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Nov 8, 2019

Posted November 2019

Reimbursement

  • Bill Correctly for Medicare Telehealth ServicesCMS released the Medicare Telehealth Services Video to help you bill correctly.
  • Skilled Nursing Facility Claims Hold. As CMS has undertaken the implementation of the Patient Driven Payment Model (PDPM), we are holding a limited number of Skilled Nursing Facility (SNF) claims while we make further refinements to our claims processing system. PDPM is a historic reform of the SNF prospective payment system. PDPM focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment. PDPM was effective on October 1, 2019. Specifically, CMS is holding claims with:
    • Dates of service October 1, 2019 or later and
    • Type of Bill (TOB) inpatient services (21X) and swing bed services (18X) subject to SNF Patient Driven Payment Model (PDPM) and
    • Multiple line items, Health Insurance Prospective Payment System (HIPPS) codes, with different rate codes (revenue code 0022).
  • CMS Finalizes Calendar Year 2020 Payment and Policy Changes for Home Health Agencies. In November 2018, CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The final rule with comment period also increases Medicare payments to home health agencies (HHAs) by an estimated 1.3 percent ($250 million) for calendar year (CY) 2020.
    •  CMS is implementing the Patient-Driven Groupings Model (PDGM), a new case-mix payment methodology for home health services, which more accurately pays for home health services and focuses on patient needs by relying heavily on patient characteristics rather than volume of care. 
    • CMS is addressing potential Medicare fraud by phasing out pre-payments for home health services over the next year and eliminating those payments completely in 2021.
  • Final OASIS D-1 Data Submission Specifications Now Available

Quality

  • The submission deadline for the Inpatient Rehabilitation Facility (IRF), Long-Term Care Hospital (LTCH), and Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) has been extended to November 18, 2019.

Clinical

Posted October 2019

Reimbursement

Quality

Clinical

Posted September 2019

Reimbursement

Quality

Clinical

Posted August 2019

  • Centers for Medicare & Medicaid Services Special Open Door Forum Open Payments Expansion under the SUPPORT Act Thursday, August 29, 2019 2:00pm – 3:00pm Eastern Time Conference Call Only.
    • Open Payments is a national disclosure program that promotes a more transparent and accountable health care system by publishing the financial relationships between applicable manufactures and group purchasing organizations (GPOs) and health care providers (physicians and teaching hospitals).
    • In the fall of 2018 President Trump signed the SUPPORT Act into law which expands the Open Payments definition of a covered recipient to include: physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives.

Quality

Clinical

    Posted July 2019

    Reimbursement

    Quality

    Clinical

    Posted June 2019

    Reimbursement

    Quality

    Clinical

    Posted May 2019

    Reimbursement

    Quality

    Clinical

    Posted April 2019

    Reimbursement

    Quality

    Clinical

    Posted March 2019

    Reimbursement

    Quality

    Clinical

    Posted February 2019

    Reimbursement

    Quality

    Clinical

    Posted January 2019

    Reimbursement

        Clinical

        Posted December 2018

          Clinical

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