CMS Proposed SNF Payment System -- Resident Classification System: Version I (RCS-1)
|
|
- Jared Gallagher
- 5 years ago
- Views:
Transcription
1 CMS Proposed SNF Payment System -- Resident Classification System: Version I (RCS-1) Ohio Health Care Association Mike Cheek, Senior Vice President, Reimbursement Policy October 3, 2017 Background 1
2 FY18 Could Entail Two Rules and Two Sets of Comments, Again Notice of Proposed Rulemaking (NPRM) August: Begin Work on Rule October: Open Discussion Ends and Formal Drafting Begins January: Drafts Shared with OMB March: Final Draft Goes to OMB April: NPRM Published June: Comments Due July: Final Rule Released Advanced Notice of Proposed Rulemaking (ANPRM) - Comment Period Closed on August 25 th Comments Submitted All Negative - CMS not required to respond in Writing to Public Comments - Next steps for CMS could be nothing, proposed rule at any time, interim final rule at any time Background: How? Currently, therapy payments under the SNF PPS are based primarily on the amount of therapy minutes provided to a patient, regardless of the specific patient characteristics and care needs. Current CMS initiatives have moved towards paying providers based on resident characteristics and assessing value rather than paying directly for input use. Move from payment based on volume to payment based on patient characteristics 2
3 Why is CMS Focused on Reforming SNF Payment Policy? SNF PPS Demonstration Evaluations Identified Payment Challenges Years Ago Nursing Home Casemix and Quality Demonstration (NHCQD) ( ) CMS Implements SNF PPS in 1998 CMS Attempts Adjustments by Adding RUGs and Changes in MDS to Address Therapy and NTA Concerns Balanced Budget Act of 1997 Includes SNF PPS Framework NHCQD Evaluation and CMS Preliminary Experiences Point to Problems in
4 Congressional and CMS Concern About Existing SNF Prospective Payment System Medicare Payment Advisory Commission (MedPAC) March 17 Report to Congress: Almost since its inception, the SNF PPS has been criticized for encouraging the provision of excessive rehabilitation therapy services and not accurately targeting payments for nontherapy ancillary (NTA) services. [CMS should] base therapy payments on patient characteristics (not service provision), remove payments for NTA services from the nursing component, [and] establish a separate component within the PPS that adjusts for payments for NTA services. Top 10 RUGs in 2014 by Claims Analysis RUG RUG Description Total Days 2014 Distinct Beneficiaries Per RUG Payment Per Payment Per Day Beneficiary Total Payment Percent Percent Total Total Days Payment RUB Ultra-High Rehab - ADL ,644, ,158 $496 $12,382 8,248,162, % 30.4% RUC Ultra-High Rehab - ADL ,287, ,153 $486 $13,444 5,971,130, % 22.0% RUA Ultra-High Rehab - ADL 0-5 8,353, ,764 $395 $7,846 3,301,240, % 12.2% RVB Very-High Rehab - ADL ,854, ,329 $339 $5,756 1,981,956, % 7.3% RVC Very-High Rehab - ADL ,568, ,308 $391 $7,499 2,177,103, % 8.0% RVA Very-High Rehab - ADL 0-5 4,236, ,643 $333 $5,296 1,412,053, % 5.2% RHC High Rehab - ADL ,108, ,839 $320 $5, ,540, % 2.5% RHB High Rehab - ADL ,761, ,267 $285 $3, ,503, % 1.9% RHA High Rehab - ADL 0-5 1,445, ,842 $243 $3, ,643, % 1.3% RMC Medium Rehab - ADL ,075,592 73,013 $263 $3, ,006, % 1.0% Source: AHCA Analysis of CMS Skilled Nursing Facility Public Use File 4
5 Percent of RU MDS Assessments Between Minutes, 2013 Source: CMS Analysis of MDS Assessments Advanced Notice of Proposed Acumen Proposal Rulemaking 5
6 Offers Overview of Acumen Resident Classification System (RCS) Version 1 Concept Five year research project Four technical expert panels (TEPs) held Therapy, Nursing, and two final TEPs on the overall payment revision design Framework for Research Remain within existing statutory authority Use existing data sources Develop an approach which is readily implementable Proposed Revised PPS Essentially is a New PPS RUGs and minutes replaced by mutually-exclusive resident groups based on resident characteristics and additional adjustments Technically defined as per diem odaily payments based on % of stay of care costs within each resident group Per-diem payments taper by PT/OT and NTA components over course of stay Per-diems would vary by components resident groupings set for stay at admission Per diem would be based on the sum of five components 6
7 The Impact of Data Analyses How was historical claim data used when developing the RCS-I? Claims data was analyzed for all sections in the proposed payment system including: Which sections of the MDS align with increased or decreased use of PT, OT and SLP services? How do therapy disciplines provide care during the course of the stay in regards to frequency and intensity? How do therapy providers relate to each other in trends for providing care? Which diagnoses do we treat as relates to acute care DRG? Why the focus on DRG Dx? SNF claims data are missing specific dx info on residents with more than 40% of residents being assigned generic V codes under ICD-9 Principle diagnoses from the inpatient stay is predictive of therapy costs and more predictive of NTA costs than the SNF claim. Challenge How long does it take the SNF to receive the acute care DRG? 7
