Medicare Fee Schedules
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Other Updates | |
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email inquire@hwco.com for questions, or visit our Healthcare Services page for more info. |
2008 Medicare Fee Schedules:
We are pleased to provide you with the Medicare Fee Schedules (in PDF format found in the links above) for Ohio, effective January 1, 2008.
IMPORTANT: Be sure to forward these files to your billing department
The Centers for Medicare and Medicaid Services (CMS) was delayed in posting the fee schedule data until the first week of January due to the passage of the Medicare, Medicaid, and SCHIP Extension Act of 2007 in late December. The law temporarily rescinds a scheduled payment cut for Part B services, including rehabilitation therapies, allowing for a 0.5% increase instead of the scheduled 10.1% cut. In the absence of further action by Congress to extend the law, the payment cuts are scheduled to go into effect on July 1, 2008. If you received fee schedules from any other source, please ensure that they were calculated using the revised files. We will keep you informed of any action that Congress takes regarding the fee schedules and any payment cuts that could potentially go into effect.
Our Billing Consultants are available to assist with any billing questions you may have. Please contact your HW Healthcare Advisor if you need additional codes, fee schedules for any other states, or if you would like a copy of the schedules in Excel format.
Many of the fee schedules change or are updated on a quarterly basis. Please review the appropriate schedule based on the Centers for Medicare & Medicaid Services (CMS) updates. Check the CMS website(cms.hhs.gov) on a regular basis for updates to these schedules. Please note that these schedules are not all inclusive. We have attempted to limit this information to the most commonly used Healthcare Common Procedure Coding System (HCPCS) codes for long-term care facilities.
Many providers use only the therapy fee schedules. We have provided the lab, radiology, PEN and DMEPOS schedules in order to help you identify potential cost savings for your Medicare Part A and Managed Care residents. The fee schedules may be useful in negotiating and verifying the rates being paid to ancillary services providers and will provide guidance to ensure you are paying a cost effective rate.
2008 Medicare Part A Co-Insurance and Medicare Part B Premium and Deductible
Effective January 1, 2008, the Medicare Part A co-insurance rate will increase to $128.00 (for days 21 to 100). The Medicare Part B monthly premium will be $96.40 and the Part B deductible will increase to $135.00.
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Therapy Cap Update
Effective January 1, 2008, the Medicare Part B therapy cap limit for Occupational Therapy alone and Physical/Speech Therapy combined is $1,810. The Medicare, Medicaid, and SCHIP Extension Act of 2007 provides a six month extension of the therapy caps extension process through June 30, 2008. Please remind your therapists and clinical staff to document for medical necessity and support the diagnosis code selected for billing. We will keep you informed if there are any new developments.
2006 Benchmarking Reports Now Available
HW Healthcare Advisors is able to offer a unique report, from all cost reports in the Ohio State Medicaid Cost Report Database, which benchmarks your facility to county, peer group, statewide and selected competitors average per diems, census, pricing analysis, average hourly wage, full time equivalent and average staffing hours per resident day.
We have found the benchmarking report to be an invaluable tool in the areas of:
1. Budgeting
2. Benchmarking
3. Evaluating:
* Financial results
* Staffing levels
* Staff compensation levels
4. Evaluating and understanding the Long-Term Care Industry
Here is a condensed sample of the report format as well as the 2006 order form. We also have the ability to compile one report for multiple facilities of a chain organization or custom design reports based upon selected attributes.
Please contact Paula Reape at (216) 831-1200 or preape@hwco.com if you have any questions or wish to customize your report.
Deficit Reduction Act (DRA) 2005 Enforcement Begins January 1, 2008
The Ohio Department of Job and Family Services has recently sent providers which received more than $5,000,000 in Ohio Medicaid payments from October 1, 2006 - September 30, 2007 a letter reminding them that they must be in compliance with the Deficit Reduction Act (DRA) 2005 requirements for Employee Education about False Claims Recovery. Medical Assistance Letter (MAL) 522 provides guidance on the implementation. Click here for a copy.
The DRA mandates that providers that meet the criteria must establish written policies for employees, contractors, or agents of the organization for detecting and preventing fraud, waste and abuse. In addition, employee handbooks must include a specific discussion of employees' rights to be protected as whistleblowers and the organization's policies and procedures for detecting and preventing fraud and abuse and waste. This is the first time Congress has mandated important compliance program elements.
Contact HW Healthcare Advisors for assistance with implementing the proper policies and procedures to be in compliance.
The Ohio Department of Aging has recently released the 2007 Resident Satisfaction Survey results. The statewide average satisfaction score was 86.2 (out of a possible 100). The Resident Satisfaction Survey results will be used as one of the eight accountability measures for the quality incentive add-on in fiscal year (FY) 2009. Family Satisfaction Survey results were used in FY 2008. Facilities above the statewide average of 86.2 will be awarded a quality point in the FY 2009 (7-1-08 to 6-30-09) Medicaid price calculation. For FY 2008, the point value was 81 cents per day. Actual price per point will be recalculated for FY 2009. For more details including a list of top 25 facilities go to:
http://www.goldenbuckeye.com/infocenter/news/n_2007-12-28_NHResSat2007.html
Long-Term Care Facility Annual Renewal Licensing Fee
The Ohio Department of Health has issued the following bulletin:
Reminder: A non-refundable annual renewal licensing fee of $170 for each 50 beds or part thereof of a facility's licensed capacity (e.g. $170 for 1 to 50 licensed capacity, $340 for 51 to 100 licensed capacity, etc.) is due by January 31, 2008 either postmarked or submitted online. Beginning the first day of February, a late fee of $100 will be charged for each week or part thereof the renewal fee is not paid.
Renew and pay electronically via the Enhanced Information Dissemination & Collection (EIDC) initiative at http://pubapps.odh.ohio.gov/EID.
If you have questions on any of these or any of the other healthcare services and solutions we provide, please feel free to contact Paula or your HW Healthcare Advisors Professional.
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Paula is a Principal in our HW Healthcare Advisors Group. She has over 20 years experience in the healthcare profession, specializing in long-term care, facility operation, third-party reimbursement consulting, and is a Licensed Nursing Home Administrator.