HFMA Express News - September 09, 2005

Dear HFMA Members:

Thank you to everyone throughout the country who has contacted HFMA National to tell us what you are doing to support the hurricane recovery effort, suggest actions for HFMA, convey good wishes, and otherwise pull together as a community in this time of crisis.

HFMA has set up a special Hurricane Relief e-mail ListServe to help members communicate with each other in the wake of the disaster. There are already a couple requests for information, so please check the list to see if you can provide any insights. Click here to join. (You will receive instructions on how to send e-mails to the list when you confirm your subscription to the list).

HFMA staff has been in touch with the presidents of the Mississippi, Louisiana, and Alabama chapters to identify ways the Association can support the members in those states, and HFMA’s special task force for hurricane relief is hard at work on projects to develop tools and information to help members affected by this situation. We encourage your input on this topic, too.

Finally, healthcare finance leaders are among the many volunteers that HHS is seeking for relief efforts. To learn more and to register, go to the HHS "Health Care Professionals and Relief Personnel Volunteer Page" or call 1-866-KATMEDI (1-866-528-6334).  As the waves of refugees spread throughout the country and Katrina's aftermath touches more and more of HFMA's community, this year's chairman's theme, "The Business of Caring," strikes an ever deeper chord. We send you all wishes for strength, forbearance, and comfort in the time to come.

IN THIS WEEK’S ISSUE:  

1. Hurricane Recovery Financial Information for Providers
2. IRS Relaxes Deadlines for Benefit Plans and Form 990
3. CMS Proposes Limits on Prior Determination Services
4. Medical Necessity Certificates Dropped for Power Wheelchairs
5. CMS Town Hall Meeting Seeks Provider Feedback
6. OIG Reports on Medicare Outpatient Cardiac Rehabilitation
7. Leadership Competency Tool to be Introduced
8. Medicare Billing and Coding Update
9. Quick Links

1. HURRICANE RECOVERY FINANCIAL INFORMATION FOR PROVIDERS

Under its public health emergency authority, HHS has relaxed various regulations to make it easier for providers to respond to the healthcare needs of their communities. CMS has posted Frequently Asked Questions regarding waived Medicare regulations, such as the three-day hospital stay prior to SNF admission, the critical access hospital bed limit, and the use of psychiatric unit beds for acute care, and other questions.

For fiscal intermediary or contractor help with other Medicare issues, CMS urges the use of the standard toll-free contact numbers, if possible. Those can be found under the following links:

Alabama , Florida , Louisiana , Mississippi, Texas

If issues are unresolved at the fiscal intermediary level, help is also available through the CMS regional offices. For Florida, Alabama, and Mississippi, contact the Atlanta Region IV office: (404) 562-7390, (404) 562-7374, or (404) 562-7242. For Louisiana and Texas contact the Dallas Region VI office: (214)-767-6401, (214)-767-8123, or (214)-767-0250.

Due to the relocation effort, states outside the disaster area may have the need to reach key contacts at the state medical assistance offices.

2. IRS RELAXES DEADLINES FOR BENEFIT PLANS AND FORM 990

The IRS, the Employee Benefits Security Administration, and the Pension Benefit Guaranty Corporation have announced they are relaxing deadlines in connection with certain employee benefit plans because of damage in the Gulf Coast area caused by Hurricane Katrina.

IRS Notice 2005-60 provides that certain benefit plans will have until October 31 to make minimum funding contributions or apply for waivers if the deadline for such actions was from August 29 through October 30.

Deadlines for the submission of 990s were also extended to October 31.

3. CMS PROPOSES LIMITS ON PRIOR DETERMINATION SERVICES

CMS has published a proposed rule that would limit physician services for which prior coverage determination may be requested. Under the rule, CMS would establish an initial pool of 50 eligible physicians’ services with the highest allowed charges that are performed at least 50 times annually. The list would include plastic and dental surgeries that Medicare may cover under some circumstances and that have an average allowed charge of at least $1,000. Services that are subject to a national coverage determination would be excluded from this list.

The proposed rule also defined a “prior determination of medical necessity” as a decision by a Medicare contractor, before a physician’s service is furnished, as to whether or not the service is consistent with the medical necessity requirements for coverage. The proposed rule was published in the August 30 Federal Register, and comments are due October 31, 2005.

4. MEDICAL NECESSITY CERTIFICATES DROPPED FOR POWER WHEELCHAIRS

A certificate of medical necessity (CMN) is no longer required for power wheelchairs and power-operated vehicle Medicare claims, according to an interim final rule published in the August 25 Federal Register. Instead of a CMN, providers will need to include clinical documentation from a patient’s medical record with a written prescription to the supplier before the supplier delivers a power wheelchair or scooter to the beneficiary. CMS said it would make additional payments to practitioners for preparing the required documentation.