8 Skilled Nursing Facility Level of Care Definition Has NOT Changed Care in a SNF is covered if all of the following four factors are met: The patient requires skilled nursing services or skilled rehabilitation services, i.e., services that must be performed by or under the supervision of professional or technical personnel (see ); are ordered by a physician and the services are rendered for a condition for which the patient received inpatient hospital services or for a condition that arose while receiving care in a SNF for a condition for which he received inpatient hospital services; The patient requires these skilled services on a daily basis (see 30.6); and As a practical matter, considering economy and efficiency, the daily skilled services can be provided only on an inpatient basis in a SNF. (See 30.7.) The services delivered are reasonable and necessary for the treatment of a patient s illness or injury, i.e., are consistent with the nature and severity of the individual s illness or injury, the individual s particular medical needs, and accepted standards of medical practice. The services must also be reasonable in terms of duration and quantity. Other Key Requirements and Programs NOT Impacted by RCS-1 Requirements of Participation IMPACT Act Quality Reporting Program PAMA SNF Re-Hospitalization Value-Based Purchasing Program Payroll-Based Journal Reporting Requirements 8
9 RCS-I Structure Current SNP Prospective Payment System None Minutes Individual Length Of Stay Impact Payment Unit of Measure Modes of Treatment Allowed Concurrent Group capped at 25% MDS Assessment to Determine RUG RUG level based on: Scheduled assessments: 5, 14, 30, 60 and 90 day. Rolling 7 day checkpoint to determine any increase or decrease in total therapy minutes 9
10 Resident Classification System, Version I Length Of Stay Impact PT/OT incremental payment decrease after day 14 NTA adjustment factor for days 1 to 3 at 3.00 and then setting it at 1.00 Individual Modes of Treatment Allowed Concurrent capped at 25% (this may be made discipline specific) Group capped at 25% (this may be made discipline specific) MDS Assessment to Determine RCS 5-day SNF PPS scheduled assessment to classify into RCS level. No additional assessments/change to RCS level unless criteria for a significant change hit MDS Schedule Fundamentally Changes Proposed MDS Schedule 5 Day Unclear how IMPACT Act requirements for a Comprehensive Person- Centered Plan of Care will interact Discharge Current MDS Schedule 5 Day 30 Day 90 Day 14 Day 60 Day Discharge 10
11 Other Important features Only two required MDS admission and discharge but may request a Significant Change assessment as needed Concurrent therapy would be limited to 25% of total therapy minutes, in addition to the existing 25% limitation on group therapy leaving 50% for one-to-one Envisioned to be a budget neutral change at this point but subject to final decision Creates an interrupted stay policy </= 3 days following a discharge and readmit is counted as same stay > 3 days following a discharge and readmit is counted as a new stay and requires a new five day assessment Operational Considerations and Issues Require SNFs to obtain on admission, hospital diagnosis, treatment, and other clinical and possibly patient demographic information that is not currently available, and that hospitals are not otherwise mandated to provide to SNFs Require CMS to significantly update The MDS 3.0 assessment instrument, RAI manual, and provider training materials Require CMS to update policy guidance and educational materials CMS Claims Processing Manual guidance CMS Benefit Policy Manual CMS Medicare Learning Network (MLN) and other educational materials related to SNF PPS Significant changes to Fiscal Intermediary (MAC) operations 11
12 5-Day Assessment Becomes Critical RCS-I considers the possibility of reducing the administrative burden on providers by concurrently revising the assessments that would be required under the RCS-I model Specifically, they are considering the possibility of using the 5-day SNF PPS scheduled assessment to classify a resident under the RCS-I model under consideration for payment purposes for the entirety of his or her Part A SNF stay, except as described below (SCSA, interrupted stay) Errors in the 5 day assessment could have notable implications particularly for low volume providers Significant Change Assessment Importance RCS- I also considers permitting providers to reclassify residents from the initial 5-day classification using the Significant Change in Status Assessment (SCSA), which is a Comprehensive assessment (that is, an MDS assessment which includes both the completion of the MDS, as well as completion of the Care Area Assessment (CAA) process and care planning), This would only be used in cases where the criteria for a significant change are met in cases where an SCSA is completed, considering an approach in which this assessment could reclassify the resident for payment purposes, but the resident s variable per diem adjustment schedule would continue rather than being reset on the basis of completing the SCSA. 12
13 Model RUGs IV RCS-I Payment Resident Resource Classification Utilization Group(RUG) System, Version I Structure MDS Assessme nts Impact of Length of Stay on Reimburse ment Therapy Treatment Modes Allowed with 23 Therapy levels and 43 Nursing levels RUG level based on scheduled assessment periods: 5, 14, 30, 60, and 90 day rolling 7-day checkpoint to determine any increase or decrease in total therapy minutes Reimbursement is based on volume of services received with assessment periods determining rate Individual, Concurrent, and Group (capped at 25%) Case Mix Groups with 30 PT/OT levels; 18 SLP levels; 43 Nursing levels; 6 Non- Therapy Ancillary (NTA) levels; and a Non- Case Mix Level (room and board) 5- day SNF PPS scheduled assessment to classify into the RCS case mix level for each of the 5 areas above. No additional assessments/changes to RCS case mix unless criteria are met for a significant status assessment Initial reimbursement rate determined by clinical categories on the MDS with consistent rate for SLP, and Nursing during course of care. A reduced rate is proposed after day 14 for the PT/OT case mix; and after day 3 for NTA. Individual; Concurrent and Group potentially capped at 25% Case Studies 13
