IN THIS WEEK’S ISSUE:
- E-Claims Attachment Rule Comment Period Extended
- Medicare Rule Notes Exceptions to Electronic Claims Requirements
- Ambulance Service Payment Update Announced
- Hospice Care Payment and Coverage Rules Revised
- CAH Relocation Guidelines Given to State Survey Offices
- Special Forum Addresses SNF Time Study
- Quick Links
- New in the Resource Center
1. E-CLAIMS ATTACHMENT RULE COMMENT PERIOD EXTENDED
Providers now have until January 23, 2006, to comment on the HIPAA electronic healthcare claims attachments proposed rule. The proposed rule adopts two new X12N transaction standards: a Health Level Seven (HL7) messaging standard to carry clinical information in the response transaction and HL7 specifications for the content or questions that may be asked in each of the six attachment types. The attachment types covered by the proposed rule include laboratory results, emergency department services, ambulance services, clinical reports, medications, and nine rehabilitation specialties. CMS said it extended the deadline because of the highly technical nature of materials, the length of the 10 documents being reviewed, and the importance of ensuring their accuracy and usefulness to the industry.
2. MEDICARE RULE NOTES EXCEPTIONS TO ELECTRONIC CLAIMS REQUIREMENTS
A CMS rule released November 25 allows for “reasonable and limited” exceptions to the requirement for mandatory submission of electronic claims to Medicare, making final the earlier interim final rule implementing section 3 of the Administrative Simplification Compliance Act (ASCA). The ASCA required Medicare providers to submit claims electronically by October 16, 2003.
One exception applies to bills for which there is no method available for the electronic submission: claims filed by beneficiaries, roster billing of vaccinations, claims under Medicare demonstration projects, and claims where more than one health plan is responsible for payment before Medicare. The other exception listed was for small service providers or suppliers, with “small” defined by the statute.
3. AMBULANCE SERVICE PAYMENT UPDATE ANNOUNCED
Medicare payments for ambulance services will receive a 2.5 percent ambulance inflation factor (AIF) update in calendar year 2006, according to a notice in the November 25 Federal Register. The update, as required by law, must be the percentage increase in the Consumer Price Index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year.
For 2006, the national ground services fee schedule transitions to a blend comprised of 40 percent of the regional ground base rate and 60 percent of the national ground base rate. For air ambulance services, as of January 1, 2006, the total payment amount will be based on 100 percent of the national ambulance fee schedule.
4. HOSPICE CARE PAYMENT AND COVERAGE RULES REVISED
A final rule revising regulations that govern Medicare coverage and payment for hospice care was published by CMS on November 22. The revisions reflect current policy on the required documentation needed to support a certification or recertification of a terminal illness, admission to a Medicare hospice, and a new requirement allowing patient discharges from hospice under very limited circumstances. CMS notes that the final rule, effective January 23, 2006, incorporates most of the provisions contained in the proposed rule published on November 22, 2002. The new rule also expands the hospice benefit periods, clarifies hospice discharge procedures, provides guidance on hospice admission procedures, and addresses the changing needs of beneficiaries, suppliers, and the Medicare program.
5. CAH RELOCATION GUIDELINES GIVEN TO STATE SURVEY OFFICES
CMS recently gave state survey offices details of the requirements critical access hospitals (CAHs) must meet to maintain CAH status upon relocation. The letter addresses:
Criteria and procedures for determining if a provider remains essentially the same provider and serves the same community after relocation
Documentation to be included in a letter of attestation from a provider that wishes to relocate and maintain its provider agreement
The requirement to have an effective date before January 1, 2006, to participate in Medicare as a CAH using a grandfathered necessary provider designation
The letter also goes into the details of determining compliance with the relocation regulations’ 75 percent rule regarding maintenance of the same service area and services after relocation, as well as 75 percent of the same staff, including medical staff.
6. SPECIAL FORUM ADDRESSES SNF TIME STUDY
CMS has recently implemented a national nursing home staff time measurement study, the “Staff Time and Resource Intensity Verification (STRIVE) Project,” which is to provide some of the basis for updating the RUG-III payment system. The STRIVE project, CMS says, represents the first nationwide time study for nursing homes since 1997, and will collect staff time and resident-level clinical data regarding health status, medical conditions, services received, and facility resources used to provide care from a large sample of nursing homes. The Iowa Foundation for Medical Care will collect the data and provide analysis for the project.
CMS will hold a special open door forum on STRIVE on December 13, from 2:00 p.m. to 3:30 p.m. EST, to review the scope of the project and allow public discussion on topics such as the scope and objectives of the project. To participate, dial 1-800-837-1935 and refer to conference ID 2654075.
7. QUICK LINKS
SNF PSS UPDATES. CMS has revised pertinent sections of the Medicare Benefits Policy Manual to reflect the new definition of “indirect employment relationship” for certification and recertification for extended care services, included in the FY06 SNF PPS final rule.
UPDATED OIG EXCLUSIONS. The OIG has posted the full updated list of excluded individuals and entities database file reflecting all OIG exclusion and reinstatement actions through October 2005.
UPDATED INTEGRITY AGREEMENTS. The OIG has posted an updated list of its recent corporate integrity agreements and settlement agreements with integrity provisions.
NURSING HOME OCCUPANCY RATES. Nursing home occupancy rates reached 93.3 percent during the third quarter 2005, up from 92.7 percent in the previous quarter, reversing a recent trend of declining occupancy rates, according to NIC’s third quarter 2005 Market Area Profiles data.
8. NEW IN THE RESOURCE CENTER
2006 MEDICARE PHYSICIAN FEE SCHEDULE FINAL RULE HIGHLIGHTS. Use this handy reference to guide you through the highlights of the latest physician fee schedule update.
Copyright 2005 Healthcare Financial Management Association, all rights reserved. HFMA Express News ISSN: 1540-0689. Volume 12, Number 47. Editor: Rob Fromberg, rfromberg@hfma.org, (800) 252-HFMA, ext. 385.
For customer service, send an e-mail to HFMA’s Member Service Center, memberservices@hfma.org, or call (800) 252-HFMA, and press 2.
PricewaterhouseCoopers is pleased to sponsor this weekly update of critical financial and regulatory issues.