sábado, 10 de agosto de 2013

Skilled Nursing Facilities/Long-Term Care Open Door Forum - Centers for Medicare & Medicaid Services

http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODF_SNFLTC.html

Centers for Medicare & Medicaid Services

Special Open Door Forum:

CMS Rule 1599-F: Inpatient Hospital Admission and Medical Review Criteria (2-Midnight Provision) and Part B Inpatient Billing in Hospitals.

Thursday, August 15, 2013

3:00pm – 4:00pm Eastern Time

Conference Call Only

CMS will host a Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to give feedback on the physician order and physician certification, inpatient hospital admission and medical review criteria, and Part B inpatient billing provisions that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS) final rule (CMS-1599-F).

The final rule instructs the physician on when an inpatient hospital admission should be ordered and certified, and clarifies for the practitioner and facility when inpatient hospital admissions are generally appropriate for Medicare Part A payment. The new rules are intended to address concerns about some Medicare beneficiaries having long stays in the hospital as outpatients and improve program integrity. Under the rule, if a physician expects a beneficiary’s surgical procedure, diagnostic test or other treatment to require a stay in the hospital lasting at least two midnights, and admits the beneficiary to the hospital based on that expectation, it is generally appropriate that the hospital receive Medicare Part A payment. The final rule emphasizes the need for a formal order of inpatient admission to begin inpatient status, but permits the physician to consider all time a patient has already spent in the hospital as an outpatient receiving observation services, or receiving care in the emergency department, operating room, or other treatment area in guiding their two-midnight expectation.

We finalized our proposal to continue applying the timely filing restriction to the billing of all Part B inpatient services, under which claims for Part B services must be filed within 1 year from the date of service. However, we will permit hospitals to follow the Part B billing timeframes established in CMS Ruling-1455-R after the effective date of the final rule (October 1, 2013), provided (1) the Part A claim denial was one to which the Ruling originally applied; or (2) the Part A inpatient claims has a date of admission before October 1, 2013, and is denied after September 30, 2013 on the grounds that although hospital outpatient services would have been reasonable and necessary, the inpatient admission was not. In the final rule, we also discussed appeals, beneficiary liability and other impacts of our final policies.

You can find the final rule by going to: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2014-IPPS-Final-Rule-Home-Page.html

Feedback and questions on the two midnight provision for admission and medical review can be sent to IPPSAdmissions@cms.hhs.gov. Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule.

Special Open Door Participation Instructions:

Dial: Participant Dial-In Number(s): (877) 251-0301
Conference ID # 31049561

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Skilled Nursing Facilities/Long-Term Care Open Door Forum

Overview:

The Skilled Nursing Facilities / Long-Term Care Open Door Forum (ODF) addresses the concerns and issues of both the Medicare SNF, the Medicaid NF, and the nursing home industry generally. The types of issues that come up during this forum are often related to the Minimum Data Set, SNF Consolidated Billing, the roles and responsibilities of different SNF, NF or LTC professional staff under CMS regulations, clarifications of issues that are covered during a survey and certification process, and the many rules and requirements under which different related services can be payable. Timely announcements and clarifications regarding important rulemaking, quality program initiatives, and other related areas are also included in the forums.