14 Resident Example 1- Rehab Patient Component PT/OT SLP Data sources for resident characteristics and groupings vary by component Resident Characteristics and Groupings Clinical Category: Major Joint Replacement/Spinal Surgery Functional Score: Moderate to Severe Cognitive Impairment: No Clinical Category: Acute Neurologic Swallowing Disorder: No SLP Comorbidity or Cognitive Impairment: No Nursing Behavioral Symptoms and Cognitive Performance* NTAS Comorbidity/Extensive Service: Tier Very High** (IV Medication) *Presence of behavioral or cognitive symptoms identified. Final group determined by ADL score and number of restorative nursing services **Recommended comorbidity score is a weighted count of comorbidities and extensive services Resident Example 2 Medically Complex Component PT/OT SLP Resident Characteristics and Groupings Clinical Category: Medical Management Functional Score: Moderate to Severe Cognitive Impairment: No Clinical Category: Non-Neurologic Swallowing Disorder: No SLP Comorbidity or Cognitive Impairment: Neither Nursing Special Care Low* Data sources for resident characteristics and groupings vary by component NTAS Comorbidity/Extensive Service: Tier Medium (Multiple Sclerosis) *Presence of behavioral or cognitive symptoms identified. Final group determined by ADL score and number of restorative nursing services **Recommended comorbidity score is a weighted count of comorbidities and extensive services 14
15 Different Per-Stay Payment Patterns: Rehab vs. Medically Complex Resident Ex. 1 - Rehab Resident Ex. 2 - Medical Days 1-3 Days 4-14 Day 30 Day 40 Day 100 PT/OT SLP Nursing NTAS Days 1-3 Days 4-14 Day 30 Day 40 Days 100 PT/OT SLP Nursing NTAS Possible Payment Implications Therapy Payment system redesign goal is to reduce therapy component margins Likely would see decreases in payments for traditional RU and possibly RV patients by reallocating nursing and NTA dollars Nursing Acumen appears to have re-weighted to favor nursing for complex patients Nursing payments are intended to be higher Unclear due to use of old STRIVE approach and cost-to-charge ratio data Non-Therapy Ancillaries (NTA) Acumen proposes to use 43% of the current nursing component funding to finance the NTA component Acumen uses Part D drug data as a proxy in its NTA component design Intended to more accurately reimburse for these costs but as yet unclear 15
16 Key Comment Areas Key AHCA Comments Coordinated with SNF Coalition SNF Stakeholders AHCA Interdisciplinary Work Group Reimbursement Clinical Practices Legal Quality Major Comment Areas Impact Analysis Diagnosis & Classification MDS Redesign Staff & Operations Post-Discharge Follow Along Component Analysis Compliance and Program Integrity Patient Protections LeadingAge Therapy Associations (ASHA, AOTA, APTA) NASL AMDA Beneficiary Groups Consultant Pharmacists AHA 16
17 More Information on Proposal and Rationale Advanced Notice of Proposed Rulemaking Acumen RCS Version 1 Technical Report SNF Public Use File Data CMS Therapy Utilization Memo OIG Report on Need for SNF Payment Overhaul 17
Patient-Driven Payment Model
Patient-Driven Model Why a New System? Top 10 RUGs in 2015 Comprise 90% of SNF Days and 92% of SNF s RUG RUG Description Total Days 2015 Distinct Beneficiaries Per RUG Per Day Per Beneficiary Total Percent
More information2/20/2018. Resident Classification System RCS-1. CMS Proposal
Resident Classification System RCS-1 CMS Proposal Resident Classification System I (RCS-I) Complete overhaul of the Medicare A payment system (replacing RUGs-IV) On April 27, 2017 CMS released an Advance
More informationMedicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I
Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I Introduction to the Resident Classification System - I Concepts Structure Implications RCS is NOT the Unified
More information6/12/2017. The Rumor is True: A New PPS Payment System is on the Horizon Presented by: RKL, LLP Senior Living Services Consulting Group
The Rumor is True: A New PPS Payment System is on the Horizon Presented by: RKL, LLP Senior Living Services Consulting Group 1 Speaker Introductions Stephanie Kessler, RAC-CT Partner 717.885-5724 skessler@rklcpa.com
More informationSNF proposed rule revisions to case-mix methodology
SNF proposed rule revisions to case-mix methodology Comments due: August 25, 2017 CMS intent to propose case-mix refinements in the FY 2019 SNF PPS proposed rule Summary of changes Goals of the change:
More informationMedicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I ZIMMET HEALTHCARE 2018
Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I Introduction to the Resident Classification System - I Concepts Structure Implications RCS is NOT the Unified
More informationPatient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model
Patient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model By Devin Kassi, PT, DPT, and Melissa Keiter, RN, RAC-CT, DNS-CT, DON Centers for Medicare & Medicaid Services
More informationObjectives 9/18/2018. Patient Driven Payment Model(PDPM) Janine Finck Boyle, MBA/HCA, LNHA Vice President of Regulatory Affairs Fall 2018
Patient Driven Payment Model(PDPM) Janine Finck Boyle, MBA/HCA, LNHA Vice President of Regulatory Affairs Fall 2018 Mission: The trusted voice for aging. Objectives List the five(5) case mix components
More informationThe Shift is ON! Goodbye PPS, Hello RCS
The Shift is ON! Goodbye PPS, Hello RCS Presented By Maureen McCarthy, RN, BS, RAC-MT, QCP-MT President/CEO Maureen McCarthy, RN, BS, RAC-MT, QCP-MT Maureen is the President of Celtic Consulting, LLC and
More informationGoodbye PPS: Hello RCS!
