Current Legislative Issues and Impacts - APC (Ambulatory Payment Classification) PROPOSED 2009 CHANGES FOR OPPS & ASC
On July 3, 2008, CMS issued a proposed rule that would update payment policies and rates for both hospital outpatient departments and ambulatory surgical centers for calendar year 2009.
Non-Acute Providers - Physicians PROPOSED 2009 CHANGES TO MEDICARE PHYSICIAN FEE SCHEDULE
On June 30, the Centers for Medicare & Medicaid Services (CMS) issued proposed changes to the Medicare Physician Fee Schedule (MPFS) for 2009.
Non-Acute Providers - Rural Health Center RHCs - CMS ISSUES PROPOSED CHANGES IN COP AND PAYMENTS
CMS issued a proposed rule to update certification and participation regulations and payment provisions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) 6/26/08.
General Unimplemented OIG Recomendations May 2008
The OIG presents the “Compendium of Unimplemented Office of Inspector General Recommendations.” The purpose of the Compendium is to combine significant unimplemented monetary and nonmonetary recommendations addressed to the Department into one publication for interested parties to obtain information about outstanding recommendations, which, if implemented, have the potential to result in cost savings and improvements to program efficiency and effectiveness.
General MEDICARE UPDATES ITS LIST OF RECOGNIZED SOURCES TO HELP MAKE COVERAGE DECISIONS FOR ANTI-CANCER CHEMOTHERAPY DRUGS
CMS will recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium™ as an additional source of information and cease use of the no longer updated or maintained American Medical Association Drug Evaluations (AMA-DE) compendium. Both of these revisions will be reflected in CMS’ Medicare Benefit Policy Manual.
Medicare Cost Report Items - Wage index/occupational mix Implementation of the 2007-2008 update to the Medicare Wage Index Occupational Mix Survey (Form CMS-10079 (2008))
Here is a link to the NGS website for information on the 2007 - 2008 Occupational Mix Survey.
Medicare Cost Report Items - Wage index/occupational mix CMS Open Door Forum for Wage Index Reform
The agenda for the Special Open Door Forum on Wage Index Reform scheduled for Tuesday, May 20, 2008 has been posted to the CMS website.
Current Legislative Issues and Impacts Interview on Form 990 with Rob Friz and Gwen Spencer - audio and transcript
Rob Friz and Gwen Spencer of PriceWaterhouseCoopers answer five pertinent questions about the new form 990. Listen to the audio or read the transcript.
Non-Acute Providers - Skilled Nursing Facilities/Swing Beds Proposed FY09 SNF Rates
CMS Proposes More Accurate Payment Rates for Medicare Skilled Nursing Facilities in FY09
Non-Acute Providers CMS clarifies use of NPI for provider subparts
CMS clarifies use of NPI for provider subparts.
Current Legislative Issues and Impacts LTCH Interim Final Rule
On May 1, 2008, CMS issued an interim final rule with comment implementing changes to the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) that were mandated by the Medicare, Medicaid, and SCHIP Extension Act of 2007. The LTCH provisions in the law affect several policies that were adopted in the LTCH PPS final rule for the Rate Year 2008, which was published in the May 11, 2007 Federal Register. In this IFC, CMS is incorporating the MMSEA changes into its existing LTCH PPS regulations. This IFC includes changes other than the proposed changes that were included in the LTCH PPS proposed rule for RY 2009, which was published in the January 29, 2008 Federal Register and for which the deadline for submission of comments was March 24, 2008.
Current Legislative Issues and Impacts - Inpatient Psych Facilities-Prospective Payment System (Psych Subproviders/distinct part units) IPF Payment Update Beginning July 1, 2008 (RY 2009)
This notice updates the prospective payment rates for Medicare inpatient psychiatric hospital services provided by inpatient psychiatric facilities (IPFs). These changes are applicable to IPF discharges occurring during the rate year beginning July 1, 2008 through June 30, 2009.