CMS will host a Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to give feedback on the physician order and physician certification, inpatient hospital admission and medical review criteria, and Part B inpatient billing provisions that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS) final rule (CMS-1599-F). If you wish to participate, dial 1-877-251-0301; Conference ID: 31049561. Please see the full announcement in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
The agenda for the Thursday, August 1, 2013, Skilled Nursing Facilities/Long-Term Care Open Door Forum is now available in the Downloads section below. If you wish to participate, dial 1-800-837-1935; Conference ID: 14927067. Thank you for your continued interest in the CMS Open Door Forums.
The Centers for Medicare & Medicaid Services will host an ICD-10 Basics National Provider Call on Thursday, August 22, 2013, from 1:30-3:00pm ET. The target audience is medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers. Please see the Downloads section below for the full announcement including registration instructions. Thank you.
The Thursday, July 25, 2013, Skilled Nursing Facilities (SNFs)/Long-Term Care (LTC) Open Door Forum has been rescheduled for Thursday, August 1, 2013, from 2:00pm – 3:00pm ET. If you wish to participate, dial 1-800-837-1935; Conference ID: 14927067. We will send a separate notification when the agenda is available. Thank you for your continued interest in the CMS Open Door Forums.
CMS will host a National Provider Call on Wednesday, July 10, 2013, from 1:30-3pm ET, titled: CMS National Partnership to Improve Dementia Care in Nursing Homes. Registration is now open. Please see Downloads section below for full announcement.
After much anticipation, CMS is pleased to announce the rollout of Quality Assurance and Performance Improvement (QAPI) materials to help nursing homes establish a foundation to support and sustain QAPI. This is the first step in meeting the Patient Protection and Affordable Care Act requirement for CMS to develop a technical assistance program to help nursing homes establish best practices in quality. Please see the Downloads section below for the full rollout announcement.
The next Skilled Nursing Facilities (SNFs)/Long-Term Care (LTC) Open Door Forum is scheduled for Thursday, June 13, 2013, from 2:00pm – 3:00pm, ET. If you wish to participate, dial 1-800-837-1935; Conference ID: 78876773. Please see the full participation announcement in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
‘Discharge Assessments and the Use of Dashes’ video will soon be activated on the DHHS YouTube site; Access to this video will be made available on the MDS 3.0 Training page in the Related Links section or at: http://youtu.be/Qkn22jv2HSY. (Please note once the ‘What’s New’ notice is posted, that there potentially can be a lag time in viewing materials subsequent to the posting request, so if not viewable check back in 24 hours). Discharge Assessments and the Use of Dashes are addressed in our new MDS 3.0 Provider Update Training Series. This training series is the first web-based training offered in 2013 to providers addressing post-acute care topics. Video No. 1 covers MDS 3.0 updates for the Nursing Home setting. It includes a CMS Introduction, a panel presentation explaining what the MDS 3.0 RAI Manual and the MDS 3.0 Assessment Instrument are, and includes two training topics. The first training topic focuses on our relatively new discharge assessments, and the second topic explains how to properly code with dashes. Currently this video is viewable for the RAI Coordinators. We anticipate provider viewing to be live by the end of this week, so please stay tuned.
On Thursday, May 16th, CMS hosted a webinar titled, “Data.Medicare.Gov: Get Started!” Please see the Downloads section below for the link to the May 16th webinar. Thank you.
On Thursday, May 16, 2013, the Centers for Medicare & Medicaid Services will be hosting a webinar, “Data.Medicare.Gov: Get Started!” to: Provide an introduction to Data.Medicare.Gov; Demonstrate options for accessing the data; and Describe how to make use of the site’s tools for exploring and interacting with the data. Please see the Downloads section below for full announcement with background information and registration instructions.
May 9, 2013 MDS 3.0 Updates:
MDS 3.0 RAI Manual V1.10 May 2013 – Note: The next MDS 3.0 RAI Manual update will be posted sometime next week. We have made recent enhancements, so there has been a slight delay. Please check the MDS 3.0 RAI Manual webpage next week.
MDS Provider Update Training – Note: The first training video, which includes coding of discharge assessments and use of dashes, has been finalized. This video will soon be available for preview by the RAI Coordinators for a two week time period. We anticipate public posting last week in May. Access to the video will be from the DHHS YouTube site and have a link from our MDS 3.0 Training page. **Please note that specific addresses are not yet available and will be announced prior to posting.
CMS Seeks Public Comment on Defining QIO Service Areas - Comments Accepted through Friday, May 31, 2013. Please see Downloads section below for full announcement.
CMS will host a National Provider Call on Wednesday, May 22, 2013, titled: National Physician Payment Transparency Program (Open Payments) - What You Need To Know. Please see Downloads section below for full announcement.
The agenda for the May 2, 2013 Skilled Nursing Facilities/LTC Open Door Forum is now available in the Downloads section below. If you wish to participate, dial 1-800-837-1935; Conference ID: 78862506. Please see the full participation announcement in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
The next Skilled Nursing Facilities (SNFs)/Long-Term Care (LTC) Open Door Forum is scheduled for Thursday, May 2, 2013, from 2:00pm – 3:00pm, ET. If you wish to participate, dial 1-800-837-1935; Conference ID: 78862506. Please see the full participation announcement in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
Per request during the March 21, 2013 Skilled Nursing Facilities/Long Term Care Open Door Forum, the Current Regulatory Plan and the Unified Agenda of Regulatory and Deregulatory Actions web link is as follows: http://www.reginfo.gov/public/do/eAgendaMain . Thank you for your continued interest in the CMS Open Door Forums.