News Front: Regulatory and Industry News
Breaking News
Therapy Caps Update
The exceptions to the Medicare Part B Therapy Caps expired December 31, 2009. The exceptions mean the caps do not apply to most beneficiaries in SNFs. The 2010 caps are $1860 per year for PT and Speech/Language Pathology combined and $1860 for OT.

CMS reports that the healthcare reform bill in progress contains provisions to extend the exceptions process.

In the article, CMS states that for services provided on or after January 1, 2010, healthcare providers may choose, to the extent possible, to hold their claims until it becomes clearer as to whether new legislation will be enacted to extend the exceptions. Click here to check the Keane Care blog for updates.



The following article has been updated since the newsletter was printed.
MDS 3.0 Next Steps
At the SNF Open Door Forum December 8, 2009 CMS officials reported they were on schedule for rolling out MDS 3.0 and RUG-IV on October 1, 2010. The exception is that part of the RAI manual (chapters 2, 4, 6 and Appendix C) were not released with the rest of the manual and at press time were expected later in December 2009. Chapter 6, on the RUG-IV system, was released on January 13, 2010.

After the Open Door Forum it was learned that a one-year delay of the RUG-IV Medicare Part A payment system was included in the Senate version of the healthcare reform bills.

These items remain in the timetable:

  • December 2009 - Publish Chapters 2, 4, and Appendix C of the MDS 3.0 RAI manual
  • March/April 2010 - Train the Trainer
  • April/May 2010 - Proposed Rule published on SNF Medicare payment
  • SNF PPS July 2010 - Final Rule published on SNF Medicare payment
  • September 2010 - National Quality Forum endorsement of Quality Measures based on MDS 3.0
  • October 1, 2010 - MDS 3.0 and RUG-IV Implementation

    For more information, see the articles in this publication on MDS 3.0 and RUG-IV.


    Auditing Medicare and Medicaid Payment
    CMS has set up programs to perform reviews and audits for overpayment identification for both Medicare and Medicaid.

    Medicare Recovery Audit Contractor (RAC) is a permanent program that went into effect March 1, 2009 following a demonstration that resulted in more than $900 million in overpayments being returned to the Medicare Trust Fund and $38 million in underpayments returned to providers.

    RAC will be administered by four regional Recovery Audit Contractors. Each RAC must set up a Website and post the results of each audit by January 1, 2010. See CMS' RAC Website for more information.

    CMS launched the preliminary Medicaid Integrity Program (MIP) using Medicaid claims data it receives for research. MIP conducted audits in 17 states 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. Click here to reach CMS' MIP Website.


    F441 Tag Guidelines Revised
    Transmittal 55 was released December 2, 2009 to replace Transmittal 54 that revised the guidelines for Tag F441 on Infection Control. Click here to open it.

    5010 Format for Medicare Claims/Payment
    CMS has announced a new HIPAA electronic transaction format for Medicare claims/payment, ANSI 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, click here to see Medlearn Matters MM6589.

    ICD-10 Myths & Facts
    CMS addresses urban legends that are spreading about ICD-10 codes in a fact sheet.

    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. Click here to download the fact sheet.