect your h@ login ID and will make it easier to connect. This will not affect your login ID for all other accounts (CASPER Login ID and State Login ID).

The CMSNet migration is tentatively scheduled to begin November 15, 2011 and will be completed by the end of the first quarter of 2012. It is being phased in by state. For your start date, see the Migration Schedule that you can download from the QTSO Website along with an Installation Guide, and Frequently Asked Questions. Use the link below.

QTSO Website

RAI Manual Chapter 6 update posted
The rules for carrying out Change of Therapy and EOT-R OMRAs are now in Chapter 6 of the RAI manual (V1.07) dated October 2011. The chapter includes

Characteristics of the RUG-IV classifications

Explanations of the AI Code (last 2 positions of the HIPPS code used for billing)

Rules on combining assessments when there are more than one assessment within one PPS scheduled assessment window (pages 6-8 thru 17).

Walk-thru that puts into words the software calculations that determine a RUG-IV score.

To download updated Chapter 6, use the link below (scroll to Downloads/MDS 3.0 RAI manual (V1.07) zip file.

MDS 3.0 Training Materials Website

Leave of Absence & COT Clarification
The revised guidance document (see the October 6 entry) has generated additional questions about the Leave of Absence policy and NASL has submitted them to CMS. An example:

Question: Wednesday is Day 2 of the COT observation window, and the patient receives 100 minutes of PT and OT therapy services during the day. However, that night the patient is taken to the emergency room at 9:00 PM and returns to the SNF on Thursday morning at 10:00 AM and resumed therapy treatments later that day. The overnight LOA makes Wednesday a non-billable day, but in considering whether a COT OMRA is necessary, would the 100 minutes provided on the LOA day count toward the 7-day COT window?

CMS Response: The 100 minutes would count for the COT observation period. I would note, just to be clear, that if a COT OMRA is deemed necessary, even after including those 100 minutes, the LOA day would still not be billable to Medicare.

Updated! Q&A from Aug 23 and Sept 1 Open Door Forums
CMS has updated the pdf that was posted on September 29 to include more information on Leave of Absence on page 2. It was also reported that they've answered the question at Section VI, #8 regarding dashed responses.

Topics include setting ARDs, COT clarification, group therapy, revised MDS schedule, revised EOT rules, and new EOT-R policy. The following are examples. Use the link below to download the 12-page document.

Question II-16. COT rules when a patient's therapy category changes, but the patient index maximizes into the same non-therapy RUG: A COT OMRA is only necessary in cases when the patient's RUG used for billing would change as a result of changes in therapy.

Question II-22, regarding completion of interview questions for a COT OMRA: facilities may complete the resident interviews within a day or two of the ARD of the COT OMRA. If the interviews are not completed by this time, then facilities should use the staff assessment to complete that portion of the COT OMRA.

We would note, however, that... facilities are expected to continually evaluate the therapy intensity for a given SNF resident and anticipate the possibility that a COM OMRA may be necessary.

Question II-23, regarding COT OMRAs with a non-compliant ARD: COT OMRAs with the ARD set for something other than Day 7 of the COT observation period will be treated as if the ARD has been set late. As such... facilities should bill the default rate for all days that are not in compliance with the ARD requirement.

III-1, Group therapy definition: a single therapist or therapy assistant providing therapy to four residents doing the same or similar activities at the same time. III-2, Unplanned patient absence: as long as the therapy session was planned for four residents, then the group session may continue. Group therapy minutes reported on the MDS will still be divided by four.

IV-1, Effective date of assessment schedule: Any ARDs set after October 1, 2011 must be in line with the updated assessment schedule. When October 1, 2011 is Day 19, 34, 64, or 94 of the stay, assessments should be completed by September 30 or the assessments will be considered late and payment penalties will apply.

IV-3, Grace days still exist under the revised assessment schedule. There is no penalty for using grace days.

V-4, Minimum number of therapy minutes for a therapy day. Answer: If a patient receives 15 or more codable minutes of therapy in one discipline in a given day, including a therapy evaluation, then this would count as a therapy day.

V-5, EOT needed when one disciple is discontinued? Answer: An EOT OMRA is necessary only when all therapies have been discontinued.

CMS' followup Q&A document

Billers need Validation reports
Similar to this time last year, it will be very important that clinicians share with Medicare billers the MDS 3.0 CMS Validation reports. They are the reports clinicians receive after submitting PPS assessments and it lists the appropriate RUG to bill based on whether an assessment is for FY2011 or FY2012.

If the billing period is split between fiscal years, FY11 RUG-IV and FY12 RUG-IV groups will both be needed to establish payment for the entire period. As of 9/18/11, the validation reports now reflect both RUG groups.

