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SPECIAL EDITION PULSE: Updated Sections to the MDS 3.0
As of July 15 2010, CMS has
released all updated sections of the
RAI User’s Manual for the MDS 3.0,
except for Appendix F. A list of the
major changes to each section included in Chapter 3 of
the manual is attached. |
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PART B PHYSICIAN FEE SCHEDULE
EXTENSION SIGNED INTO LAW
The Senate and House passed a short-term extenders
bill that will stop the 21.3% cut in the Medicare
Physician Fee Schedule (MPFS), which is the same
schedule used to pay for Part B therapies in nursing
facilities and replaced it with a 2.2% increase from
June 1 through November 30, 2010. President Obama
signed into law the “Preservation of Access to Care for
Medicare Beneficiaries and Pension Relief Act of
2010”, on June 25th. |
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Implementation of RUG-IV payment plan in 2010 to be interim measure
Section 10325 of the Patient Protection and Affordable Care Act (PPACA) includes a provision addressing Medicare payments for SNFs in FY 2011. This section mandates a delay in the introduction of the RUG-IV case mix classification system until FY 2012. In addition, it requires that version 3.0 of the Minimum Data Set (MDS 3.0) Resident Assessment Instrument will be implemented as planned in FY 2011. |
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Healthcare Reform Law and Mandatory Compliance Programs
The Patient Protection and Affordable Care Act (PPACA)
grants to the Secretary of the Department of Health & Human
Services the authority to require health care providers to adopt
compliance programs as a condition to enrollment or
revalidation in the Medicare, Medicaid and CHIP programs. |
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Congress Passes Legislation to Avoid 21.2% Medicare Cut Thru May 31, 2010
On April 15, 2010, President Obama signed into law
the “Continuing Extension Act of 2010”. This
legislation extends through May 31, 2010, the zero
percent update to the Medicare Physician Fee schedule
(MPFS), which is the same schedule used to pay for
Part B therapies in nursing facilities. The zero percent
update to the MPFS was in effect for claims with dates
of service January 1, 2010 through March 31, 2010.
The law is retroactive to April, 2010. |
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President Obama signs the healthcare reform bill into law
President Obama signed the healthcare reform bill into law on March 23, 2010. Listed in this special edition of the Polaris Pulse are a summary of key healthcare reform provisions affecting Long Term Care providers |
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PHYSICIAN FEE SCHEDULE FIX,
EXTENSION OF THERAPY CAP
EXCEPTIONS PROCESS
The Senate joined the house in approving H.R. 4691,
the Temporary Extension Act of 2010, which
President Obama signed into law. The Temporary
Extension Act of 2010 extends a number of
important Medicare provisions through March 31,
2010. |
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MDS 3.0 Updates - CMS posted the remaining sections of the new RAI User's Manual on January 27, 2010
The recently released sections include Chapter 2 –
Assessments for the RAI, Chapter 4 Care Area
Assessment (CAA) Process and Care Planning, and
Appendix C – CAA Resources. In addition to the
final RAI User’s Manual sections, CMS also posted
a new version of the MDS 3.0 item subsets and a file
that lists the changes that have been made to each of
the individual item subsets from the previously
posted versions. |
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2010 Medicare Physician Fee Schedule Updates
Temporary Delay in Part B Fee
Schedule Rate Change
On December 19th, the President signed into law H.R.
3326, the "Department of Defense Appropriations Act,
2010," which includes a zero percent Medicare Part B
Fee screen update through February 28, 2010.
This action staves off a 21% pay cut for Part B fee
screens scheduled for January 1, 2010. Congress will
continue to work in the new year on a physician fee
schedule fix |
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CMS has published parts of the RAI manual for MDS 3.0.
What is Published and What is Not:
Chapter One: RAI overview is published.
Chapter Two: Instructions and Schedule for when to
complete mandated and Medicare assessments is NOT
published yet.
Chapter Three: Item by Item coding directions is
published.
Chapter Four: Related to Care Area Triggers (CATS)
and CAAs (Care Area Assessment) (RAPs) is NOT
published yet.
Chapter Five: Submission and Correction procedures is
published.
Chapter Six: Medicare Skilled Nursing Home PPS is
NOT published yet.
Appendix A: Glossary of terms is published.
Appendix B: State agency and regional office contacts is
published.
Appendix C: CAA is NOT published.
Appendix D: Interviewing techniques is published.
Nothing surprising but should be helpful.
Appendix E: Cognitive Performance scale is published.
Appendix F: Draft Matrix is published.
