November 2009 Health Care Update

Health Care

Date:

11/25/2009

We are proud to bring you the latest developments and updates for the Health Care Industry. If you have any questions relating to these or any other industry updates, please feel free to contact our HW Healthcare Advisors directly at 877.FOR.HWCO.

We hope you find this information is helpful and wish you all a Happy Thanksgiving!

Medicare Rates
Therapy Cap Update
Medicare Billing Claims
The New PS&R System
Health Care Reform Impact
Proposed Rules for Chart & Cost Report Bundling
Credit Balance Reports
MDS Correction Date Changes
DME Competitive Bid Process

1. 2010 Medicare Part A Co-Insurance and Medicare Part B Premium and Deductible

Effective January 1, 2010, the Medicare Part A co-insurance rate for SNFs will increase to $137.50 per day for days 21 thru 100. The Part B deductible will increase to $155.00 per year. The Medicare Part B monthly premium for most beneficiaries will continue to be $96.40 since beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2010. New Part B beneficiaries and those that do not currently have the Part B premium withheld from their Social Security benefit will pay $110.50, which is a 15% increase over the 2009 premium. If income exceeds $85,000 (single) or $170,000 (married couple), the Medicare Part B premium may be higher than $110.50 per month.
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2. Therapy Cap Update

Effective January 1, 2010, the Medicare Part B therapy cap limit for Occupational Therapy alone and Physical/Speech Therapy combined is $1,860. The therapy cap exception process is set to expire on December 31, 2009. However, there is a provision in the Affordable Health Care for America Act (H.R. 3962), which passed in the House on November 7, 2009, to extend the current exceptions process for Medicare Part B therapy caps through December 31, 2011. 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.
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3. Medicare Billing Claims Set to Expire

The Medicare billing claims for the period of October 1, 2007 thru September 30, 2008, are set to expire on December 31, 2009. All claims must meet what is known as clean claim definition in order to be processed. Clean claim definition states that the claim does not contain a defect requiring the Medicare contractor to investigate or develop prior to adjudication. If the claim does not meet clean claim definition, the claim will be returned to the provider with no right to appeal. Be sure to review claims from this period to ensure you get reimbursed. Contact your HW Healthcare Advisor if you need assistance.
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4. Register Now for New PS&R System

The redesigned PS&R system will be used for any fiscal year ending on or after January 31, 2009. The fiscal intermediary is no longer required to send PS&R data to providers. Providers will request and receive their PS&R reports in the new CMS system via the internet. Providers must register in IACS (Individuals Authorized Access to the CMS Computer Services) to gain access to the redesigned PS&R. There may be a backlog when you need a PS&R, so providers should begin the registration process now to avoid delays since not filing a timely cost report may cause your payments to be interrupted. For more information about the redesigned PS&R and the enrollment process:

NGS website:
http://www.ngsmedicare.com/Content.aspx?CatID=1&DOCID=20807

CMS website:
http://www.cms.hhs.gov/PSRR

If you need help with the registration process; it is provided through CMS and you can contact the IACS help desk at 866-484-8049 or e-mail them at EUSSupport@cgi.com.
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5. Health Care Reform Impact On Medicare

The U.S. House of Representatives narrowly passed the Affordable Health Care for America Act (H.R. 3962) on November 7, 2009. If enacted, several provisions will impact long term care providers.

Beginning April 1, 2010, recalibrates rehab and non-therapy ancillary (NTA) Medicare PPS payments to SNFs. Medicare payments for patients requiring the most intense rehabilitation services will be decreased by 5.5 percent as a result. If enacted, current PPS rates for FY 2011 that were effective October 1, 2009 will be updated April 1, 2010 instead of October 1, 2010.

Cuts Medicare funding for skilled nursing facilities (SNFs) by $23.9 billion over ten years through two provisions that would eliminate SNF market basket updates and a Medicare productivity adjustment beginning in 2012.

Includes the RUGs IV overhaul detailed in the FY 2010 SNF PPS Update issued by CMS that goes into effect on October 1, 2010.

Implements significant new nursing home oversight measures through “transparency” provisions. These provisions include significant increases in civil monetary penalties as well as enhanced reporting and disclosure requirements.

Provides $6 billion over four years in dedicated Medicaid funding for nursing homes that meet specific criterion.

Extends the current exceptions process for Medicare Part B therapy caps through December 31, 2011.

Includes a pilot project for implementing a Medicare bundled payment system for post-acute care providers.

On Saturday, 11/21, the Senate voted to bring the HC reform bill to the floor. The Patient Protection and Affordable Care Act, H.R. 3590, is scheduled to begin debate on the floor of the Senate on November 29th. The Senate proposed bill in its current form is similar to that passed by the House of Representatives. Of significant difference is that the Senate bill proposed cuts to Skilled Nursing Facilities estimated at $14.6 billion over ten years, rather than the $23.9 billion over the same period provided for in the House Bill.

Stay tuned for more details as the health care reform bill is discussed further in the Senate...
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6. Proposed Rules Issued for H.B.1 Bundling Chart & Cost Report Changes

On November 16, 2009, ODJFS issued proposed rules which include changes to the nursing facility chart of accounts and cost report necessary to implement the H.B.1 Consolidated Services provisions (bundling). Click here for our November 18, 2009 eblast with details.
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7. Credit Balance Reports

Medicare Credit Balance reports are due at the end of each quarter and are to be filed electronically. The December 31, 2009, credit balance report is due no later than January 30, 2010. Due to the changes in the criteria to file a low utilization cost report, many providers previously exempt from completing the credit balance report are now required to file. Check with your business office personnel to ensure they are not continuing to check the box “qualify as low utilization provider” if you no longer qualify. Another tip on completing the hard copy certification page is to complete it in blue ink. To access the form click here: http://www.cms.hhs.gov/cmsforms/downloads/cms838.pdf
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8. MDS Correction Date Changes

Effective October 16, 2009, the Ohio Medicaid MDS correction period changed from 80 days to 45 days. This will impact corrections submitted for the reporting period end of September 30, 2009 and later.
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9. DME Competitive Bid Process – Reminder and Update

On November 17th, The Centers for Medicare and Medicaid Services (CMS) began soliciting round 1 rebids for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for the Cincinnati–Middletown and Cleveland-Elyria-Mentor CBSA’s in Ohio. Bids must be submitted online via DBidS by December 21, 2009 at or before 9:00 p.m. EST. Required hardcopy documents must be postmarked by 11:59 p.m. on December 21, 2009. DBidS information can be found at http://www.dmecompetitvebid.com.

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