The Centers for Medicare and Medicaid Services (CMS) just released the final inpatient prospective payment system (IPPS) rule for Fiscal Year (FY) 2012. While covering reimbursements for approximately 3,400 acute care hospitals, the final rule also updates reimbursement policies for more than 400 long-term care hospitals (LTCHs).
According to CMS, total Medicare operating payments to acute care hospitals for inpatient services will increase by 1.1 percent ($1.13 billion) for FY 2012, compared with FY 2011. Medicare reimbursements to LTCHs during the same period are projected to increase by 2.5 percent ($126 million).
The final IPPS rule also contains provisions designed to strengthen the relationship between reimbursements and quality of care. For example, it expands quality measures that must be reported under the Hospital Inpatient Quality Reporting Program by focusing on prevention of healthcare-related infections and readmissions.
Also, the final rule sets forth initial readmissions measures that will be included in a forthcoming Hospital Readmissions Reduction Program, as mandated by the Patient Protection and Affordable Care Act (PPACA). The program will apply to rates of readmissions for heart failure, acute myocardial infarction (heart attack) and pneumonia. CMS indicated that it plans to continue the implementation of this program in future rulemaking. The program itself is set to begin in FY 2013.
The final IPPS rule takes effect on October 1, will be published in the Federal Register on August 18.
However, you can download a copy of the rule now. [PDF, 4.09MB, 1492 pgs]
CMS announced a series of calls on specific Medicare program vulnerabilities identified in HHS Office of Inspector General (OIG) reports. Some of the issues being addressed on the calls correspond to some recently posted RAC Approved Issues. Since CMS has included specific emails for sending in questions before the sessions, provider may wish to compose and send off questions about these issues. The issues listed by CMS are vague enough as to allow for quite a broad range of questions, particularly for the Day Two topics. Find a complete PDF of topics, dates and times below. Continue reading
On July 29, 2011, the Centers for Medicare and Medicaid Services (CMS) published the final rule for skilled nursing facility Medicare reimbursement in fiscal year 2012. Among other things, the rule imposes an approximate 11% cut in Medicare reimbursement rates for all skilled nursing facilities.
CMS first introduced the cut in an April 28, 2011 proposed rule to recapture extra funds that were unintentionally reimbursed for therapy services under RUG- IV, the classification system implemented earlier this year. Finalizing most provisions in the proposed rule, the final rule included a recalibration adjustment of 12.6%, which, coupled with the 1.7% market basket update, resulted in a net update of -11.1% (equivalent to $3.87 billion) in payment for fiscal year 2012. Importantly, the impact on each facility will vary depending on its case-mix and geographic location.
CMS will host a national provider call on the rule on August 23, 2011, from 1:30 P.M. to 3:00 P.M. (EST). Registration is open until 1:30 P.M., August 22, 2011, or when space has been filled. Subject matter experts will discuss new MDS 3.0 policies, including allocation of group therapy and a question and answer session will follow the presentations.
[Original article by Seyfarth Shaw LLP]
Five-year Test Showed Improved Innovation and Care, But Few C0st Savings
The results from the five year “Group Practice Demonstation” project, which incentivized ten leading health systems if they could reduce costs by “treating older patients more efficiently while providing high-quality care,” were reported June 1 in the Washington Post. Reports issued by CMS and the GAO also offer disappointing conclusions for the project. Continue reading
In a letter dated May 31, to Sarah Hall Ingram, Commissioner for Tax Exempt and Government Entities – the American Hospital Association (AHA) asked the IRS to make it clear that participating in an accountable care organization (ACO) will not result in impermissible inurement or private benefit to tax-exempt nonprofit hospitals and will not generate unrelated business income tax (UBIT) if the entity involved is in compliance with the Centers for Medicare and Medicaid Services’ (CMS) eligibility rules for participation in the Medicare Shared Savings Program (MSSP).
Reaction to the proposed rules issued by the U.S. Centers for Medicare & Medicaid Services (CMS), and published in the Federal Register on April 7, 2011, to implement the Medicare Shared Savings Program (MSSP) has reportedly been harsh and critical.
Physician-owned facilities also express concern over PPACA growth caps In the year since President Barack Obama signed the ground-breaking Patient Protection and Affordable Care Act (PPACA) into law, doctors and health care facilities have carefully studied new health care mandates, incentives and compliance issues to understand how the many reform provisions will alter how they do business.
On Tuesday, May 24, 2011, seven members of the Senate Finance Committee sent a letter to HHS Secretary Kathleen Sebelius and CMS Administrator Don Berwick, M.D. regarding the ACO Proposed Rule (published in the April 7, 2011 Federal Register).