The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires the reporting of standardized patient assessment data by Post-Acute Care (PAC) providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals. During this call, CMS experts discuss goals, requirements, progress to date, and key milestones for 2017. A question and answer session follows the presentation.
A regional director for a SNF company with 24 facilities dialed in the conference number for the “Strategic Planning” call that had appeared on her calendar along with most of the rest of the corporate team. The CEO set up the call just the day before; nobody really had much of an idea why. She hoped it was a response to the rash of open positions throughout the company.
On February 15, 2017, The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.
In the Fiscal Year (FY) 2016 SNF Prospective Payment System (PPS) final rule, CMS adopted the SNFRM as the first measure for the Skilled Nursing Facility Value Based Purchasing (SNF VBP) Program. The measure is defined as the risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare beneficiaries within 30 days of discharge from their prior hospitalization. Hospital readmissions are identified through Medicare hospital claims (not SNF claims) so no readmission data is collected from SNFs and there are no additional reporting requirements for the measure.
In late December, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models that continue the Administration’s progress to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost.
On January 31, 2017, the Centers for Medicare & Medicaid Services (CMS) announced plans to consolidate all rounds and areas included in the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program into a single round of competition – Round 2019. After the current Round 1 2017, Round 2 Recompete, and National Mail-Order competitions conclude on December 31, 2018, Round 2019 contracts will become effective on January 1, 2019 through December 31, 2021. Round 2019 will include 141 competitive bidding areas (CBAs) and have a total of 11 product categories.
On January 12, 2017, lawmakers introduced a bill that lifts restrictions which previously prohibited Medicare from covering basic healthcare necessities such as eyeglasses, hearing aids, and dental care. The Seniors Have Eyes, Ears and Teeth Act (H.R. 508) is anticipated to improve beneficiaries’ quality of life, while decreasing healthcare costs by creating healthier seniors.
By submitting a UB-04, whether electronically or via direct data entry, the Medicare biller is certifying that all the information on the form is correct and complete. While a simple mistake on one claim is unlikely to be considered fraudulent billing, a pattern of mistakes (especially inflated charges) probably will be. As such, a review of UB-04 claim elements must be included in the monthly triple-check process.