TKA removed from Medicare IPO list: Implications for SNFs

Mar 22, 2019
 | 
Billing Alert for Long-Term Care

In the final 2018 outpatient prospective payment system (OPPS) rule released by CMS, total knee arthroplasty, also known as total knee replacement (TKA/TKR), was removed from the Medicare inpatient-only (IPO) list. The IPO list includes procedures that are only paid under the hospital inpatient prospective payment system.

MedPAC makes recommendations for FFS payment updates in annual report

Mar 22, 2019
 | 
The Bottom Line

In their annual report to Congress, the Medicare Payment Advisory Commission (MedPAC) made policy recommendations for nine provider sectors in fee-for-service (FFS) Medicare, including recommendations against raising payment rates for both skilled nursing facilities (SNFs) and home health agencies. MedPAC recommends that Congress not increase base payment rates for SNFs in 2020 and suggests that Congress reduce base payment rates for home health agencies by 5 percent for 2020.

Updates to QIES won’t change the way providers submit data

Mar 01, 2019
 | 
The Bottom Line

CMS announces that starting in March, the Quality Improvement and Evaluation System (QIES), Certification and Survey Provider Enhanced Reports (CASPER) and Automated Survey Processing Environment (ASPEN) will undergo a series of modernizing enhancements. The agency clarified that once updated, the new system, Internet Quality Improvement and Evaluation System (iQIES), will not change how providers currently submit data to CMS.

2019 Revenue Integrity Symposium call for speakers—deadline extended through March 1

Feb 22, 2019
 | 
The Bottom Line

NAHRI is currently seeking speakers to present at the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16, 2019, at the Renaissance Orlando at SeaWorld in Orlando, Florida. We seek speakers to present on all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings. NAHRI will waive admission fees to the 2019 Revenue Integrity Symposium for all selected speakers and co-speakers. Click here to learn more and complete the call for speakers application. Contact NAHRI Director Jaclyn Fitzgerald at jfitzgerald@hcpro.com with questions.

What you need to know about CMS updates to Part B, Part D, and Medicare Advantage plans

Feb 22, 2019
 | 
Billing Alert for Long-Term Care

Between 2011 to 2016, Medicare fee-for-service drug spending increased from $17.6 billion to $28 billion under Medicare Part B. Medicare Part D total spending has almost doubled from 2010 to 2016, increasing from $77.5 billion to $146.1 billion, with costs projected to increase further, according to the Centers for Medicare & Medicaid Services (CMS). Drug prices for beneficiaries in the U.S. are also on the rise and can be found in places like Europe for up to 80% cheaper, according to NPR. The cause? A market full of hurdles and barriers to creating biosimilars (drugs with the same or similar active ingredients as the original and often available at a reduced price); current laws that prevent vendors from negotiating drug prices; and outrageous prices for essential drugs that treat ever-more-common chronic conditions, such as cancer, rheumatoid arthritis, and hepatitis C.

2019 Revenue Integrity Symposium call for speakers—deadline extended through March 1

Feb 15, 2019
 | 
The Bottom Line

NAHRI is currently seeking speakers to present at the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16, 2019, at the Renaissance Orlando at SeaWorld in Orlando, Florida. We seek speakers to present on all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings. NAHRI will waive admission fees to the 2019 Revenue Integrity Symposium for all selected speakers and co-speakers. Click here to learn more and complete the call for speakers application. Contact NAHRI Director Jaclyn Fitzgerald at jfitzgerald@hcpro.com with questions.

Navigating tax reform in 2019

Feb 01, 2019
 | 
Billing Alert for Long-Term Care

After speaking with a few subject matter experts about the new tax laws, Billing Alert for Long-Term Care has the good, the bad, and the salvageable for 2019 tax reform. For some long-term care (LTC) facilities, these changes will have significant dollar impacts on 2018 tax returns, while other facilities will slip through the IRS’ narrow cracks mostly unaffected. Just as the care plan for each resident should be individualized to his or her care needs, each facility’s approach to taxes this year should be customized to its unique situation. Here are a few changes to keep in mind and discuss with your certified public accountant (CPA) before submitting this year’s tax return.

CMS update changes requirements for functional reporting

Feb 01, 2019
 | 
The Bottom Line

CMS announced an update on therapy caps and functional reporting in an MLN Matters article dated January 25, 2019. Effective for dates of service on or after January 1, 2018, providers of therapy services shall continue to report the KX modifier on claims as applicable. The modifier no longer represents an exception request but serves as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record after the beneficiary has exceeded the threshold of incurred expenses

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