Reimbursement Corner

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2017 Medicare Part B Fee Schedule (Retroactive April 2017 Quarterly Update to the Medicare Physician Fee Schedule Database)

The revised 2017 therapy fees for each CPT/HCPCS Code in each Georgia geographic area are provided in the files below (changes have been highlighted in yellow): The 2017 Medicare Part B Fee Schedule for Outpatient Rehabilitation for each Georgia Carrier and Locality (Part B Fees) The 2017 Medicare Part B MPPR Fee Schedule for "Always Therapy Services (50% MPPR Factor) for each Georgia Carrier and Locality (MPPR Fees) The 2017 Relative Value Units for each Outpatient Rehabilitation Therapy Code (RVUs) The 2017 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI) The 2017 Counties Included in 2017 Localities (GPCI Counties) The Part B Fee Schedule amounts are calculated as follows: ((A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and ((A1 x B1) + ((A2 x B2) x (1-MPPR Factor) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where: A1 = Physician Work RVU A2 = Non-Facility Practice Expense RVU A3 = Malpractice RVU B1 = Work GPCI B2 = Practice Expense GPCI B3 = Malpractice GPCI Conversion Factor = $35.8887 MPPR Factor = 50% Please note that the fees effective January 1, 2017 are calculated based upon the Calendar Year (CY) 2017 Medicare Physician Fee Schedule (MPFS) Final Rule (CMS-1654-F) published in the Federal Register on November 15, 2016. This [...]

March 30th, 2017|News, Newsfront, Reimbursement Corner|

Skilled Nursing Facility 30-Day All Cause Readmission Measure (SNFRM)

As reported by CMS: In the Fiscal Year (FY) 2016 SNF Prospective Payment System (PPS) final rule, CMS adopted the SNFRM as the first measure for the Skilled Nursing Facility Value Based Purchasing (SNF VBP) Program. The measure is defined as the risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare beneficiaries within 30 days of discharge from their prior hospitalization. Hospital readmissions are identified through Medicare hospital claims (not SNF claims) so no readmission data is collected from SNFs and there are no additional reporting requirements for the measure. Readmissions to a hospital within the 30-day window are counted regardless of whether the beneficiary is readmitted directly from the SNF for after discharge from the SNF as long as the beneficiary was admitted to the SNF within 1 day of discharge from a hospital stay. The measure excludes planned readmissions because they do not indicate poor quality of care.  The measure is risk-adjusted based on patient demographics, principal diagnosis from the prior hospitalization, comorbidities, and other health status variables that affect probability of readmission. In calculating the readmission measure, unplanned readmissions are identified using a modified version of the CMS planned readmissions algorithm. Other exclusions include patients who were hospitalized for medical treatment of cancer, do not have Medicare Part A coverage for the [...]

February 9th, 2017|News, Newsfront, Reimbursement Corner|

SOURCE Day Held at GHCA Headquarters February 2

Yesterday, SOURCE Steering and Leadership Committees met at the Fred A. Watson Training Center at GHCA headquarters in Stockbridge. We were excited to have many SOURCE providers in attendance. The group was joined by Brian Dowd and Lorrie Stewart from DCH, who shared updates and information about cost of care reports, expanding Medicaid eligibility for potential SOURCE clients, conflict-free case management, and the 2016 SOURCE Quality Incentive. The Quality Committee reported that, along with the Hospice Association, a subcommittee has planned training to education the case managers of both organizations on best practices around caring for their hospice clients. Tony Marshall, GHCA President and CEO, shared information regarding the potential for Medicaid block grants as well as news that GHCA is advocating for a 3% monthly case management fee increase for SOURCE agencies. SOURCE President, Dorothy Davis, announced that Hope Hickman, GHCA liaison for SOURCE members, plans to retire at the end of March. She expressed appreciation for Hope’s dedication to the SOURCE group and wished her well.

February 3rd, 2017|News, Newsfront, Reimbursement Corner|

DCH December Board Meeting Recap

Yesterday, the Department of Community Health (DCH) held their December Board meeting.  It was Commissioner Frank Berry’s first Board meeting as DCH commissioner. During the meeting, Medicaid Director Linda Wiant shared an update regarding the SNF ventilator rate increase of 3% which was approved by the 2016 Legislature and was supposed to become effective on July 1, 2016.  Due to a typo in the submission of the State Plan Amendment in which the old rate of $494 was used rather than the new rate of $509, DCH must go through the entire process again, which includes initial adoption of the Public Notice by the DCH Board, Public Hearing and Public Comment period, Final Adoption by DCH Board (January Board meeting), resubmission of SPA, and approval by CMS. In order to utilize the entire budget appropriated, DCH plans to increase the rate for six months to $524 for an average of $509 for FY 2017.  The SPA will have an effective date of January 1, 2017 for the payment of the rate of $524.  On July 1, 2017 the rate will decrease to $509.  Claims will not be paid at any rate other than the current one until after CMS approval has been received by DCH.

