This week in Medicare updates—5/9/18
FY 2019 Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Proposed Rule, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program
On April 27, CMS published the FY 2019 SNF PPS and Consolidated Billing Proposed Rule outlining 2019 payment updates and proposed quality program changes for SNFs. The three major provisions of the proposed rule include changes to the case-mix classification system used for the SNF PPS, changes to the SNF Value-Based Purchasing Program, and changes to the SNF Quality Reporting Program. One change to the SNF PPS includes renaming the Resident Classification System, Version 1 (RCS-I) to the SNF Patient-Driven Payment Model (PDPM), which would tie payment to patients’ conditions and care needs rather than the volume of services provided.
CMS published a Fact Sheet and Press Release on the same date to accompany the proposed rule. Comments on the proposed rule are due by 5 p.m. on June 26, 2018.
The proposed rule was published in the Federal Register on May 8.
FY 2019 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Proposed Rule
On April 27, CMS published the FY 2019 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule to propose updated payment rates and policies under the IRF PPS. Some of the major provisions include a reduction in the number of measures IRFs have to report in the IRF Quality Reporting Program, allowing the post-admission physician evaluation to count as one of the face-to-face physician visits, allowing the rehabilitation physician to lead interdisciplinary team meetings remotely without additional documentation requirements, and removing the admission order documentation requirement.
CMS published a Fact Sheet and Press Release on the same date to accompany the proposed rule. CMS is also specifically seeking comments regarding additional changes to the physician supervision requirement. Comments on the proposed rule are due by 5 p.m. on June 26, 2018.
The proposed rule was published in the Federal Register on May 8.
FY 2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Proposed Rule
On April 27, CMS published the FY 2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Proposed Rule, which would update payment rates, the wage index, and the cap amount for 2019. The rule proposes updating the payment rate by +1.8%, setting the cap amount at $29,205.44, and revising data policies for the hospice quality measures on Hospice Compare.
CMS published a Fact Sheet and Press Release on the same date to accompany the proposed rule. Comments on the rule are due by 5 p.m. on June 26, 2018.
The proposed rule was published in the Federal Register on May 8.
FY 2019 Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Updates Proposed Rule
On April 27, CMS published the FY 2019 Inpatient Psychiatric Facilities Prospective Payment System Proposed Rule. Major provisions of the rule include the removal of eight IPF quality reporting program measures beginning with the FY 2020 payment determination, updating the IPF payment rate by +1.25%, and updating IPF regulation language that is out of date (such as references to ICD-9-CM that would be changed to ICD-10-CM). No policies in those regulations would change.
CMS published a Fact Sheet and Press Release on the same date to accompany the proposed rule. Comments on the rule are due by 5 p.m. on June 26, 2018.
The proposed rule was published in the Federal Register on May 8.
A Guide to Submitting CMS Multi-Payer Model Requests for Other Payer Advanced APM Determinations – Commercial Payers
On April 27, CMS published a Fact Sheet regarding the Payer-Initiated Submission Form used to determine whether payment arrangements will qualify as Other Payer Advanced Alternative Payment Models (APM) under the Quality Payment Program (QPP). The fact sheet guides payers through completion of the form to help ensure accuracy when filling out the form, as the information there will be used to determine Advanced APM status.
Medicare Cost Report E-Filing
On April 30, CMS published One-Time Notification Transmittal 2075 regarding the new Medicare Cost Report E-Filing system. The transmittal was issued to guide providers through the new system, and the process must be completed annually to determine the providers’ Medicare reimbursable costs.
Effective date: June 12, 2018
Implementation date: June 12, 2018
Updated Civil Monetary Penalties and Affirmative Exclusions
On April 30, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusion agreements reached in April, including:
- Affordable Medical Care f/k/a Andalusia Medical Center and Dr. Kevin Diel (AMC), of Opp, Alabama, reached a $40,000.50 settlement agreement on April 5 with the OIG to resolve allegations that AMC received improper remuneration from Millenium Health, LLC, in the form of point of care test cups which resulted in prohibited referrals due to a financial relationship.
