Medicare Posts

Regulatory Updates and Additional Changes for Clinics and Other Safety Net Providers

Tuesday, February 24th, 2015

The following are updates on regulatory and other changes that impact RHCs, FQHCs and other clinic based providers. Topics covered are: Medicare PS&R report changes, 2015 Medicare rates, 340B Program re-certification, Low Utilization cost reports, PQRS reporting and ICD-10 in 2015.

Medicare PS&R Reports

CMS switched from IACS to EIDM (Enterprise Identity Management System) effective February 7, 2015. The important thing to know is that no new registrations or profile changes can take place in IACS, effective after January 30, 2015.

What you should DO:

  1. Log on to EIDM and run your PS&R report to make sure you can access it when needed for the Medicare cost report.
  2. Make sure that you know your User ID and Password. Your User ID and Password were moved “as is” on January 30th.
  3. Reset your password if you think that your password expired between January 30 and February 9, 2015.
  4. Work with your Application help desk to get any pending request approved.
  5. Review your profile and ensure that all information is correct.

What you should NOT do:

  1. DO NOT register for a new User ID in EIDM! This will only complicate moving your IACS User ID to EIDM!
  2. DO NOT make changes to your user profile or submit a request of any type if it was not approved prior to January 30, 2015.

(more…)

Achieving Clinical Operations Excellence

Monday, February 2nd, 2015

awardAs we settle into 2015, hospitals, long term care, rehab, and outpatient care delivery facilities will benefit operationally and financially from evaluating the efficiency and effectiveness of their clinical operations.

Never before has there been such intense focus on regulatory compliance, the patient experience, and clinical outcomes of care, all of which are linked to the cost of care and the overall financial well-being of an organization. It is critical for patients and the future of the health delivery organizations that clinical operations and services run efficiently, effectively, and are compliant with state and federal regulations.

Healthcare organizations will benefit by paying attention to the following areas in order to cope with today’s challenging healthcare environment and economic challenges:  (more…)

CMS Migration of IACS Services to EIDM

Wednesday, January 28th, 2015

CMS is switching from IACS to EIDM (Enterprise Identity Management System) which is to take effect February 7, 2015.  The important thing to know is that no new registrations or profile changes can take place in IACS after 5 pm on January 30, 2015. So for those  who need to run a PS&R report for the Medicare Cost Report, please run it now or after the migration.

What you should DO as per the CMS site:

1. DO make sure that you know your User ID and Password. Your User ID and Password will be moved “as is” on January 30 after 5:00 PM. You should be certain that you know your User ID and Password AND that you can successfully login to IACS before 5:00 PM, Friday, January 30, 2015.
2. DO reset your password if you think that your password might expire between January 30 and February 9, 2015.
3. DO work with your Application Help Desk to get any pending request approved before 5:00 PM, Friday, January 30, 2015.
4. DO review your profile and ensure that all information is correct prior to 5:00 PM, Friday, January 30, 2015.

What you should NOT do!

1. DO NOT register for a new User ID in IACS if it cannot be approved prior to 5:00 PM, Friday, January 30, 2015
2. DO NOT register for a new User ID in EIDM! This will only complicate moving your IACS User ID to EIDM!
3.  DO NOT make changes to your user profile or submit a request of any type that cannot be approved prior to 5:00 PM, Friday, January 30, 2015.

For more details, please go to this link: http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/IACS/index.html

For more information, contact Diana Surber at 510-768-0066, dianas@hfsconsultants.com

PPS for FQHCs to Raise Medicare Payments 32 Percent – But the Effect on Most FQHC’s Finances will be Limited

Saturday, November 8th, 2014

Medicare payments summaryCMS recently published the final rule for a new Prospective Payment System for FQHCs effective for Cost Reporting Periods
beginning on/after 10/1/14. This is the first major revamp of Medicare FQHC payments in decades, and was a requirement of
the Affordable Care Act. CMS expects to increase total Medicare payments by 32 percent. Why is the industry so lucky to receive this large amount from CMS? Because FQHCs were very much favored in ACA, specifically, the legislation required that the new PPS remove two current limitations on FQHC rates: the provider productivity standards and the Upper Payment Limit.

On the face of it, this is really exciting news, but looking more closely, the reality is not as exciting. (more…)

The Improving Medicare Post-Acute Care Transformation Act of 2014

Tuesday, September 30th, 2014

Congress recently passed The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, which will have significant consequences for all post-acute care providers over the next few years. The Act, which is on its way to the President’s desk for signature, would require skilled-nursing facilities (SNFs), long-term acute care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and home health agencies (HHAs)  to collect and report standardized assessment data as a first step in developing recommendations for alternative post-acute care payment models. Additionally, the legislation includes new survey and medical review requirements for hospices.

