Reliant Reveal

Headlines in this Issue…

CMS Updates
PEPPER Reports
Clinical Services: The Client Connection Monthly Webinar Series
Clinical Appeals Corner: New ABN Form Use Begins May 7
HIPAA Happenings: Printer Toner Scam
Care Matters Spotlight

CMS Released the SNF Proposed Rule for FY 2019

The much anticipated FY2019 SNF proposed rule was released on Friday, April 27 and includes Medicare policy and rate updates. CMS indicates the “payment policy proposals for Fiscal Year 2019 further advance the agency’s priority of creating a patient-driven healthcare system that fosters innovation of efficient and accountable programs while removing waste, fraud, and abuse.”
Included in the proposed rule:
  • SNF payment update of 2.4% (increase of $850 million), as mandated by the 2018 Bipartisen Budget Act- effective October 1, 2018.
  • Revisions to the previously introduced payment model: Resident Classification System (RCS-1), which simplify the model based on stakeholder feedback significantly enough that the proposed model is renamed: Patient-Driven Payment Model (PDPM)- effective October 1, 2019.
  • Major changes include separating OT and PT payment categories, replacing Section G with Section GG for use of patient classification, reducing the number of components within each payment category, allowing the 5-day SNF PPS scheduled assessment to reclassify a patient, combined 25% limit on concurrent therapy and group therapy for each discipline of therapy provided, and amount of therapy provided is detailed in the PPS Discharge Assessment.
  • Updates to SNF QRP to add costs to current measures, but no new reporting requirements are implemented- effective October 1, 2018.
View the
fact sheet,
proposed rule (to be published in federal register on May 8th), and
press release.
CMS has scheduled an Open Door Forum for Tuesday May 1, @ 2 p.m. ET. The proposed rules will be addressed during this call. View agenda and call in information
here.

Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 

Per the Medicare Learning Network (MLN) article “Change Request (CR) 10531 provides direction to MACs to reprocess claims related to several provisions of the Bipartisan Budget Act of 2018, referred to as Medicare Extenders. Specifically, the CR provides guidance to MACs regarding Medicare Fee For Service (FFS) claims reprocessing requirements and timeframes. Make sure your billing staffs are aware of these changes.” Updates include:
  • The MACs will reprocess therapy claims with the KX modifier containing Dates of Service in Calendar Year 2018, which were denied prior to the implementation of the updated legislative effective dates issued on January 25, 2018. NOTE: For institutional claims, these claims will include revenue codes 042x, 043x, or 044x and modifiers GN, GO, or GP.
  • The MACs will reprocess therapy claims with the KX modifier which were denied due to an invalid date provided by CMS on February 12, 2018.
  • The MACs will reprocess 2018 therapy claims which cannot be automatically reprocessed only if you bring such claims to the attention of your MAC.
  • The MACs will reprocess claims which cannot be automatically reprocessed only if you bring such claims to your MAC’s attention.
  • MACs will reprocess home health claims with the following criteria:
  • Type of Bill 32X
  • Claim “Through” dates on or after January 1, 2018
  • Value code 61 amounts in the range 999xx
  • Receipt dates prior to the installation of the revised home health Pricer, which reflects the extension of the 3% rural add-on for CY 2018.
View MLN article
here.

SNF PEPPER Reports Now Available!

The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides provider-specific Medicare data statistics for services vulnerable to improper payment. Data statistics are obtained from the UB-04 claims sumitted to the MACs and are analyzed to identify target areas within the SNF PPS.
PEPPER identifies areas at high risk for fraud, waste, and abuse and helps identify both potential overpayments and potential underpayments. There is no good or bad PEPPER, but the information gleaned from the report, if analyzed appropriately, can help your facility better its policies and procedures.
PEPPER Repo
rts for Q4 of FY2017 are available for download through the PEPPER Resources Portal.
T
o obtain your SNF’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer of your organization should: 
  1. Review the Secure PEPPER Access Guide.
  2. Review the instructions and obtain the information required to authenticate access. Note: A new validation code will be required. A patient control number (UB04 form locator 03a) or medical record number (UB04 form locator 03b) from a claim for a traditional Medicare FFS beneficiary with a claim “from” or “through” date between July 1 – Sept. 30, 2017, will be required.
  3. Visit the PEPPER Resources Portal.
  4. Complete all the fields.
  5. Download your PEPPER.



