FY 14 SNF Proposed Final Rule Published four hours ago

This is the direct link,(below)   but if it doesn't work for you,  paste this into google:

CMS-1446-P: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014  and click from there

http://www.ofr.gov/(S(xktpldwfpom25pl2ijpyrpt1))/OFRUpload/OFRData/2013-10558_PI.pdf

CMS announces new MDS inactivation/modification policy

In the SNF ODF tomorrow, John Kane is going to go over these slides.  Chapter 5 of the new RAI manual will have the details:  http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Inact_ModChange_final_public.pdf

CMS PROPOSES NEW SAFEGUARDS AND INCENTIVES TO REDUCE MEDICARE FRAUD

On April 24, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would increase incentives for people to report information that leads to a recovery of funds from individuals and entities that have or are engaged in Medicare fraud and abuse. This proposed rule would also improve CMS’ ability to detect new fraud schemes, and help ensure that fraudulent entities and individuals do not enroll in or stay enrolled in Medicare. 

This fact sheet summarizes CMS’s proposed changes for the Medicare Incentive Reward Program as well as new provider enrollment provisions outlined in the proposed rule.

SUMMARY OF THE INCENTIVE REWARD PROGRAM PROPOSALS

CMS is proposing to increase the potential reward amount for information that leads to a recovery of Medicare funds from 10 percent to 15 percent of the final amount collected. The current program caps the reward at $1,000, meaning CMS pays a reward on the first $10,000 it collects as a result of a tip. CMS is also proposing to increase the portion of the recovery on which CMS will pay a reward up to the first $66 million recovered – this means an individual could receive a reward of $9.9 million if CMS recovers $66 million or more.

In 1998, CMS began paying rewards to individuals who reported tips that led to the recovery of funds. To date, CMS has recovered approximately $3.5 million as a result of this program and paid just $16,000 for 18 rewards. The proposed changes are similar to the IRS whistleblower program that has resulted in recoveries of over $2 billion since 2003.   

SUMMARY OF THE PROVIDER ENROLLMENT PROVISIONS

Provider enrollment is the gateway to Medicare. CMS routinely evaluates its provider enrollment policies, and has implemented new safeguards as a result of the Affordable Care Act. In the February 2011 final screening rule (72 FR 5862). CMS identified additional changes in enrollment policy that would increase the integrity of the Medicare program. Now, CMS is proposing include the following provisions:

• Add the ability to deny the enrollment of providers, suppliers and owners affiliated with an entity that has unpaid Medicare debt. This proposal would prevent individuals and entities from being able to incur substantial debt to Medicare, leave the Medicare program and then re-enroll as a new business to avoid repayment of the outstanding Medicare debt. We are proposing that CMS would only enroll individuals or entities if they repay the debt or enter into a repayment plan, if they are otherwise eligible for the program.

• Deny enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses. This provision ensures that CMS can block or remove bad actors from the Medicare program to protect beneficiaries and safeguard the Medicare Trust Fund.

• Permit CMS to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements. This proposal is intended to address providers and suppliers that regularly submit inaccurate claims in such a way that it poses a risk to the Medicare program.

• Make the effective date of billing privileges consistent across certain provider and supplier types. Most practitioners and practitioner groups may only submit bills as of the filing date of their enrollment application. CMS is proposing to eliminate ambulance suppliers’ current ability to bill for up to a year prior to enrollment in the Medicare program. CMS is also proposing to require that ambulance providers and other provider and supplier types submit any claims within 60 days of revocation of billing privileges, consistent with the requirements for practitioners and practitioner groups.

The proposed rule can be downloaded at: https://www.federalregister.gov/public-inspection.

Hero nursing home workers in West, Texas Nursing Home

This is who we are.

Dr. Smith and the employees and neighbors of West Rest Haven Nursing Home, A five star facility in West, Texas:

WEST, Texas -- A battered and bloody EMS director is recounting the moments leading up to the massive explosion at a fertilizer plant in the Central Txas town of West.

George Smith said they got a report of a fire at the plant, so they sent fire trucks and an EMS unit.

Meanwhile, he went to help senior citizens who lived nearby.

"I saw how bad it was, so I went to the nursing home... I'm the medical director for the nursing home. I went over to the station closest to where the fire was and called all personnel to me that were there in the building and said, 'Get people evacuated to the far side of the building," Smith said. "Luckily we had most everybody out then. But then there was just a major, major explosion. The windows came in on me, the roof came in on me, the ceiling came in. I worked my way out to go get some more help."

About a hundred residents were safely evacuated.  We, who are also nursing home folks, know they will not see the 100 saved, they will only remember the few who were lost.   We, who are nursing home folks, honor and support them.  Well done.  You ran towards the fire and stayed after the explosion to evacuate.  

We are so very proud of you.  

CMS Releases FAQ on Manual Medical Review April 17th

New FAQ on MMR:  http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/Downloads/FAQ_OutpatientTherapy_04172013.pdf

Quality Measures Manual moved from Technical Page to QM page, updated again

April 12, 2013

Three files related to the MDS 3.0 QM User’s Manual have been posted:

1. MDS 3.0 QM User’s Manual V8.0 contains detailed specification for the MDS 3.0 quality measures. MDS 3.0 QM User’s Manual V8.0 is available under the Downloads section of this page.
2. Quality Measure Identification Number by CMS Reporting Module Table V1.2 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module.  A unique CMS identification number is specified for each QM. The table is available under the Downloads section of this page.
3. Documentation of the Changes Made to the MDS 3.0 QM User’s Manual V6.0 to V7.0 and Also from V7.0 to V8.0 (April 2013).  The changes document is available under the Downloads section of this page.

Update on CMS clarification on ADL coding "rule of 3"

In my March 24th entry, I reported news that CMS had clarified and some would say, redefined, the rule of three.  Please see that entry for details.

Industry advocates have contacted CMS about this clarification as published by various State RAI Managers and as I reported on March 24th.   It remains possible that the ADL algorithm may not change as previously reported by CMS through the State RAI system.   We are still expecting a new RAI manual in May, so we watch and wait.  As usual,  consult your State RAI Manager for specific questions.