Disclosure of Commercial Interests I consult for the following organizations: Celtic Consulting LLC President, CEO Celtic Consulting is a Long-Term Care advisory firm, focused on providing one-on-one oversight
More informationMedicare Skilled Nursing Facility Prospective Payment System
Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Program Year: FY2019 August 2018 1 TABLE OF CONTENTS Overview and Resources... 2 SNF Payment Rates... 2 Wage Index and Labor-Related
More informationProposed RCS-1 & It s Impact on Therapy Services- Will it Happen? Krista Olson, MS,CCC-SLP
Proposed RCS-1 & It s Impact on Therapy Services- Will it Happen? Krista Olson, MS,CCC-SLP Objectives: What is RCS-1? Why the proposed change in payment system? Differences between RCS-1 and current PPS
More informationMedicare Program; Prospective Payment System and Consolidated Billing for Skilled. AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
This document is scheduled to be published in the Federal Register on 05/04/2017 and available online at https://federalregister.gov/d/2017-08519, and on FDsys.gov DEPARTMENT OF HEALTH
More informationCMS (Medicare), Patient Driven Payment Model PDPM. Presented by: Cindy Gensamer, MBA, HSE, LNHA Vice President Absolute Rehabilitation
CMS (Medicare), Patient Driven Payment Model PDPM Presented by: Cindy Gensamer, MBA, HSE, LNHA Vice President Absolute Rehabilitation What is it? PDPM Released in Final Rule 7-31-18 Effective 10-1-19 Patient
More informationWhat Every Administrator Needs to Know About the PROPOSED Patient Driven Payment Model (PDPM)
What Every Administrator Needs to Know About the PROPOSED Patient Driven Payment Model (PDPM) Presented by: Robin L. Hillier, CPA, STNA, LNHA, RAC-MT robin@rlh-consulting.com (330) 807-2850 PDPM Overview
More informationJune 26, Dear Ms. Verma:
Seema Verma Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201 RE: CMS 1696 Medicare Program; Prospective Payment
More informationAugust 25, Dear Ms. Verma:
Seema Verma Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201 CMS 1686 ANPRM, Medicare Program; Prospective
More informationCMS Requirements of Participation Facility Assessment
HEALTHCARE I N S I G H T S May 2017 THE NEWSLETTER FROM LOEB & TROPER FOR NURSING HOMES AND HOME CARE AGENCIES CONTENTS CMS Requirements of Participation Facility Assessment Managed Care Contracts and
More informationMedicare Part A Update
Medicare Part A Update Jennifer Bogenrief, JD Manager, Regulatory Affairs AOTA AOTA Specialty Conference: Effective Documentation Friday, September 12, 2014 1 Topics Medicare Therapy Documentation Requirements
More informationMEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW OHA Finance/PFS Webinar Series. May 10, 2016
MEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW 2016 OHA Finance/PFS Webinar Series May 10, 2016 Spring is Medicare PPS Proposed Rules Season Inpatient Hospital Long-Term Acute Care Hospital Inpatient Rehabilitation
More informationPEPPER for Home Health Agencies and Skilled Nursing Facilities: Practical Applications for Compliance
PEPPER for Home Health Agencies and Skilled Nursing Facilities: Practical Applications for Compliance April 19, 2016 Victor Kintz, Polaris Group and Kimberly Hrehor, TMF Agenda What is PEPPER? Focus: HHA
More information2014 AANAC 9_30_ AANA C AANA
2013 2014 AANAC AANAC 9_30_14 Expert Advisory Panel Guests Deb Myhre, RN, RAC-MT, C-NE Mark McDavid, OTR, RAC-CT Requirements for Successful Completion 1 Contact hour will be awarded for this continuing
More informationPatient Driven Payment Model 101
Patient Driven Payment Model 101 MARK MCDAVID, OTR, RAC-CT Presented by Why a New Payment Model? MedPAC has raised concerns about: Provider advantage Payment inequities for different patient types Patient
More informationAugust 30, [Contact Name] SNF Name, [Address Line 1] [Address Line 2] [City], B8 [ZIP]
Bridgepoint 1, Suite 300 5918 West Courtyard Drive, Austin TX 78730-5036 August 30, 2013 [Contact Name] SNF Name, 009168 [Address Line 1] [Address Line 2] [City], B8 [ZIP] RE: Program for Evaluating Payment
More informationRCS-1. (Resident Classification System-Version 1) New Medicare payment system: What to Expect!