THE CLIENT CONNECTION:
A COLLABORATIVE APPROACH TO QUALITY OUTCOMES

YOU’RE INVITED!
Every month on the third Thursday, Reliant’s Clinical Services offers a webinar to our partners on relevant topics within our industry.
In April, The Client Connection presented our new Clinical Appeals Portal! If you were unable to attend, please contact your assigned Clinical Appeals Specialist for a demo!

Stay tuned for May’s presentation on the SNF Proposed Rule for FY2019. Clinical Services will dive into the SNF proposed payment system: the Patient Driven Payment Model (PDPM).

We hope you’ll join us!

REVISION OF SNF ADVANCED BENEFICIARY NOTICE OF NON-COVERAGE (SNF ABN)

CMS has revised the Skilled Nursing Facility Notice of Non-coverage, Form CMS-10055.
  • Mandatory use of the new form is May 7, 2018. SNFs may continue to use old version until then but it is recommended the revised form be used as soon as possible.  
  • With the revision of the ABN, CMS is discontinuing the five SNF Denial Letters (Intermediary Determination of Noncoverage, the UR Committee Determination of Admission, the UR Committee Determination on Continued Stay, the SNF Determination on Admission and the SNF Determination on Continued Stay), and the Notice of Exclusion from Medicare Benefits (NEMB-SNF), Form CMS-20014).
  • Note that the NOMNC is not being discontinued with this revised SNF ABN.  
Download new form
here
.

DID YOU KNOW

When you choose Reliant Rehabilitation as your therapy provider, you will have a designated Clinical Appeals Specialist for your appeal and denial needs!
Find out more
today
!

HIPAA Happenings will bring you information relevant to protecting the security, privacy, and integrity behind the many facets of technology in business and healthcare.

Printer Toner Scam

Beware of vendors attempting to scam you by tricking you into paying for printer toner by:
  1. Posing as our printer toner vendor and asking questions about your printer to send you toner and invoice you for expensive toner, or
  2.  Sending an invoice for toner you never received, or
  3. Calling to tell you they can sell you toner for an extremely discounted price.
Here are the facts about Reliant’s printer toner vendor:
  1. Our vendor for printer toner is Denitech.
  2. Our printer toner does not cost us anything extra. It is built into our printer lease agreement.
  3.  Denitech will never call you to ask you if you need more toner. You contact them by calling 1-888-812-5931 or online through www.Denitech.com.
  4.  You will never receive an invoice for printer toner.
What should the therapy department do:
  1. Always order your printer toner through Denitech – 1-888-812-5931 or www.Denitech.com.
  2. Never pay an invoice for printer toner.
  3.  Never order printer toner from anywhere other than Denitech.
  4.  Refuse shipments of printer toner you did not order from Denitech.
Contact
Reliant IT Support
at
support@geninf.com
or call 972-379-7835 if you receive invalid invoices, bogus vendor calls, have any questions, or concerns. You can also contact the Privacy and Information Security Officer at
Lspears@ReliantPacs.com
or 479-226-1468.

Reliant Rehab Therapists Partner with the Facility for a Snazzy Jazzy Ball!

A ball is nice, but a Snazzy Jazzy Ball… priceless. Reliant therapists join the facility staff of our partner facility in Palmyra, Tennessee to host a resident ball that truly demonstrates the beauty of collaboration and care. We really do go together like a wink and a smile!

FOLLOW US

Leave a Reply