- CAH Acquisition Company 1, d/b/a Washington County Hospital (WCH), of Plymouth, North Carolina, reached a $52,414 settlement agreement with the OIG on April 9 to resolve allegations that WCH violated the EMTLA by failing to provide an appropriate medical screening examination and stabilizing treatment to a woman who EMTs attempted to take to WCH before they were told that WCH was on diversion. WCH was not on diversion at the time and WCH had been informed that the ambulance was already on its property, but WCH still directed the EMTs to take the patient to another hospital.
New Provider Self-Disclosure Settlements
On May 3, the OIG updated its list of Provider Self-Disclosure Settlements reached in April. The list includes:
- On April 2, The Mary Lanning Memorial Hospital Association d/b/a Mary Lanning HealthCare, of Nebraska, reached a $677,239.56 settlement with the OIG for billing for E&M services in nursing homes that were not medically necessary and did not meet requirements for the codes.
- On April 2, BenchMark Rehabilitation Partners, LLC, BenchMark Growth Partners, LLC, BenchMark Premier Partners, LLC, BenchMark East Partners, LLC, BenchMark Development Partners, LLC and BenchMark West Partners, LLC, of Tennessee, Georgia, Alabama, South Carolina, North Carolina, Texas, and Kansas, reached a $3,157,771.50 settlement with the OIG for submitting outpatient rehabilitation therapy claims for services provided when the therapists did not provide constant attendance or direct one-on-one contact with the beneficiary.
- On April 5, Shands Teaching Hospital and Clinics, Inc., d/b/a UF Health Shands, of Florida, reached a $249,413 settlement agreement with the OIG for employing an individual it knew or should have known was excluded from participation in federal health care programs.
- On April 12, DLP Marquette General Hospital, LLC for Marquette General Hospital, of Michigan, reached a $545,663.69 settlement with the OIG for presenting claims for reimbursement on behalf of a physician for hyperbaric oxygen therapy which were excessive.
- On April 19, Pecos County Memorial Hospital, of Texas, reached a $136,436.94 settlement with the OIG for billing for services with documentation that was either incomplete or inappropriate.
- On April 24, Hartford Hospital, of Connecticut, reached a $423,017.45 settlement with the OIG for providing improper remuneration to a medical practice in the form of an office space where Hartford charged the practice rent at less than the fair market value, creating a financial relationship that led to prohibited referrals in violation of Stark Law.
- On April 27, Tuscarawas County General Health District, of Ohio, agreed to a $55,203.42 settlement with the OIG for employing an individual it knew or should have known was excluded from participation in federal health care programs.
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--January Through March 2018
On May 4, CMS published a Notice in the Federal Register as it does each quarter listing all CMS manual instructions, substantive and interpretive regulations, and other notices published from January through March 2018.
Announcement of the Advisory Panel on Hospital Outpatient Payment Meeting on August 20–21, 2018
On May 4, CMS published a Notice in the Federal Register to announce the dates for the annual Advisory Panel on Hospital Outpatient Payment meeting for 2018. The meeting will take place on Monday, August 20, 2018, from 9:30 a.m. to 5 p.m. EDT and Tuesday, August 21, 2018, from 9:30 a.m. to 1 p.m. EDT. Registration for those who wish to attend the meeting in person will take place online from Monday, June 25, 2018, through Monday, July 30, 2018 at 5 p.m. EDT. Participants who plan to participate in the meeting via webcast or teleconference do not need to register.
ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)
On May 4, CMS published One-Time Notification Transmittal 2076 regarding a maintenance update of ICD-10 conversions and other coding updates specific to NCDs.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Implementation of Changes to the Pre-Payment Additional Documentation Request (ADR) Letters for Medical Review
On May 4, CMS published One-Time Notification Transmittal 2083 to implement changes to the existing format of the Pre-Payment ADR letter for medical review.
Effective date: October 1, 2018
Implementation date: October 1, 2018
FY 2019 IPPS Proposed Rule Published in Federal Register
On May 7, CMS published the 2019 Inpatient Prospective Payment System proposed rule in the Federal Register. Comments on the proposed rule are due by 5 p.m. on June 25, 2018.