RCS-1 (Resident Classification System-Version 1) New Medicare payment system: What to Expect! Presented by: Patricia J. Boyer Director of Clinical Services Wipfli LLP Wipfli LLP 10000 Innovation Drive,
More informationSkilled Nursing Facility Program for Evaluating Payment Patterns Electronic Report. User s Guide Sixth Edition. Prepared by
Skilled Nursing Facility Program for Evaluating Payment Patterns Electronic Report User s Guide Sixth Edition Prepared by Skilled Nursing Facility Program for Evaluating Payment Patterns Electronic Report
More informationRegulatory Compliance Risks. September 2009
Rehabilitation Regulatory Compliance Risks September 2009 1 Agenda - Rehabilitation Compliance Risks Understand the basic requirements for Inpatient Rehabilitation Facilities (IRFs) and Outpatient Rehabilitation
More information& Reward. Opportunity, Risk. HealthPRO Heritage National healthcare solutions firm specializing in Care ReDesign for top of market clients 9/5/2018
Opportunity, Risk & Reward Care Redesign Cross Continuum Connections Built on a Foundation of Clinical Innovation Elisa Bovee, MS OTR/L, Vice President of Clinical Strategies 2017 LeadingAge New York Annual
More informationThe President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary
Current Law The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform Summary Home Health Agencies Under current law, beneficiaries who are generally restricted to
More informationFinal Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2017
Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2017 August 2016 Table of Contents Overview and Resources... 2 Skilled Nursing Facility (SNF) Payment Rates...
More informationNational Association for the Support of Long Term Care
Seema Verma, Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence Avenue, SW Washington, D.C. 20201
More informationCHAPTER 6: MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM (SNF PPS)
CHAPTER 6: MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM (SNF PPS) 6.1 Background The Balanced Budget Act of 1997 included the implementation of a Medicare Prospective Payment System (PPS)
More informationPitch Perfect: Selling Your Services to LTC Facilities
Pitch Perfect: Selling Your Services to LTC Facilities Lou Ann Brubaker, President Brubaker Consulting www.brubakerconsulting.com 301 535 5449 brubak97@aol.com Linkedin Disclosure Lou Ann Brubaker is the
More informationFinal Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016
Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016 August 2015 Table of Contents Overview and Resources... 2 SNF Payment Rates... 2 Effect of Sequestration...
More informationMDS FOR THE ADMINISTRATOR: WHAT YOU NEED TO KNOW
MDS FOR THE ADMINISTRATOR: WHAT YOU NEED TO KNOW LIBBY YOUSE, LNHA Long Term Care Leadership Coach OBJECTIVES Understanding factors why MDS s are so important in your home Identify the effects it places
More informationThank you for joining us!
Thank you for joining us! We will start at 1 p.m. CT. You will hear silence until the session begins. Handout: Available at PEPPERresources.org in the SNF Training and Resources section. A recording of
More informationEqualizing Medicare Payments for Select Patients in IRFs and SNFs
Equalizing Medicare Payments for Select Patients in IRFs and SNFs Doug Wissoker Bowen Garrett A report by staff from the Urban Institute for the Medicare Payment Advisory Commission The Urban Institute
More informationJune 22, Submitted electronically
June 22, 2018 Seema Verma, MPH Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G Attn: CMS-1696-P Hubert Humphrey Building 200 Independence Ave,
More informationAll Medicare Advantage Organizations (MAOs), PACE Organizations, Cost Plans, and certain Demonstrations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE MEDICARE PLAN PAYMENT GROUP TO: FROM: SUBJECT:
More information11/23/2011. Proactive vs. Reactive Relationship
Overview Focus on Resident Voice Assessment Schedule EOT OMRA and New Resumption Items New PPS Assessment: COT OMRA CMS Clarifications Coding New Quality Measures Draft MDS and Care Planning as Risk Management
More information5/11/2017. Carol Maher, RN-BC, RAC-CT, RAC-MT, CPC. It s official!
Carol Maher, RN-BC, RAC-CT, RAC-MT, CPC It s official! 2 1 Capturing the services and resident characteristics provided to Medicare A residents in specific timeframes. Determining the Medicare payment
More informationSeema Verma Centers for Medicare & Medicaid Services Department of Health and Human Services Attn: CMS-1696-P P.O. Box 8016 Baltimore, MD
June 26, 2018 Seema Verma Centers for Medicare & Medicaid Services Department of Health and Human Services Attn: CMS-1696-P P.O. Box 8016 Baltimore, MD 21244-1850 Re: CMS-1696-P Medicare Program; Prospective
More informationJanuary 10, Glenn M. Hackbarth, J.D Hunnell Road Bend, OR Dear Mr. Hackbarth:
Glenn M. Hackbarth, J.D. 64275 Hunnell Road Bend, OR 97701 Dear Mr. Hackbarth: The Medicare Payment Advisory Commission (MedPAC or the Commission) will vote next week on payment recommendations for fiscal
More informationExecutive Summary. This Project
Executive Summary The Health Care Financing Administration (HCFA) has had a long-term commitment to work towards implementation of a per-episode prospective payment approach for Medicare home health services,