- CMS' submission system now calculates both the FY11 RUG-IV and FY12 RUG-IV groups for ARDs from 8/22 through 10/31
- For FY11, the FY12 RUG group will be shown in Error Message #1059
- For FY12, the FY11 RUG group will be shown in Error Message #1060

New Change of Therapy (COT) OMRA
This new assessment type is required for patients classified into a therapy RUG-IV group, whenever the therapy minutes change so much that the resident classifies to a different RUG. The Assessment Reference Date (ARD) of the Change-of-Therapy (COT) OMRA would be set for Day 7 of a COT observation period. Described as a rolling 7-day observation period, facility staff must review the status of residents in therapy RUGs every 7 days to see if a COT OMRA is needed. The ARD (assessment reference date) would go back to the first day of the 7-day look-back period.

End of Therapy with Resumption (EOT-R)
An End-of-Therapy OMRA must be completed when a resident in a therapy RUG receives no therapy services for three consecutive days, regardless of the reason. Beginning October 1, SNFs may choose to complete an EOT-R assessment, using the EOT OMRA form and completing the new items, O0450A and O0450B. To use an EOT-R rather than a Start-of-Therapy, the RUG must be the same as before EOT and therapy must have restarted no more than 5 days after the last day of therapy.

Use the link below for a revised MDS 3.0 schedule and more information on the transition.

Cheat sheet for FY2012 MDS Transition

Therapy Claims Reprocessing
Since February 2011 CMS has been reprocessing millions of claims that were affected by passage of the Affordable Care Act that led to changes in the Medicare Physician Fee Schedule for services provided January 1 to May 31, 2010. The affected claims were reprocessed automatically.

CMS sent a notice yesterday that contractors have encountered situations where claims were not reprocessed correctly. These claims involved therapy services when the KX modifier was not used because the patient had not reached the therapy cap, but where the patient subsequently received therapy services beyond the cap.

In an announcement, CMS advises providers that its contractors will no longer automatically reprocess claims involving services subject to the therapy cap. Providers now must request the contractors reprocess therapy claims that would have been subject to the cap. Studies have shown that approximately 14 percent of therapy claims exceed the cap each year.

NASL reports that it has heard that the fee schedule adjustments may amount to only a few cents and suggest that if you have a large number of claims affected, it might be worth your effort to request the contractor to reprocess your therapy cap claims.

Medicare Claims Processing Manual rev. 2/18/11

Clarification of Billing occurrence code 16
Medlearn Matters MM7339 article clarifies how to use occurrence code 16: "In all cases where an End of Therapy (EOT) - Other Medicare Required Assessment (OMRA) is completed, SNFs must submit occurrence code 16, date of last therapy, to indicate the last day of therapy services for the beneficiary."

CMS further clarified on June 24th: "Please note that only one occurrence code may be billed on a single claim, therefore, you would use the final date therapy was provided in relation to the latest EOT OMRA applicable for the claim being billed."

Note to Keane clients: the code can be added now via UB Data Entry and will be automated in an upcoming release.

Medlearn Matters MM7339 Revised

Complaint and Enforcement Info on Nursing Home Compare
CMS will begin posting information about complaints and enforcement actions on its Nursing Home Compare Website beginning July 21, 2011. Providers can preview the information to be posted at the CASPER site at the top of your MDS State Welcome page beginning June 15. Questions may be emailed to bettercare@cms.hhs.gov.

The Nursing Home Compare site already includes survey results (requirements that the nursing home failed to meet). Use the link below for the Website.

CMS' Nursing Home Compare Website

Bundling Errors for CT Scans and Dacogen
CMS has learned that some new HCPCS billing codes created for January 2011 should have been excluded from SNF consolidated billing bundled payment and allowed to be paid separately:

CT Scans (HCPCS 74176, 74177, and 74178). Effective July 5, 2011, for dates of service on or after January 1, 2011, claims processing edits will be revised.

Dacogen (HCPCS code J0894), a high-intensity chemotherapy drug. Effective October 3, 2011, for claims with dates of service on or after January 1, 2011 claims processing edits will be revised.

SNFs that submitted claims with dates of service on or after January 1, 2011 for these services would have had claims denied. If this happened to you contact your Medicare Carrier, Fiscal Intermediary, or Medicare Administrative Contractor to have the claims reopened and reprocessed.

CMS Proposals for 2012 Payment
CMS is considering several options before setting the 2012 Medicare payment rates for SNFs. One calls for an increase in payment, one calls for a decrease.

One option is the standard rate update that would provide an increase of $530 million, or 1.5 percentage points. The increase is derived from applying the 2012 market basket index of 2.7 percent reduced by 1.2 percentage points to account for greater efficiencies in the operation of nursing homes. This provision was called for in the Affordable Care Act.

The other option CMS is considering adjusts for an unexpected spike in nursing home payments during FY 2011, beginning October 1, 2010. Under this option, CMS would restore overall payments to their intended levels which would require reducing FY 2012 payments to Medicare SNFs by $3.94 billion, or 11.3 percent lower than payments for FY 2011.

In implementing RUG-IV, CMS adjusted payment to ensure that the new system did not trigger a change in overall payment levels. Instead, the new system appears to have resulted in a significant increase in Medicare expenditures. CMS has come to this conclusion because actual utilization under RUG-IV has differed significantly from the original projections.

