On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed Fiscal Year (FY) 2017 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). On April 28, 2016, CMS held an Open Door Forum to discuss the following items included in the proposal:
SNF PPS proposed FY 2017 rates
SNF VBP Program potentially preventable readmission measure
SNF Quality Reporting Program (QRP) proposes additional policies and measures
This Q&A is adapted from HCPro’s January 13, 2016, webcast, with Melissa Korey and Janet Potter, CPA, MAS, at Marcum, LLP
Q: Can you give an example of a circumstance when a resident would choose not to elect their Medicare benefit?
A: One example is if a husband and wife are living together in the nursing facility, in the non-certified section, and one of the spouses would qualify for Medicare, but they don’t want to leave the room to move to a certified section. Another example could be if an individual has Alzheimer’s or another dementia-type issue, and it’s better for their overall care to stay in the same room and not be relocated for the time period.
A new contractor and a new set of rules signify an upgrade from the previous program, but concerns linger about exactly what will be reviewed. New updates to manual medical reviews (MMR) of therapy claims will likely have therapists and LTC providers breathing a sigh of relief—and then quickly bracing for a new round of audits.
In early 2014, the Centers for Medicare and Medicaid Services (CMS) released clarifications for its Medicare Benefit Policy Manual that would change how long-term care facilities documented therapy, especially surrounding the long-practiced “improvement standard”—which contradicts Medicare law. The clarifications were required due to the landmark case of Jimmo v. Sebelius.
Although the final rule offers more clarification on when the 60-day clock starts ticking, new questions have emerged about what constitutes ‘reasonable diligence’. In February, CMS published its long-awaited final rule on returning Medicare overpayments to the government within 60 days, a provision that has elicited much controversy and provider confusion since its inclusion in the Affordable Care Act (ACA). But federal officials may have created dozens more questions for every question CMS answered in the latest final rule.