December 9th, 2016|News, Newsfront, Reimbursement Corner|

2017 Medicare Part B Fee Schedule (Georgia Localities)

The 2017 therapy fees for each CPT/HCPCS Code in each Georgia geographic area are available below: The 2017 Medicare Part B Fee Schedule for Outpatient Rehabilitation for each Georgia Carrier and Locality (Part B Fees) The 2017 Medicare Part B MPPR Fee Schedule for "Always Therapy Services (50% MPPR Factor) for each Georgia Carrier and Locality (MPPR Fees) The 2017 Relative Value Units for each Outpatient Rehabilitation Therapy Code (RVUs) The 2017 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI) The 2017 Counties Included in 2017 Localities (GPCI Counties) The Part B Fee Schedule amounts are calculated as follows: ((A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and ((A1 x B1) + ((A2 x B2) x (1-MPPR Factor) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where: A1 = Physician Work RVU         A2 = Non-Facility Practice Expense RVU         A3 = Malpractice RVU         B1 = Work GPCI         B2 = Practice Expense GPCI         B3 = Malpractice GPCI Conversion Factor = $35.8887 MPPR Factor = 50% Please note that the fees effective January 1, 2017 are calculated based upon the Calendar Year (CY) 2017 Medicare Physician Fee Schedule (MPFS) Final Rule (CMS-1654-F) published in the Federal Register on November 15, 2016. This final rule reflects the requirements [...]

December 8th, 2016|News, Newsfront, Reimbursement Corner|

PASRR Enhancements in GAMMIS System

See below message from DCH: Effective November 1, 2016, enhancements are being made to our Georgia Medicaid Management Information System (GAMMIS) that should allow Skilled Nursing Facility (SNF) providers to better utilize our Web Portal’s Provider Workspace features. This change is effective for Level I PASRR requests.  This enhancement will allow for search and edit functions to be utilized and provide better control over the quality of applications being submitted.  Due to the volume of applications with errors and little success in correcting those errors, an update is being made to remove the Preadmission Screening and Resident Review (PASRR) link from the public portion of the GAMMIS effective January 1, 2017. Providers who are seeking PASRR approval for a Nursing Facility admission will be required to make the request through the Provider Workspace. Also, it will increase the ability of providers to correct errors on those applications submitted. The following is a list of updates on GAMMIS currently being developed for SNF providers enrolled in Category of Service (COS) 110 and/or 160: A) Update errors in Medicaid ID Numbers; B) Update errors in Date of Birth; C) Update errors in member's name; D) Correct Social Security Numbers. The system will be updated to allow providers to submit a Change Request if the Level I decision is [...]

December 2nd, 2016|News, Newsfront, Reimbursement Corner|

November DCH Board Meeting Recap

This week, DCH held its November Board meeting.  There were several public notices that affect GHCA members: Nursing Facility Rules Update - Addition of the requirement for each facility to carry or be covered by liability insurance or have established for its benefit a self-insurance trust for a nursing home claim as a condition precedent to obtaining or maintaining a permit to operate a nursing home.  Click here for the public notice. Click here for the proposed revised rule. Assisted Living Communities Rules Update - Addition of the requirement to provide each resident with educational information on influenza no later than September 1 of each year. Click here for the public notice. Click here for the proposed revised rule. Norman Boyd, DCH Board Chair, thanked Commissioner Clyde Reese for his dedicated service to the Department of Community Health, wishing him well in his next opportunity serving the state of Georgia. Click here for the Board meeting minutes.

November 10th, 2016|News, Newsfront, Reimbursement Corner|

Payroll-Based Journal: Submit Staffing Data by November 14

This is a reminder that the deadline for nursing centers to submit July through September 2016 staffing data is November 14. If you are struggling with data collection and understanding the details of the PBJ requirements, check out AHCA’s YouTube video on how to get started with PBJ. Additional resources like on demand webinars, list of vendors, and FAQ documents are available on ahcancalED. Click here to access. If you haven’t registered, click here to do so. PBJ questions can be submitted to AHCA at staffdatacollection@ahca.org.

November 3rd, 2016|News, Newsfront, Reimbursement Corner|

DCH: Suspension of Providers Who Have Not Revalidated Their Enrollment Effective November 1

Effective November 1, 2016, the Georgia Department of Community Health, Division of Medicaid will suspend those providers who were sent revalidation letters from Hewlett-Packard Enterprise (HPE) between June 1, 2016, and September 1, 2016, and have not submitted a revalidation application. As noted in the revalidation letter, DCH allowed providers a period of 60 days to revalidate. Those providers who have not revalidated their enrollment within the 60-day time period will be suspended from the Georgia Medicaid program. Click here to view the full notice from DCH.

October 25th, 2016|News, Newsfront, Reimbursement Corner|

October 13 DCH Board Meeting Recap

On October 13, the Department of Community Health (DCH) held its monthly Board meeting. There was no Commissioner report, as Commissioner Reese was not in attendance. After committee reports, the Board gave final approval to two public notices: Community Behavioral Health Rehabilitation Services State Plan Amendment to add new services for children, youth, and families and expand services New Options Waiver (NOW) Program Amendment to add new rates and services There was no new business for the Board.

October 13th, 2016|News, Newsfront, Reimbursement Corner|