More informationMedicare Program Integrity Manual Chapter 6 - Intermediary MR Guidelines for Specific Services
Medicare Program Integrity Manual Chapter 6 - Intermediary MR Guidelines for Specific Services Transmittals for Chapter 6 Table of Contents (Rev. 475, 07-19-13) 6.1 - Medical Review of Skilled Nursing
More informationMEDICARE PART A SNF PROSPECTIVE PAYMENT SYSTEM
MEDICARE PART A SNF PROSPECTIVE PAYMENT SYSTEM MDS 3.0 Captured Services as Qualifiers for Medicare Part A RUG-IV Grouper REHABILITATION Base Rates Urban Unadjusted AWI = 1.0000 ADL END 10/1/2017 INDEX
More informationHousekeeping. Harmony Healthcare International, Inc. The Devils in The Details: RUG Intimacy. Objectives. Copyright 2012 All Rights Reserved
The Devils in The Details: RUG Intimacy Harmony University The Provider Unit of (HHI) Presented by: Caroline Mullin, OTR/L Corporate Consultant/Denial Manager Housekeeping Sign In and Sign Out Contact
More informationGet A Seat at the Table
Get A Seat at the Table Develop Cross-Continuum Networks in the Competitive, Performance-Driven Senior Living Industry Hilary Forman, PT, RAC-CT Senior VP, Clinical Strategies Division, HealthPRO Heritage
More informationChapter 6 Section 3. Hospital Reimbursement - TRICARE DRG-Based Payment System (Basis Of Payment)
Diagnostic Related Groups (DRGs) Chapter 6 Section 3 Hospital Reimbursement - TRICARE DRG-Based Payment System (Basis Of Payment) Issue Date: October 8, 1987 Authority: 32 CFR 199.14(a)(1) 1.0 APPLICABIITY
More informationMDS 3.0: What Leadership Needs to Know
MDS 3.0: What Leadership Needs to Know especially prepared for CANPFA Ann Spenard RN, MSN History of the MDS and RAI Process The Resident Assessment Instrument (RAI) was part of a set of reforms enacted
More informationSWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals
SWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals Federal Regulations Hospitals under 100 Beds Critical Access Hospitals CMS State Operations Manual Appendix T Regulations and
More informationThe Prospective Payment System
Judy Wilhide Brandt, RN, BA, RAC-MT, QCP, CPC, DNS-CT judy@judywilhide.com 909-800-9124 www.judywilhide.com The Prospective Payment System January 2018 NC & VA Source: Current RAI Manual, Chapter 2 & 6
More informationDevelopment of Updated Models of Non-Therapy Ancillary Costs
Development of Updated Models of Non-Therapy Ancillary Costs Doug Wissoker A. Bowen Garrett A memo by staff from the Urban Institute for the Medicare Payment Advisory Commission Urban Institute MedPAC
More informationAll Medicare Advantage Organizations (MAOs), PACE Organizations, Cost Plans, and certain Demonstrations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE MEDICARE PLAN PAYMENT GROUP TO: FROM: SUBJECT:
More informationMedicare Home Health Prospective Payment System (HHPPS) Calendar Year (CY) 2013 Final Rule
Last updated 11/13/12 Contact: Advocacy@apta.org Medicare Home Health Prospective Payment System (HHPPS) Calendar Year (CY) 2013 Final Rule Introduction COMPREHENSIVE SUMMARY On November 2, 2012, the Centers
More informationA Critique of MedPAC s Post-Acute Care Prospective Payment System Prototype
A Critique of MedPAC s Post-Acute Care Prospective Payment System Prototype Model Review and Policy Recommendations Dobson DaVanzo & Associates, LLC Vienna, VA 703.260.1760 www.dobsondavanzo.com 2017 Dobson
More informationIMAGES & ASSOCIATES O UR S ERVICES OPERATIONAL REVIEW AND ENHANCEMENT
O UR S ERVICES OPERATIONAL REVIEW AND ENHANCEMENT The Prospective Payment System (PPS) for Inpatient Rehabilitation Facilities creates both opportunities and challenges for facilities that provide comprehensive
More informationDistrict of Columbia Medicaid Specialty Hospital Payment Method Frequently Asked Questions
District of Columbia Medicaid Specialty Hospital Payment Method Frequently Asked Questions Version Date: July 20, 2017 Updates for October 1, 2017 Effective October 1, 2017 (the District s fiscal year
More informationProposed Rule Summary. Medicare Inpatient Psychiatric Facility Prospective Payment System: Federal Fiscal Year 2015
Proposed Rule Summary Medicare Inpatient Psychiatric Facility Prospective Payment System: Federal Fiscal Year 2015 June 2014 Table of Contents Overview and Resources 1 IPF Payment Rates 1 Effect of Sequestration
More informationUnderstanding the PEPPER
Understanding the PEPPER and What It Means to Your IRF FIM, UDS-PRO, and UDSMR are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. Sue Gehrman,
More informationMEDICARE PROGRAM; FY 2014 HOSPICE WAGE INDEX AND PAYMENT RATE UPDATE; HOSPICE QUALITY REPORTING REQUIREMENTS; AND UPDATES ON PAYMENT REFORM SUMMARY
MEDICARE PROGRAM; FY 2014 HOSPICE WAGE INDEX AND PAYMENT RATE UPDATE; HOSPICE QUALITY REPORTING REQUIREMENTS; AND UPDATES ON PAYMENT REFORM SUMMARY On April 29, 2013, the Centers for Medicare & Medicaid
More informationChanges to the RAI manual effective October 1, 2013
Changes to the RAI manual effective October 1, 2013 CMS released on Friday, September 27 an updated version of the RAI manual that became effective October 1, 2013. The manual is found here> http://www.cms.gov/medicare/quality-initiatives-patient-assessment-
More informationCAH SWING BED BILLING, CODING AND DOCUMENTATION. Lisa Pando, Sr. Consultant GPS Healthcare Consultants
