IN THIS WEEK’S ISSUE:
- Appropriations Bill Prevents Rehab Redesignations
- CMS Clarifies “Repetitive Services”
- Ambulance Services: No Change In 2005 Conversion Factor
- Billing Instructions for Rural Health Clinics and Health Centers Updated
- CMS Updates 2005 DMEPOS Fee
- Study Finds Consumers Concerned About Healthcare Safety
- Quick Link
- In the HFMA Resource Center
1. APPROPRIATIONS BILL PREVENTS REHAB REDESIGNATIONS
Over the weekend, Congress approved the conference report on HR 4818, termed the Consolidated Appropriations Act of 2005, which included appropriations for Health & Human Services. Prominent among the health policy points in the bill is a provision that prevents the HHS secretary from redesignating any facility that was considered to be an inpatient rehab facility (IRF) on or before June 30, 2004, until the GAO completes its report on IRFs, required by the Medicare Modernization Act of 2003.
2. CMS CLARIFIES “REPETITIVE SERVICES”
At a November 17 Hospital Open Door Forum teleconference, CMS staff clarified that the “examples” of repetitive services contained in transmittal 270, issued August 3, are actually the complete list of services that CMS considers to be repetitive. The transmittal also referred to infusion therapy as a repetitive service; however, it is not, a CMS official said during the forum.
Transmittal 270 requires fiscal intermediaries to accept monthly bills from skilled nursing facilities (SNFs) and Tax Equity and Fiscal Responsibility Act (TEFRA) hospitals, and addresses the proper billing when an individual outpatient PPS service is performed on the same day as an outpatient PPS repetitive service. A correction to the transmittal is expected soon.
3. AMBULANCE SERVICES: NO CHANGE IN 2005 CONVERSION FACTOR
CMS has set the ambulance inflation factor at 3.3 percent and made no change to the conversion factor used to determine 2005 Medicare ambulance fee schedule rates, according to a November 15 Federal Register notice. CMS estimates a 3 percent increase in Medicare revenues for all ambulance suppliers and providers that furnish services to Medicare beneficiaries.
A transition to 100 percent payment under a fee schedule began in 2002, replacing the retrospective reasonable-cost payment system for providers and the reasonable-charge system for suppliers of ambulance services. During the transition period, the ambulance inflation factor is applied to both the fee schedule portion of the blended payment amount and to the reasonable charge or cost portion of the blended payment amount separately for each ambulance provider or supplier. These two amounts are combined to determine the total payment amount for each provider or supplier.
4. BILLING INSTRUCTIONS FOR RURAL HEALTH CLINICS AND HEALTH CENTERS UPDATED
General billing instructions in chapters 9, 18, and 32 of the Medicare Claims Processing Manual (Pub. 100-04) are being updated to provide more detailed instructions for rural health clinics (RHCs) and federally qualified health centers (FQHCs), CMS announced in a November 19 transmittal. RHCs and FQHCs will no longer report additional line items when billing for preventive services on bill types 71X and 73X.
Additionally, independent FQHCs will not be required to report one of five designated HCPCS codes for each line item on the bill, and hospital-based FQHCs will not be required to report HCPCS codes for each FQHC service line item on the bill. Also, except for the telehealth originating site facility fee reported using revenue code 0780, all charges must now be reported on the revenue code line for the encounter, 052x or 0900/0910, or the claim will be returned to the provider. The updates are effective April 1, 2005.
Read updated billing instructions for RHCs and FQHCs.
5. CMS UPDATES 2005 DMEPOS FEE
CMS issued the annual update for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in a November 19 transmittal. The update reduces certain DME payments by an amount equal to the percentage difference between 2002 Medicare fee schedule amounts and the median 2002 price paid under the Federal Employee Health Benefit plans surveyed by the OIG. Among other provisions, most of which are effective January 1, 2005, are:
- Adjustment of previously paid claims for codes K0646 and K0648 submitted between July 6, 2004, and January 1, 2005, if resubmitted on or after January 1, 2005
- An increase of 3.3 percent to fee schedule amounts for class III DME, but no increase for items that are not classified as class III devices by the FDA
- New HCPCS codes with corresponding fee schedule amounts
6. STUDY FINDS CONSUMERS CONCERNED ABOUT HEALTHCARE SAFETY
Despite efforts by hospitals, physicians, health plans, and purchasers to reduce medical errors and improve the quality of care, Americans say they do not believe that the nation’s quality of care has improved, according to a new survey by the Henry J. Kaiser Family Foundation, the U.S. Agency for Healthcare Research and Quality, and the Harvard School of Public Health.
The mid-2004 telephone survey of 2,012 U.S. residents found that almost half (48 percent) of the respondents say they are concerned about the safety of health care today, and more than half (55 percent) of respondents say they are dissatisfied with healthcare quality in the United States. Additionally, nine in 10 (88 percent) say that physicians should be required to tell a patient if a preventable medical error resulted in serious harm.
7. QUICK LINK
LEAPFROG REPORT: HOSPITALS IMPLEMENTING SAFETY MEASURES. On November 16, the Leapfrog Group released a survey measuring hospitals’ progress toward reaching the group’s patient safety goals.
8. IN THE HFMA RESOURCE CENTER
HFMA EXECUTIVE ROUNDTABLE: ISSUES IN UP-FRONT COLLECTIONS. Self-pay accounts are surging as more Americans are uninsured or face increased cost-sharing. Read about the experiences of a group of healthcare finance executives in using proactive collection strategies to address this trend.
UPDATED! KEY HOSPITAL FINANCIAL STATISTICS AND RATIO MEDIANS. HFMA's popular compilation of national key financial statistics has been updated for 2004.
Copyright 2004 Healthcare Financial Management Association, all rights reserved. HFMA Express News ISSN: 1540-0689. Volume XI, Number 48.
For customer service, send an e-mail to HFMA’s Member Service Center or call (800) 252-HFMA, and press 2.