General Hospital Compare
This tool provides you with information on how well hospitals care for their patients with certain conditions or procedures. The information on this website has been provided primarily by hospitals that have agreed to submit quality information for Hospital Compare to make public.
Non-Acute Providers - Skilled Nursing Facilities/Swing Beds Nursing Home Compare
The primary purpose of this tool is to provide detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country.
Current Legislative Issues and Impacts - DRG (Diagnostic Related Groups) IPPS 2009 - RAND and RTI Reports on Refinements to Weights
In the FY2009 IPPS Proposed Rule, Rand and RTI had been contracted to further analyze charge compression for MS-DRG weights. The reports were not ready for publishig w/ the proposed rule, so are reported separately here. They will be considered for the final rule.
Current Legislative Issues and Impacts - Inpatient Rehab Facilities-Prospective Payment System (Rehab Subproviders/distinct part units) IRF PPS Proposed FFY09
This proposed rule would update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2009 (for discharges occurring on or after October 1, 2008.)
Current Legislative Issues and Impacts MUPs & HPSAs - Proposed Changes
This proposed rule would revise and consolidate the criteria and processes for designating medically underserved populations (MUPs) and health professional shortage areas (HPSAs). Comments are due by April 29, 2008.
Current Legislative Issues and Impacts - DRG (Diagnostic Related Groups) Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Fiscal Year 2009
CMS posed online the Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Fiscal Year 2009.
The Future of Medicare - Medicare Advantage Medicare Advantage - Rates & Statistics
Great source of information on Medicare Advantage (Medicare+Choice, Average Adjusted per Capita Costs) Rates & Statistics. The Medicare Payment Out of Network Guide is also very good.
General CMS Online Manual System
The CMS Online Manual System brochure has been updated. This brochure explains how to navigate the CMS Online Manual System.
Administrative Contractors MAC Chosen for J4
The Future of Medicare - Transition from Fiscal Intermediary to Medicare
HFMA Key Hospital Financial Statistics and Ratio Medians 2007
Check out the major healthcare data for 2007 from six indexes as aggregated by HFMA.
Provider Enrollment/Re-enrollment - Provider enrollment (i.e. 855) Revised CMS-855 Medicare Enrollment Applications 03/08
The Centers for Medicare & Medicaid Services (CMS) issued revised CMS-855 Medicare enrollment applications in March 2008.
Non-Acute Providers - Durable Medical Equipment/Enterals FIRST ROUND OF THE MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM
CMS announced the single payment amounts for the first round of the Medicare DMEPOS competitive bidding program.
Current Legislative Issues and Impacts Disclosure of Health and Hospital Charges, 2007-08
This article from the National Conference of State Legislatures details the fight for hospital pricing transparency.
Relationship between Medicare and Medicaid The Administration’s Medicaid Regulations: State-by-State Impacts
On March 3, Rep. Henry A. Waxman (D-Calif.), chairman of the Committee on Oversight and Government Reform, released The Administration’s Medicaid Regulations: State-by-State Impacts. The report details the effects of seven regulations issued by the Centers for Medicare and Medicaid Services (CMS) that would make major, wide-ranging changes in Medicaid.
Current Legislative Issues and Impacts CMS MLN Updates
Updates to CMS Medicare Learning Network. The Medicare Learning Network uses a variety of mechanisms, such as the Internet, national educational articles, brochures, fact sheets, web-based training courses, and videos, to deliver a planned and coordinated provider education program.
Non-Acute Providers - Hospice Hospice Payment System Fact Sheet
Hospice Payment System Fact Sheet from CMS.
Medicare Cost Report Items - Rate setting Refinements in Cost Reporting for Recalibrating DRGs
The purpose of this CR is to inform the fiscal intermediaries and Medicare administrative contractors of the hospital/medical associations initiative on encouraging hospitals to modify their cost reporting practices with respect to costs and charges, in an effort to improve the consistency of the cost-based IPPS DRG relative weights.
