News And Events

Nursing Home Five-Star Quality Rating System - February News

Provider Preview access information:

• Visit the MDS State Welcome page available on the State servers where you submit MDS data to review your results.

• To access these reports, select the Certification and Survey Provider Enhanced Reports (CASPER) Reporting link located at the bottom of the login page.
• Once in the CASPER Reporting system,
  i.  Click on the "Folders" button and access the Five-Star Report 
       in your 'st LTC facid' folder,
  ii.  Where st is the 2-digit postal code of the state in which your
  facility is located, and
     iii.  Facid is the state assigned facid of your facility.
  
  
  
  2.  BetterCare@cms.hhs.gov
  
  
  is available to address any Five Star rating questions and concerns.
  3.  Nursing Home Compare will update with February's Five-Star data on Thursday, February 25, 2010.
  4.  Please visit
  http://www.cms.hhs.gov/CertificationandComplianc/13_FSQRS.asp 
  for the latest Five-Star Quality Rating system information.
  

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CMS: Medicare Claims Crossover to Supplemental Payer Problem

Part A Institutional Claims
No action is required by Part A institutional providers.  As of February 2, 2010, CMS successfully implemented a systems fix to ensure that all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers.  As part of the fix, CMS' Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not.  On February 2, 2010, the affected Medicare cdontractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers.  This effort is now largely completed.  Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.

• One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND
• One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts.

CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise.  Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above.  Once identified, providers will need to take action to balance bill the beneficiary's supplemental payer.  As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.

The CMS has already notified supplemental payers of these issues.  We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.

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CMS:  Inpatient Rehabilitation Facility(IRF) Prospective Payment System (PPS) PC Pricers Updates
The FY2010 and FY 2009 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) PC Pricers have been updated with January 2010 Provider Specific data and are ready for download from the Centers for Medicare&Medicaid Services (CMS) web page at http://www.cms.hhs.gov/PCPricer/06_IRF.asp.  If you use the IRF PPS PC Pricers, please go to the page above and download the latest versions of the Pricers, posted 02/05/10, in the Downloads section.


New from the Medicare Learning Network (MLN):  The Centers for Medicare&Medicaid Services (CMS) has released two new HIPAA Version 5010 fact sheets, as well as two companion checklists, to assist providers  in transitioning to 5010.
Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions; and version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation.
The implementation of HIPAA Version 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries for eligibility or claims status.  These new educational materials inform providers of these changes and how they need to plan for their implementation. This information is designed for Medicare Fee-For-Service providers; however, it may be of interest to all health care providers.  Go to the CMS 5010 website at
http://www.cms.hhs.gov/Versions5010andD0 and click on “Educational Resources” to view these new educational products.

    * The purpose of the Act is to provide consistency with mandatory  
  reporting among other state statutes.  The Act mirrors the mandatory 
  reporting section of the Medical Practice Act.

    * The Act amends Section 17 dealing with grounds for disciplinary action
  adding:
 Failure by the licensee to report any adverse final action taken against
  them by another licensing jurisdiction, government agency, law
  enforcement agency or any court
    * Failure to report to Illinois Department of Financial and Professional
  Regulation surrender of license or authorization to practice as nursing
  home administrator in another state or jurisdiction
    * Failure to report to Illinois Department of Financial and Professional
  Regulation any adverse judgment, settlement, or award arising from a
  liability claim

Failure by the licensee to report any adverse final action taken against them by another licensing jurisdiction, government agency, law enforcement agency or any court
Failure to report to Illinois Department of Financial and Professional Regulation surrender of license or authorization to practice as nursing home administrator in another state or jurisdiction
Failure to report to Illinois Department of Financial and Professional Regulation any adverse judgment, settlement, or award arising from a liability claim
 

    * The Act amends section 17.1 entities required to report, adding:

o   Health Care Institutions: Shall report a person licensed under this Act has committed any act(s) in violation of this Act, constitutes unprofessional conduct related to patient care, may be mentally or physically disabled in a matter as to endanger patients under care or is terminated for cause

o   Professional Liability Insurers: Shall report a person licensed under this Act with the settlement of any claim or final judgment rendered in any cause of action in favor of the plaintiff which alleged negligence in the planning, organizing, directing and supervising the operation of a nursing home

o   State’s Attorney: Shall report within 5 days all instances in which a licensed person under this Act is convicted or enters a guilty plea to any crime that is a felony

o   State Agencies: Shall report a person licensed under this Act has committed any act(s) in violation of this Act, constitute unprofessional conduct relating to planning, organizing, directing and supervising the operation of a nursing home or may be mentally or physically disabled in a matter as to endanger patients under care

 Reports shall be filed in writing to Illinois Department of Financial and Professional Regulation within 60 days after a determination that a report is required

 All reports shall contain:

    *
  o Name, address and telephone number for the person making the report and the person that is the subject of the report
  o Name and date of birth of any person(s) whose treatment is a subject of the report or identification of the nursing home facility where the care in the report was rendered
  o Brief description of the facts that gave rise to the issuance of the report
  o If court action is involved, the identity of the court in which the action is filed, docket number and date of filing of the action
  o Any other pertinent information

Illinois Department of Financial and Professional Regulation will notify the person who is the subject of the report within 30 days of receipt of a report

The person who is subject of the report shall submit a written statement responding, clarifying, adding to or proposing the amending of the report previously filed no more than 30 days after which the person was notified by Illinois Department of Financial and Professional Regulation of the existence of the original report

Illinois Department of  Financial and Professional Regulation’s initial review of  materials contained in each disciplinary file may not be less than 61 days nor more than 180 days after the receipt of the initial report by the department

Transcript Summaries of ICD-10 Call Now Available
The written and audio transcript summaries of the ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Conference Call, which was conducted by the Centers for Medicare&Medicaid Services on November 19, 2009, are now available in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp .

Updated Information Regarding the Holding of Claims for Services Paid Under
The 2010 Medicare Physician Fee Schedule
This is a clarification to the listserv message that was issued on December 21, 2009.  The President has signed the Department of Defense Appropriations Act of 2010 which provides for a zero percent (0%) update to the 2010 Medicare Physician Fee Schedule for a two month period, January 1, 2010 through February 28, 2010
The Centers for Medicare&Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010.  In this regard, CMS has instructed its contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt.  Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedure.
The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than January 19, 2010.  Please note that most contractors are closed on the January 18 Martin Luther King Day holiday.  Therefore, even absent a new update, most claims likely would not have been paid any sooner than January 19, 2010, given the aforementioned statutory 14-day payment floor.
CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010.
The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year
Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010.  In addition, be on the alert for more information about other legislative provisions which may affect you.