Medicare Posts

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.

Accordingly, the deadline for hospitals to submit any revisions to its CY 2013 Occupational Mix Survey and FFY 2016 wage index (Worksheet S-3, Parts II, III & IV) data are required no later than early October 2014 (the actual date has yet to be determined by CMS). Providers wishing to make changes to the data that appears in the preliminary FFY 2016 Wage Index and Occupational Mix Survey PUFs must have all supporting documentation submitted to its Medicare Administrative Contractor (MAC) by this to be determined date. As a result of the earlier date of submission, MACs will be required to complete their wage index desk reviews by mid-December 2014. This date is moved up from the late January timeframe historically. All other PUF release dates coincide with previous years.

HFS can help with all your occupational mix and wage index needs.  If you have any questions or would like assistance filing wage index revisions, please contact Ryan Sader at ryans@hfsconsultants.com, or 714-656-4485. Our secure wage index client portal provides updates on changing regulations and presents detailed instructions and tips for reporting accurate wage index information on the Medicare cost report.

Medicare Pay for Performance

Monday, May 19th, 2014

guy_workingEach 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…)

Healthcare Organizations Can Expect Financial Pinch in 2014

Wednesday, January 15th, 2014

The Patient Protection and Affordable Care Act (PPACA) is a game changer for hospital and health system revenues, costs, and operations. In addition, legislative and regulatory actions, as well as industry trends, will produce a challenging economic landscape for providers in 2014. HFS executives provide insight on the significant changes and trends that healthcare organization executives can expect in 2014.

CEO Insight on the Affordable Care Act
Trahan WhittenThe largest issue facing healthcare organizations is the multi-faceted impact of the PPACA on both revenues and expenses. Revenues are decreasing dramatically from both Medicare and Medicaid (Medi-Cal), which do not even cover the cost of care to their beneficiaries. At the same time, insurance companies are demanding lower rates and eliminating providers from their networks, which cannot compete on costs. This will place a premium on healthcare organizations’ ability to manage cost reduction, both labor and non-labor and to achieve revenue recovery in 2014. HFS is perfectly positioned to help accomplish these difficult competing priorities.
-Trahan Whitten
CEO

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Medicare Bad Debts-FY 2013 and Beyond

Monday, August 26th, 2013

money_stethoscopeThe Middle Class Tax Relief and Job Creation Act of 2012 (the “Act”) delayed the implementation of significant reductions to Medicare physician payments that would have occurred in federal fiscal year (FFY) 2013.  In the budget neutral environment that now defines the Medicare and Medicaid programs, “funding” for this delay has to come from somewhere else within the system.  Thus, the Act also included several revisions to Medicare bad debt policy, some of them significant.  These changes will have varying impacts on Medicare bad debt reimbursement for hospitals, critical access hospitals, FQHCs and RHCs, and skilled nursing facilities.  In total, Medicare bad debt reimbursement for these types of providers is projected to decrease by almost $7 billion through FFY 2022.

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Meeting the Health Insurance Exchanges Challenge

Monday, June 24th, 2013

Understanding the Financial and Operational Impact

The next stage in what is being called the largest change in American healthcare since the adoption of Medicare/Medicaid in 1965 begins on October 1, 2013, when Health Insurance Exchanges (or Marketplaces) are scheduled to open to enroll participants for coverage, which will begin on January 1, 2014.

thescopecalculatorAs the October 1 date rapidly approaches, some see this as an important step toward universal healthcare, while others see it as a potential “train wreck.” Will the Exchanges be able to meet deadlines for enrollment and coverage implementation? To date, 16 states and the District of Columbia have established state exchanges, including Washington, Oregon, California, Idaho, Nevada and Hawaii. The remaining states will be in federally facilitated marketplaces or a state/federal partnership exchange model. (more…)

Healthcare Reform Impacts FQHCs and RHCs in California

Tuesday, May 14th, 2013

PatientSignInAmong the changes mandated in the Affordable Care Act is the expansion in the next few years of Medi-Cal eligible patients. As part of the implementation of California’s Medi-Cal program, Medi-Cal managed care will be arriving in the 25 counties not currently using the plan. This now goes into effect on September 1, 2013. For those already enrolled in managed care plans, there are significant changes in the annual reporting.

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HIPAA Compliance FAQs

Monday, April 8th, 2013

QandACommon Questions we’ve received from clients about HIPAA Compliance changes.

Q: If you have a deceased patient, does HIPAA still apply?

A: Yes, the medical record remains confidential regardless of the

patient’s status.

Q: What are the rules for emailing or texting protected health information (PHI) to outside vendors?

A: It must be under a Business Associates Agreeement and it must have an encrypted secure line. Standard text messaging is not HIPAA compliant.

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