Non-Acute Providers - Physicians 2008 Medicare Physician Fee Schedule Update
Effective for physician claims with dates of service January 1, 2008, through June 30, 2008, the update to the conversion factor will be 0.5%; and for claims with dates of service July 1, 2008 and after, will revert back to the previous payment methodology (the -10.1% update) that was outlined in the Final Rule, published in the Federal Register on November 27, 2007.
Non-Acute Providers - Rural Health Center RHC & FQHC 2008 Rates
CMS announces calendar year 2008 payment rate increases for Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) services.
Non-Acute Providers - ASC (Ambulatory Surgical Center) Revised Payment System for ASCs in 2008 - MLN SE0742
MLN Matters SE0742 announced that CMS was implementing significant revisions to the payment system for ASC services beginning with services rendered on or after January 1, 2008.
Provider Enrollment/Re-enrollment - Provider enrollment (i.e. 855) CMS Updates Medicare Program Integrity Manual’s Medicare Enrollment Chapter
On February 1, CMS issued a Transmittal updating various provisions in the health care provider/supplier enrollment chapter of the Medicare Program Integrity Manual. This update to chapter 10 contains a number of revisions. First, it furnishes guidance on the handling on CMS-855 change of information requests that cannot be processed to completion. Second, it eliminates the need for the Contractor to make a recommendation for approval to the regional office in certain situations. Third, it adds several supplier types to section 12, et al., of chapter 10. Finally, it provides instructions on the accreditation of suppliers of durable medical equipment, prosthetics, orthotics and supplies.
Charge Capture - Coding - Reimbursement HCPCS - CMS website
This is the CMS website for the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data. The Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing.
Medicare Cost Report Items - Charity/uncompensated care Annual Update of the HHS Poverty Guidlines - 2008
This notice provides an update of the HHS poverty guidelines to account for last calendar year’s increase in prices as measured by the Consumer Price Index.
Provider Enrollment/Re-enrollment - Provider based status Off-Site Provider Based ED Requirements
CMS issued a letter dated 1/11/08 to State Survey Agencies stating that provider-based off-site hospital emergency departments (EDs) are acceptable, so long as they comply with Medicare’s Conditions of Participation (CoPs) and provider-based rules. CMS’s guidance for these facilities applies immediately.
Non-Acute Providers - Physicians Physician Quality Reporting Initiative
Eligible professionals who want to report for 2008 PQRI and are not already reporting quality-data codes on claims with 2008 dates of service should begin reporting as soon as possible. The financial incentive for eligible professionals who successfully report the designated set of quality measures during 2008 is 1.5% of total allowed charges for covered services payable under the Physician Fee Schedule.
Current Legislative Issues and Impacts - APC (Ambulatory Payment Classification) CMS Issues 2008 OPPS Final Rule
CMS Issues 2008 Outpatient Prospective Payment System Final Rule On Nov. 1, the Centers for Medicare and Medicaid Services (CMS) continued its initiative to link payment with quality in a final rule with comment period updating the hospital Outpatient Prospective Payment System (OPPS), effective for services furnished during CY08. The rule also updates the payment rates for the revised ambulatory surgical center (ASC) payment system beginning in CY08.
Non-Acute Providers - Physicians CMS Issues 2008 Physician Final Rule
Medicare Final Rule for 2008 Physician Fees Under a final physician payment rule issued yesterday, the Centers for Medicare and Medicaid Services (CMS) estimates that it will pay approximately $58.9 billion to about 900,000 physicians and other healthcare professionals. The revised payments, quality incentive rates, and related policy changes, which will become effective Jan. 1, 2008, are included in the Medicare physician fee schedule final rule. The rule will be published in the Nov. 27 Federal Register.
Medicare Cost Report Items - Disproportionate Share Hospital - Supplemental Security Income % SSI Posted for 2006
New (2006) SSI% posted for DSH calculation.