CAH SWING BED BILLING, CODING AND Lisa Pando, Sr. Consultant GPS Healthcare Consultants Learning Objectives: 1. Review Medical Necessity documentation specific to swing bed patients 2. Reasons to use the
More informationState FY2013 Hospital Pay-for-Performance (P4P) Guide
State FY2013 Hospital Pay-for-Performance (P4P) Guide Table of Contents 1. Overview...2 2. Measures...2 3. SFY 2013 Timeline...2 4. Methodology...2 5. Data submission and validation...2 6. Communication,
More informationCOMMONWEALTH OF KENTUCKY OFFICE OF INSPECTOR GENERAL AND MYERS AND STAUFFER LC PRESENT MDS CODING AND INTERPRETATION ANSWER SLIDES
COMMONWEALTH OF KENTUCKY OFFICE OF INSPECTOR GENERAL AND MYERS AND STAUFFER LC PRESENT MDS CODING AND INTERPRETATION ANSWER SLIDES WOULD YOU COMPLETE A SIGNIFICANT CHANGE IN STATUS ASSESSMENT? Example
More informationThe Home Health Groupings Model (HHGM)
The Home Health Groupings Model (HHGM) September 5, 017 PRESENTED BY: Al Dobson, Ph.D. PREPARED BY: Al Dobson, Ph.D., Alex Hartzman, M.P.A, M.P.H., Kimberly Rhodes, M.A., Sarmistha Pal, Ph.D., Sung Kim,
More informationpaymentbasics The IPPS payment rates are intended to cover the costs that reasonably efficient providers would incur in furnishing highquality
Hospital ACUTE inpatient services system basics Revised: October 2015 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 701 Washington, DC 20001 ph: 202-220-3700
More informationOutcomes Measurement in Long-Term Care (LTC)
ASHA Short Course Outcomes Measurement in Long-Term Care (LTC) Bill Goulding, MS/CCC-SLP November 19, 2012 How Do We Show Value? Easy to measure! Not so easy! V $$$ A L Impact? Cost U Benefit E What do
More informationMedicare Inpatient Psychiatric Facility Prospective Payment System
Medicare Inpatient Psychiatric Facility Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2016 Overview and Resources On April 24, 2015, the Centers for Medicare and Medicaid
More informationHOMECARE AND HOSPICE REIMBURSEMENT
Hospice Modeling Hospice Changes to Prepare for Medicare Reimbursement and Care Delivery Reform Robert J. Simione Managing Principal Simione Healthcare Consultants, LLC HOMECARE AND HOSPICE REIMBURSEMENT
More informationFederal FY2019 SNF PPS Proposed Rule, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program Analysis
Federal FY2019 SNF PPS Proposed Rule, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program Analysis Part I: Update to the SNF VBP and QRP Programs Part II: Payment Updates Part III: Patient-Driven
More informationUnitedHealthcare Medicare Readmission Review Program for Medicare Advantage Plans General Clinical Guidelines for Payment Review
UnitedHealthcare Medicare Readmission Review Program for Medicare Advantage Plans General Clinical Guidelines for Payment Review Introduction The UnitedHealthcare Medicare Readmission Review Program is
More informationPayment Methodology. Acute Care Hospital - Inpatient Services
Grid Medi-Pak Advantage generally reimburses deemed providers the amount they would have received under Original Medicare for Medicare covered services, minus any amounts paid directly by Original Medicare
More informationPayment Rule Summary. Medicare Inpatient Psychiatric Facility Prospective Payment System: Update Notice for Federal Fiscal Year 2013
Payment Rule Summary Medicare Inpatient Psychiatric Facility Prospective Payment System: Update Notice for Federal Fiscal Year 2013 August 2012 Table of Contents Overview and Resources... 2 Inpatient Psychiatric
More informationMedicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements [CMS-1629-P] Summary of Proposed Rule
Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements [CMS-1629-P] Summary of Proposed Rule TABLE OF CONTENTS Issue Page I. Introduction and Background
More informationMedicare Home Health Prospective Payment System Calendar Year 2015
Proposed Rule Summary Medicare Home Health Prospective Payment System Calendar Year 2015 August 2014 1 P age TABLE OF CONTENTS Overview, Resources and Comment Submission... 1 Home Health Payment Rates...
More informationValue Based Purchasing 101. About Matt. Learning Objectives. Harmony Healthcare International (HHI)
Value Based Purchasing 101 Matt Mc Garvey, MBA, VP of Business Development Harmony Healthcare International (HHI) We C.A.R.E. About Care Version 6.21.17 About Matt As Vice President of Business Development
More informationCMS-0044-P; Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 2
May 7, 2012 Submitted Electronically Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building
More informationMDS 3.0/RUG IV OVERVIEW
MDS 3.0/RUG IV Distance Learning Series January - May 2016 OVERVIEW In keeping with the success of their previous highly-rated distance learning education offerings, LeadingAge state affiliates and Plante
More informationHealth Management Policy
Health Management Policy Policy Number: 0101 Effective Date: 4/1/18 Policy Title: Circumvention of PPS/Readmission Review Applies To: Generations Advantage Purpose: The Martin s Point Health Care Medicare
More informationInpatient Psychiatric Facility (IPF) Coverage & Documentation. Presented by Palmetto GBA JM A/B MAC Provider Outreach and Education September 7, 2016
Inpatient Psychiatric Facility (IPF) Coverage & Documentation Presented by Palmetto GBA JM A/B MAC Provider Outreach and Education September 7, 2016 1 Disclaimer This information is current as of August
More informationWhat Did Your PEPPER Tell CMS?