For example, CMS has found that patients are being classified into one of the highest paying RUG-IV therapy groups more than 40 percent of the time (as compared to less than 10 percent as originally projected by CMS), thus triggering Medicare payments far in excess of the original projections.

CMS will be reviewing RUG-IV claims data as it becomes available and will evaluate recalibrating the payment system for the FY 2012 final rule.

In addition to discussing the SNF PPS payment rate update for FY 2012, this proposed rule proposes to:

Implement section 6101 of the Affordable Care Act that requires Medicare SNFs and Medicaid nursing facilities to disclose certain information to HHS and other entities regarding the ownership and organizational structure of their facilities; and

Revise the definition of group therapy and to require allocation of group therapy minutes in assigning RUG-IV payment groups; and

Add a new Medicare-required assessment to be completed when changes occur in the intensity of therapy.

Modify the required schedule for completing the MDS 3.0; and

Revise the policy regarding line-of-sight; supervision of therapy students.

The proposed rule went on display on April 28, 2011 and public comments will be accepted until June 27. Use the link below to download the rule.

Proposed Rule published May 6, 2011

Accountable Care Organizations (ACO) Proposed
CMS has proposed a new program, ACO (Accountable Care Organizations) to encourage improved quality and reduce Medicare expenditures in return for payment incentives.

Post-Acute Care providers will be able to participate in ACOs, but only physicians and hospitals can form an ACO. To receive incentive payments, ACOs must first meet quality measures in the areas of patient/caregiver experience, care coordination, patient safety, preventive health, at-risk population/frail elderly health.

To qualify for a shared savings payment, an ACO must achieve minimum savings. That minimum savings amount will be based on the previous per capita Medicare Parts A and B expenditures for beneficiaries in each of three previous years. CMS will estimate a benchmark that will be adjusted annually.

The ACO proposal is part of the Affordable Care Act; comments will be accepted until June 6, 2011.

For full information visit CMS' Shared Savings Program Website, link below.

CMS' Shared Savings Program Website

Intermediary Errors in Applying MPPR
CMS has learned that the Fiscal Intermediary Shared System (FISS) is taking the Multiple Procedure Payment Reduction (MPPR) on claims regardless of whether services were provided on the same day. As a result of this coding error, therapy claims with dates of service on or after January 1, 2011, processed between January 3 and February 6, 2011, with one of the specified therapy codes in Change Request (CR) 7050, were processed incorrectly.

System changes were successfully implemented on February 7, 2011, and CMS has instructed Medicare contractors to adjust claims that processed incorrectly.

CMS has also learned that FISS was using a 20% reduction rather than the 25% reduction for institutional claims. As a result, all therapy services subject to the MPPR with dates of service on or after January 1, 2011, have been paid incorrect amounts.

Medicare contractors will install a corrected rate file in early May, and CMS has instructed Medicare contractors to adjust claims no later than June 30, 2011.

Nursing Home Compare Changes
Changes are coming to CMS Nursing Home Compare Website per the Affordable Care Act and MDS 3.0. Effective April 23, the Website will clearly spell out resident and consumer rights and the courses of action they can take if they feel their rights are being violated.

In July 2011, Nursing Home Compare will include information about the number of substantiated complaints received and number of enforcement actions. The Survey and Certification letter of March 18, 2011, outlines these changes. Use the link below to read it.

The Quality Measures and Five Star ratings currently on the Nursing Home Compare Website will be "frozen" until October 2011. Those measures were calculated using MDS 2.0 data submitted during quarters one thru three of 2010. Quality Measures based on MDS 3.0 data is expected to be available in early 2012.

Survey & Certification letter of March 18, 2011

CMS' Nursing Home Compare Website

Error in logic for -3810 (Submitted Late)
CMS has identified an error in the logic for -3810 (Record Submitted Late).

The -3810d message is being issued in error for any new (X0100 = 1) comprehensive assessment (A0310A = 01, 03, 04, 05) where the Z0500B is more that 14 days prior to submission.

CMS will enhance the system to only apply edit -3810c for new (X0100 = 1) comprehensive assessments. In the meantime, please disregard that message, but do not disregard error -3810c for comprehensive assessments, or -3810d for non-comprehensive assessments.

MPPR - Multiple Procedure Payment Reduction for Selected Therapy Services
A change is being made for some therapy services paid under the Medicare Physician Fee Schedule (Part B, Outpatient). This Multiple Procedure Payment Reduction (MPPR) is 25 percent, applied only to the Practice Expense (PE) part of payment.

Payment for this therapy is broken into three parts: Work, Practice Expense, and Malpractice. The PE part will be reduced 25 percent after the first unit when more than one unit or procedure is provided to the same patient on the same day.

Full payment is made for the unit or procedure with the highest PE payment. The MPPR applies to all services furnished to a patient on the same day, regardless of whether one or multiple therapy disciplines are provided such as PT, OT, or Speech-Language Pathology.

Note to Keane clients: updates for Keane AR-Billing software are now available to accommodate this change.

Medlearn Matters

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

CMS Five-Star Quality Rating Website