NF Franchise Fee Refund and Medicare Updates
|
|
||||||||||||
|
September 30, 2011 |
||||||||||||
|
|
For additional information and discussion on this topic, please get in touch with your regular HW&Co. professional or one of our HW Healthcare Advisors listed below.
Steven C. Anderson, CPA
John P. Fleischer, CPA
Paula Z. Reape, CPA, LNHA
Click here to see all our previous healthcare news releases and information.
|
|||||||||||
|
NF Franchise Fee Refund and Medicare Updates |
||||||||||||
|
Franchise Fee Refund Finally, we can share some news that does not involve budget cuts. Ohio Nursing facilities (NFs) will be receiving a franchise permit fee refund! The Ohio Department of Job and Family Services (ODJFS) has determined that the assessment to NFs for Fiscal Year (FY) 2011 has exceeded the Federal limit of 5.5% of net patient revenue. When the State collects more than the maximum allowable amount, a refund must be issued in the 1st Quarter of the next fiscal year. The total amount of the refund to all NFs is $22 million. The overpayment is the result of overstatement of estimated net patient revenue, which included a correction in how hospital-based units reported revenues. ICF/DD facilities were not impacted by the overstatement. Franchise Fee Assessment and Refund amounts are as follows:
The refund of the FY2011 overpayment will be reflected as a reduction to the 1st Quarter FY2012 payment, which is due December 15, 2011. Since the refund is for all 4 quarters of FY2011, most facilities will have a refund of $2.60 (.65 x 4) per day reflected on the assessments to be mailed by ODJFS on October 3, 2011. ODJFS has indicated that the Medicaid rate will not be adjusted. The franchise permit fee amounts for FY 2012 are $11.52 for up to 200 beds and $9.37 for beds above 200. The amount reimbursed in the Medicaid rate remains at $11.47.
As a reminder, the new PPS rates will be effective on October 1, 2011. We provided these rates, which included a rate cut of approximately 11%, in our e-blast from August 11, 2011. CMS issued a correction notice on September 26, 2011; however, the notice did not impact any Ohio CBSAs. Therefore, the rates we provided can be uploaded into your system for billing for dates of service on and after October 1. The final rule also included various changes to regulations for therapy. These changes included modifications to group therapy requirements and additional assessments for End-of-Therapy and Change-of-Therapy. A more detailed description of the changes is included in our previous e-blast. Please contact us if you would like an analysis of the impact on your facility.
CIGNA Government Services Transition to Occur on October 17, 2011 Beginning on October 17, 2011, CIGNA Government Services (CGS) will become the Part A Medicare Administrative Contractor (MAC) for Jurisdiction 15, covering Ohio and Kentucky. After that date, National Government Services will no longer have the authority to assist Ohio providers with Medicare Part A issues. It is imperative that you complete all necessary transition requirements, including Electronic Funds Transfer (EFT) re-enrollment, prior to that date in order to avoid a disruption in payment for Medicare services. CIGNA’s MAC transition website states “regardless of the date of service, all claims processing, customer service and payments will be handled by CGS, the J15 A/B MAC, upon the listed operational dates (October 17, 2011). Outgoing contractors will transfer all pending, historical, and in-process operations to CGS at that time, including but not limited to claims, appeals, re-openings, overpayment/recovery activities, and provider enrollment applications.” One area of concern to providers surrounding the transition is the status of biweekly pass-through payments for coinsurance bad debts. CIGNA recently notified providers that it intends to maintain the current payment schedule for pass-through payments. At this time, CIGNA has stated that they will not change the bad debt thresholds for receiving pass-through payments and for issuing lump sum payments. NGS has generally been requiring at least $50,000 of bad debts in order to receive pass-through payments. They have also been passing on issuing lump sum payments if the amount owed is less than $50,000. NGS will not process any credit balance reports for the quarter ending September 30, 2011. Credit balance reports received by NGS for the quarter ending September 30, 2011 will be held and forwarded to CGS for processing on October 17, 2011. Providers submitting their credit balance reports after October 13, 2011 should fax their credit balance reports for the quarter ending September 30, 2011 to CGS at (803) 462-2584. Credit balance reports being submitted with a check should be mailed to: CGS Part A Correspondence If you have any questions related to any Medicare issues, including the new rates, the changes to the therapy regulations or the MAC transition, please contact your regular HW Healthcare Advisor. |
||||||||||||