What Did Your PEPPER Tell CMS? HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Matthew P. McGarvey, MBA Director of Business Development Speaker Bio:
More informationCMS s RAI Version 3.0 Manual October 2016
Presented by: CMS s RAI Version 3.0 Manual October 2016 RAI SOM CAAs MDS Resident Assessment Instrument Utilization Guidelines from the State Operations Manual Care Area Assessments Minimum Data Set Affinity
More informationDischarge to Community Measure
The Discharge to Community Measure determines the percentage of all new admissions from a hospital who are discharged back to the community and remain out of any skilled nursing center for the next 30
More informationActing Assistant Secretary for Planning and Evaluation Centers for Medicare & Medicaid Services Department of Health and Human Services
September 13, 2017 Seema Verma John Graham Administrator Acting Assistant Secretary for Planning and Evaluation Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H.
More informationReading and Using the PEPPER Report
Reading and Using the PEPPER Report PANAC Webinar September 25, 2014 Stephanie Kessler Partner, Senior Living Services Consulting Group Disclaimer The information contained herein is of a general nature
More informationOverview of the Hospice Proposed Rule
HOSPICE Overview of Hospice Payment Reform Robert J. Simione Managing Principal Simione Healthcare Consultants On April 29, 2013 CMS issued the proposed rule that would update FY 2014 Medicare payment
More informationChapter 7 Section 1. Hospital Reimbursement - TRICARE Inpatient Mental Health Per Diem Payment System
Mental Health Chapter 7 Section 1 Hospital Reimbursement - TRICARE Inpatient Mental Health Per Diem Payment System Issue Date: November 28, 1988 Authority: 32 CFR 199.14(a) 1.0 APPLICABILITY This policy
More informationFinal Report No. 101 April Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003
Final Report No. 101 April 2011 Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 The North Carolina Rural Health Research & Policy Analysis
More informationTHE ART OF DIAGNOSTIC CODING PART 1
THE ART OF DIAGNOSTIC CODING PART 1 Judy Adams, RN, BSN, HCS-D, HCS-O June 14, 2013 2 Background Every health care setting has gone through similar changes in the need to code more thoroughly. We can learn
More informationSkilled nursing facility services
C h a p t e r8 Skilled nursing facility services R E C O M M E N D A T I O N S (The Commission reiterates its previous recommendation on updating Medicare s payments to skilled nursing facilities. See
More informationMDS Accuracy and Compliance: Where There s Smoke
MDS Accuracy and Compliance: Where There s Smoke November 2014 1 Objectives List the current trends in the Long Term Care industry that are driving scrutiny into the MDS assessment process Identify the
More informationClinical. Financial. Integrated.
Clinical. Financial. Integrated. April 2015 Table of Contents When are the rule changes effective? What is changing? What requirements must be met to avoid payment at the site neutral rate? How is the
More informationThe Medicare Prospective Payntent Systent
The Medicare Prospective Payntent Systent (Medicare, occupational therapy, prospective payment systems, third party reimbursement) Susan J. Scott In 1983 Congress adopted the most significant change in
More informationMedi-Pak Advantage: Reimbursement Methodology
Medi-Pak Advantage: Reimbursement Methodology The information located on the following pages is intended to summarize the reimbursement methodologies for Medi-Pak Advantage: Medi-Pak Advantage reimburses
More informationMedicare 101. Lisa Satterfield, ASHA director, health care regulatory advocacy Neela Swanson, ASHA director, health care coding policy
Medicare 101 Lisa Satterfield, ASHA director, health care regulatory advocacy Neela Swanson, ASHA director, health care coding policy Neela Swanson Director, Health Care Coding Policy, ASHA Disclosure
More informationA Primer on Activity-Based Funding
A Primer on Activity-Based Funding Introduction and Background Canada is ranked sixth among the richest countries in the world in terms of the proportion of gross domestic product (GDP) spent on health
More informationMEDICARE INPATIENT PSYCHIATRIC FACILITY PROSPECTIVE PAYMENT SYSTEM
MEDICARE INPATIENT PSYCHIATRIC FACILITY PROSPECTIVE PAYMENT SYSTEM PAYMENT RULE BRIEF PROPOSED RULE Program Year: FFY 2019 OVERVIEW AND RESOURCES The Centers for Medicare & Medicaid Services released the
More informationUsing SNF Data to Manage Federal & State Audit Initiatives
Using SNF Data to Manage Federal & State Audit Initiatives 2012 OIG & GAO Reports In 2009 OIG estimated that 47% of claims had misreported information on the MDS that caused significant errors in Billing
More informationFor any new proposals presented to the Committee, ASHA respectfully requests the inclusion of the following principles:
American Speech-Language-Hearing Association Statement for the Record for the Health Subcommittee of the Energy and Commerce Committee Examining Bipartisan Legislation to Improve the Medicare Program I,
More information