The rule requires physicians or practitioners to conduct face-to-face examinations of beneficiaries before prescribing power vehicles, and allows both physicians and treating practitioners to write prescriptions (currently, only specialists in physical medicine, orthopedic surgery, neurology, or rheumatology are allowed to prescribe these items.) Suppliers must get a written prescription within 30 days of the face-to-face exam before billing Medicare.

The rule goes into effect on October 25, and comments are due November 25.

5. CMS TOWN HALL MEETING SEEKS PROVIDER FEEDBACK

CMS will convene a Medicare Provider Feedback Town Hall meeting on September 12, from 2:00 - 4:00 PM EST, to gather opinions from providers, physicians, and suppliers on a variety Medicare policy and operational issues. For the Medicare provider and supplier community, it represents an opportunity to comment on issues of importance.

CMS says, “This feedback will be vital to the agency as we strive to implement innovative strategies that integrate input from our Medicare providers and suppliers and incorporate their perceptions and opinions into our work.” The meeting will be held in CMS’ auditorium, located at 7500 Security Boulevard in Baltimore, MD, and via teleconference at 1-877-357-7851, using conference ID 7970566.

6. OIG REPORTS ON MEDICARE OUTPATIENT CARDIAC REHABILITATION

In a recent audit of 34 hospitals, the OIG found that most hospitals inconsistently complied with Medicare outpatient cardiac rehabilitation coverage requirements for direct physician supervision and “incident to” services. Twenty-nine hospitals relied on emergency room physicians or “code” teams in other parts of the hospital to provide physician supervision when the medical directors were not available. The remaining five hospitals designated a particular physician to provide direct physician supervision. The OIG attributes the variation to inconsistent guidance provided in the Medicare Coverage Issues Manual, Hospital Manual, and the Intermediary Manual.

The OIG recommended that CMS clarify its national Medicare cardiac rehabilitation coverage requirements for direct physician supervision and “incident to” services, and suggested that the fiscal intermediaries educate hospitals on the clarified policy. CMS agreed to publish provider education materials to address those issues.

7. LEADERSHIP COMPETENCY TOOL TO BE INTRODUCED

A new interactive tool has been created to ensure that future healthcare leaders have the training and expertise they need to manage the nation’s healthcare organizations. Called the HLA Competency Directory, the tool was developed by the Healthcare Leadership Alliance, which comprises the nation’s top healthcare management professional societies, including HFMA.

The directory identifies 300 competencies that are important across diverse professional roles within healthcare management, categorized under leadership, communications and relationship management, professionalism, business knowledge and skills, and knowledge of the healthcare environment. The directory is in final testing now and will be highlighted on September 14-15 in Rosemont, Ill., at the symposium “Transforming Health Professional Education: Core Competencies, Microsystems, and New Training Venues,” hosted by the Joint Commission on Accreditation of Healthcare Organizations.

8. MEDICARE BILLING AND CODING UPDATE

New transmittals recently posted to the CMS web site include the quarterly update to correct coding initiative (CCI) edits, version V11.3, billing for devices under the hospital outpatient PPS, and the October 2005 update of the hospital outpatient PPS.

9. QUICK LINKS

2005 MEDICARE PHYSICIAN FEE SCHEDULE TRANSMITTAL REPLACED. Transmittal number 652, dated August 19, 2005, which included payment files issued to carriers based on the November 15, 2004, Medicare physician fee schedule final rule, has been rescinded and replaced with transmittal number 661, with amendments to the payment files.

FY06 HOSPICE CAP AMOUNT CHANGED. The hospice cap amount for the cap year ending October 31, 2005, has been changed to $19,775.51, CMS announced in transmittal 663. This new transmittal replaces transmittal 655, dated August 19. All other information in the new transmittal remains identical to that in the rescinded transmittal.

AMBULANCE FEE SCHEDULE WITHDRAWN. CMS is withdrawing the ambulance fee schedule covering the period January 1, 2000, to March 31, 2002, that was published on April 16, 2003. The fee schedule was in response to a court order associated with the case Lifestar Ambulance, Inc v. United States [211 F.R.D. 688 (M.D. Ga. 2003)], which was dismissed due to Lifestar’s “failure to exhaust its administrative remedies” before filing suit. Comments are due by October 31, 2005.

CMS ISSUES MEDICARE ADVANTAGE PROGRAM CORRECTION. CMS announced in the September 1 Federal Register that it inadvertently omitted several key provisions of the January 28, 2005, final rule establishing the Medicare Advantage program. The rule is scheduled to take effect January 1, 2006.   

For customer service, send an e-mail to HFMA’s Member Service Center or call (800) 252-HFMA, and press 2.

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