Appendix G: References is published. |
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Coding of Flu Vaccine on the MDS
For the purposes of coding the MDS during the upcoming
flu season, Nursing Facilities should only code for the “Seasonal Influenza Vaccine.” You should not code the
MDS for the “H1N1 Influenza Vaccine.” Nursing
Facilities should follow guidance from the Centers for
Disease Control and Prevention (CDC) for specific
guidance for H1N1 Influenza. For the most up to date
and accurate information, it is recommended that you
frequently check the CDC Influenza Website (http://
www.cdc.gov/flu/). Any additional questions can be
directed to mds30comments@cms.hhs.gov. |
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OIG Work Plan for Fiscal Year 2010 - Nursing Homes
The OIG has released it’s work plan for FY 2010.
There are 17 SNF- related items that
will be reviewed.
1) Part B Services in Nursing Homes: Mental Health
Needs and Psychotherapy Services
2) Accuracy of Skilled Nursing Facility Resource
Utilization Groups Coding
3) Medicare Requirements for Quality of Care in
Skilled Nursing Facilities |
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Federal Guidelines Encourage Employers
to Plan Now for Upcoming Influenza
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Priority Order of Quality Indicator Survey (QIS)
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SPECIAL PRESENTATION—5 Star Quality Rating System
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RAC Attack! Are you ready for a RAC Audit?
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Proposed Changes to the Prospective Payment System and Rate Year 2010 Rates
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Medicare Announces Sites for
Pilot Program to Improve
Quality as Patients Move
Across Care Settings
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CMS Releases Updated Special Facility Focus List
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Revised Quality of Care Guidance at F309
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OIG Supplemental
Compliance Program Guidance for
Nursing Facilities
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New HIPAA Privacy Rule Guidance for Providers
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Revised Guidance to Surveyors - F325 & F371
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2009 Medicare Premiums
Deductibles and Coinsurance
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ICD-9-CM
ANNUAL UPDATE
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Fiscal Year 2009
Skilled Nursing Facility
Prospective Payment System
(SNF PPS) Final Rule
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Medicare Improvements for Patients and Providers Act, 2008
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SPECIAL EDITION PULSE - Update on Therapy Caps
June 27, 2008 special edition
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Therapy Cap Exception Process Update
June 25, 2008 edition
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Exceptions to Therapy Caps Restricted July 1, 2008
June 11, 2008 edition
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Assignment of Providers to MACs
May 5, 2008 edition
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2008 Medicare
Deductible, Coinsurance and Therapy Caps
January 8, 2008 |
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Fiscal Year 2008 OIG Work Plan
October 24, 2007 |
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CMS Issues New Survey Tag F373 - Paid Feeding Assistants
August 23, 2007 |
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Skilled Nursing Facility (SNF) Payment Rates for Fiscal Year 2008
August 10, 2007 |
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Revised F-Tags 323 adnd 324 - Accidents and Hazards
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CMS Announces NPI Data Dissemination Policy
June 13, 2007 |
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CMS Proposes SNF Payment Increase for Fiscal Year 2008
May 10, 2007 |
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CMS Issues Contingency Plan for the National Provider Identifier (NPI) Rule
April 11, 2007 |
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Medicare Payment Advisory Commission (MedPAC) Recommendations to Congress
March 28, 2007 |
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CMS Renames the Medicare/Medicaid Provider Number
March 13, 2007 |
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NPI - Do You Have It? Are You Sharing It? Are You Using It?
February 23, 2007 |
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Part B Therapy Cap Relief for 2007
January 3 , 2007 |
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Physician Fee Schedule 2007 - Final Rule
November 9, 2006 |
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Flu Season is Here -
Are you ready for the New Regulations and Quality Measures?
October 26, 2006 |
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Medicare Nursing Home Payments to Increase in 2007
August 1, 2006 |
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CMS Issues DRAFT Revision to Surveyor Guidance at F-Tag 309 - Pain
July 14, 2006 |
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CMS Issues Guidance for Benefits Exhaust and No-Payment Bills
June 12 , 2006 |
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Who, What, When, Why & How of the National Provider Identifier (NPI)
May 31 , 2006 |
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New, Revised and Draft Guidance to Surveyors Apr. 19, 2006 |
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Therapy Cap Exception Process Feb. 16, 2006 |
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Outpatient Therapy Caps Return for 2006 Jan. 16, 2006 |
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Rehab Plus Extensive Services – Criteria to Achieve and RUG Assignment Anomalies Dec. 16, 2005 |
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Medicare Part D & Its Impact on Nursing Home Surveys Nov. 10, 2005 |
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Revisions to the State Operations Manual for Long Term Care
Oct. 27, 2005 |
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CMS FAQs Related to Hurricane Katrina Sept. 20, 2005 |
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RUG Refinements Posed to Significantly Impact Your 2006 Budget
August 23, 2005 |
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Hepatitis B Transmission in Nursing Homes July 11, 2005 |
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New Independent, Expedited Review Process for SNF Notices of Non-Coverage June 15, 2005 |
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