Reporting new quality measures must begin as early as 2016, and in 2019, SNF payments will be reduced 2% if they do not report quality measures or assessment data. All of this is geared toward eventually unifying Medicare payment systems across the post-acute setting, regardless of provider type. Instead of the four different post-acute PPS systems that currently exist, there would be one payment method which would increase payments for some providers and decrease payments for others.

Click here to view the bill.

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Information for Clinics and Other Safety Net Providers

Tuesday, August 19th, 2014

RHC’s, FQHC’s and other clinic-based providers should be aware of the following regulatory updates.

Medi-Cal Code 19 Rate Settlements
Xerox mailed a letter dated March 26, 2014 stating that they will be reprocessing Code 19 (CHIP) claims that were previously denied in error. The effective dates of service were between 10/1/2009 through 6/30/2012.  Both claims paid in error and denied in error will be reprocessed.  Look for RAD code 0819 (start April 10th) voiding out old claims, CCN prefix 407955 (start April 3rd) for payments on erroneously denied claims, and CCN prefix 410055 (start April 24th) for erroneously paid claims on your RAs.  Be aware that Xerox is reducing payments for these old claims if a valid billing limit exception was not submitted.  These newly paid claims are eligible for reconciliation to the PPS rate.  If you have received a final audit report for the Code 19 Retroactive Reconciliation, review it to determine if the visits and/or payments for these reprocessed claims were included.  If they were not, and the number is significant, consider filing an appeal to request reconciliation of the newly adjudicated claims. (more…)

Significant Changes to the Wage Index Development Timetable for FFY 2016

Tuesday, May 27th, 2014

Earlier this month in its Federal Fiscal Year 2015 Proposed Rule, CMS released the proposed FFY 2016 Wage Index Development Timetable and there are significant changes. The FFY 2016 wage index process will commence as early as late May 2014 with the publication of the preliminary FFY 2016 Wage Index Public Use File (PUF). This file was previously posted in the September/October timeframe. As a result, all subsequent dates for FFY 2016 have been drastically moved up as well.

CMS will separately release the preliminary Calendar Year (CY) 2013 Occupational Mix Survey PUF in early to mid-July as these surveys will not be submitted by providers until the July 1, 2014 deadline. (more…)

Medicare Pay for Performance

Monday, May 19th, 2014

Each year the publication of the IPPS Proposed Rule gives us more information about the Medicare Value-Based Purchasing Program, Medicare Readmissions Reduction Program, and the new Hospital-Acquired Conditions Program. These are collectively known as the Medicare Pay for Performance Programs. Boiled down to their essence, these programs put your hospital’s Medicare reimbursement at risk based on complex quality measures that become more complex each year. (more…)

Medicare Occupational Mix Survey 101 – What you need to know

Monday, April 7th, 2014

Once every three years, CMS asks hospitals to complete the Occupational Mix Survey. The survey is due on July 1, 2014, a little over two months from now. Are you ready?

CMS uses the Occupational Mix Survey (OMS) to gauge the types of nursing personnel hospitals hire. CMS uses this information to benchmark the proportion of high cost employees, such as registered nurses, against hospitals across the country. If, for example, a hospital hires a higher proportion of registered nurses than the average hospital in the U.S., its Average Hourly Wage is adjusted downward so that its hiring decisions (i.e., more high cost employees) does not artificially inflate its Average Hourly Wage.

The Survey Takes Some Time to Prepare
At face value, the OMS seems simple enough to prepare. It requires input for only five types of labor – registered nurses, licensed practical nurses and surgical technicians, nursing aides, medical assistants, and the catch-all, “all other.” Despite this simplicity, CMS estimates that a hospital should expect to spend 480 hours to accurately prepare the survey. So what takes so long? (more…)

Information for Clinics and other Safety Net Providers

Tuesday, February 18th, 2014

There are several updates on regulatory and other changes that impact RHCs, FQHCs and other clinic based providers. The following is information on: Medi-Cal Code 18 rate setting, tracking your combined payments, when you should bill the secondary bill, and Medicare rate setting.

calculator-handsMedi-Cal Code 18 Rate Setting Results
DHCS implemented Medi-Cal managed care into the remaining California counties effective November 1st. Clinics have either Anthem Blue Cross (“ABC”), Centene (“CHW”) or Partnership (“PHP”) as their managed care plan. Clinics should have submitted their initial Form 3100 to DHCS to obtain an initial rate Code 18 (“wraparound”) rate. We’ve noticed that DHCS Audits group has been approving the initial rate at 100% of the requested amount. This leads us to advise the following: (more…)

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