Medicare Cost Report Items - Inpatient Rehab Facilities SubProviders (Rehab IRF-Prospective Payment System rules) Rehab 2006 SSI Posted
Rehab 2006 SSI Posted for LIP
Current Legislative Issues and Impacts RACs
FAH: “Alarming Inceives” Turn RACs Into Modern-Day Bounty Hunters
The Future of Medicare - Transition from Fiscal Intermediary to Medicare Administrative Contractors MACs Chosen for J1 & J12
CMS AWARDS TWO CONTRACTS TO PROCESS AND PAY MEDICARE PART A AND PART B CLAIMS IN 7 STATES AND D.C. (J1 & J12). Friday, October 26, 2007.
Current Legislative Issues and Impacts CMS ANNOUNCES MEDICARE PREMIUMS, DEDUCTIBLES FOR 2008
CMS ANNOUNCES MEDICARE PREMIUMS, DEDUCTIBLES FOR 2008
Current Legislative Issues and Impacts - DRG (Diagnostic Related Groups) CMS Issues Correction Notice for FY08 IPPS Final Rule with Comment Period CMS Issues Correction Notice for FY08 IPPS Final Rule with Comment Period
Non-Acute Providers - Home Health CMS to Post Corrections to Home Health PPS Final Rule
CMS to Post Corrections to Home Health PPS Final Rule
Current Legislative Issues and Impacts - DRG (Diagnostic Related Groups) TRICARE/CHAMPUS will not use MS-DRG 10/1/07
TRICARE will not use the MS-DRG System effective 10/01/2007.
Current Legislative Issues and Impacts Quarterly Provider Update from CMS
Website for a CMS Quarterly Provider Update (QPU), for changes CMS is proposing or making. CMS publishes an Update at the beginning of each quarter to inform the public about the following: Regulations and major policies currently under development during this quarter; Regulations and major policies completed or cancelled; New/Revised manual instructions.
Relationship between Medicare and Medicaid - State resources Murphy's Unofficial Medicaid Page
Murphy's Unofficial Medicaid Page was created with the intent of bringing together in one place as many Medicaid-specific resources and links as possible. This site has links to each state's Medicaid webiste, as well as other related Medicaid sites. This site also provides general information about the Medicaid program and its history.
The Future of Medicare - Medicare Advantage Medicare Advantage Contract & Enrollment Data
CMS announces the launch of the new section on the CMS public website to house contract and enrollment data about MA and Part D plans (3/27/07). This site provides: a) a plan directory, and b) an MA claims processing contact directory. These directories contain basic information about the contract as well as contact information for the plan itself. CMS will update these directories on a monthly basis. Also, CMS is providing these data in three formats: a PDF document sorted by contract name, a PDF document sorted by contract number, and an Excel version.
The Future of Medicare - Transition from Fiscal Intermediary to Medicare Administrative Contractors MAC Chosen for J5
On September 5, 2007, CMS announced that Wisconsin Physicians Service Health Insurance Corporation (WPS) has been awarded the MAC contract in Jurisdiction 5 which includes Iowa, Kansas, Missouri and Nebraska.
Current Legislative Issues and Impacts - DRG (Diagnostic Related Groups) Crosswalk from CMS DRGs to MS-DRGs
FY 2008 IPPS Final Rule CMS crosswalk from DRG to MS-DRG. Download Excel file.
Medicare Cost Report Items Cost Report Workgroup - Cost Report Standardization for DRG Cost Based Weights
A national cost report workgroup has outlined recommended changes to the cost report, standardizing the matching costs and charges, for developing correct DRG cost based weights from MedPAR data.
Current Legislative Issues and Impacts - Inpatient Rehab Facilities-Prospective Payment System (Rehab Subproviders/distinct part units) CMS 2008 IRF Final Rule Press Release
CMS Press Release for IRF 2008 Final Rule.
Non-Acute Providers - Skilled Nursing Facilities/Swing Beds CMS 2008 SNF PPS Final Rule Press Release
CMS 2008 SNF PPS Final Rule press release.