In March's issue of ACT's Senior Living Connection, we shared information about the new Health and Human Services Secretary, Alex Azar and his focuses. Recently, Azar appointed Adam Boehler as the new Director for the Center for Medicare and Medicaid Innovation (CMMI). This is likely good news for healthcare providers, as Boehler is the founder and former Chief Executive Officer of Landmark Health, a home health provider. One of the purposes of CMMI is to identify new payment models. According to quotes made by Azar, his goal is to "create a true competitive playing field where value is rewarded handsomely." Based on the appointment and Azar's statements, it appears the focus on rewarding quality service will be on the forefront.
The Office of Inspector General (OIG) has issued a report stating that 61% of Medicare claims for outpatient physical therapy services reviewed did not comply with the Medicare medical necessity, documentation, or coding requirements. While the sample size used was only 300, the findings indicate a pattern. Based on the findings, the OIG estimates that during the six month audit period, $367 million dollars was paid out on claims that did not comply with the Medicare requirements. According to the
, Centers for Medicare and Medicaid Services (CMS) disagreed with some of the OIG findings.
Coming Down the Pike
CMS has issued a final
2019 Payment Notice Rule addressing health insurance in an attempt to mitigate some of the problems resulting from Obamacare. To promote more flexibility overall, including more choice in health care plans and lower premiums, the states will regain more local control. Consumers should benefit by having an increased choice in plans that fit their specific needs and lower health premiums, as well as stabilization of the premium growth. CMS has also expanded hardship exemptions for individuals who cannot afford health insurance coverage.
Are you monitoring the Resident Classification System, Version 1 (RCS-1) dialogue?
ACT is. Memos, internet articles, and training sessions are being offered. We are participating in the training and monitoring the information and status. At present, there has been no formal action taken since the Summary of Advance Notice in the Spring of 2017. We will continue to monitor activity and help keep you abreast of updates.
In Effect and Important
The Skilled Nursing Facility (SNF) Value Based Payment (VBP) program and the SNF 30-day All-Cause Readmission Measure (SNFRM) is currently in effect. Payment incentives will begin in October 2018 for the Fiscal Year (FY) 2017 data. Rehospitalizations continue to be monitored and will continue to impact future payment. CMS plans to post Annual Confidential Feedback reports via the Quality Improvement Evaluation System (QIES) through the CASPER reporting application during
August 2018. Providers will have 30 days from the posting date to alert CMS of any issues.
The rehospitalizations occurring now are falling within the 2018 performance window for FY 2018 and will impact your payment starting in October 2019. Providers have access to a
SNFRM Fact Sheet,
to share with staff. More detailed SNFRM information can be found on the
Ensuring a good understanding of the criteria and an effective program is vital and requires continued focus.
ACT Senior Living Consulting Services
The ACT Senior Living Consulting team can help you evaluate and develop staff education and systems to reduce unnecessary rehospitaliztions. We can help you achieve your goals by:
- Educating staff about measures that are monitored and how they impact your payment.
- Review systems that directly and indirectly impact resident and patient hospitalizations and rehospitalizations.
- Assist in developing policies, processes, and systems that support good outcomes.
- Identify and provide professional resources to communicate goals, desired actions, and outcomes to residents, patients, families, professional providers, and other customers.
Stay up-to-date with important news by accessing this newsletter and more in the
on our ACT website!