On February 5, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates Medicare Advantage (MA or Part C) and the Medicare prescription drug benefit (Part D) program to give seniors more choices and lower out-of-pocket costs, and to encourage price transparency. The proposed rule is another step in lowering drug costs for seniors, increasing competition, and further advancing the agency’s efforts to strengthen and modernize the popular MA and Part D programs.
Seema Verma, administrator for the Centers for Medicare & Medicaid Services, sat down for a rare one-on-one interview with Kaiser Health News senior correspondent Sarah Varney.
They discussed her views on President Donald Trump’s plan for sustaining public health insurance programs, how the administration would respond if Obamacare is struck down by the courts in the future and her thoughts on how the latest “Medicare for All” proposals would affect innovation and access to care.
Starting January 1, 2020, you must use the Medicare Beneficiary Identifier (MBI). We will reject claims you submit with the Health Insurance Claim Number (HICN), with a few exceptions and reject all eligibility transactions.
The Medicare Guide for SNF Billing and Reimbursement, Second Edition will help tackle the newest and most complex billing issues. This book will help billing staff understand the PDPM rate calculation methodology, identify opportunities to maximize reimbursement and accurately project revenue, correctly bill for Medicare Part A and Part B claims, and more!
CMS has confirmed that they are processing claims and eligibility requests with the Medicare Beneficiary Identifier (MBI), showing that providers are successfully using the new number. This week the agency began mailing new Medicare cards to people who live in Wave 6 states, which include Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington, and Wyoming.
Once an initial claim determination is made, beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions. There are five (5) levels in the Medicare A and B appeals process. Standard appeals give the resident the opportunity to have the SNF's decision that care will not be covered by Medicare reviewed after the care is rendered. Beneficiaries who elect this second appeal option should be cognizant of the possibility of financial liability if the appeal is not successful.
Join us in Chicago on Monday and Tuesday, August 13-14, to attend our SNF Regulatory Update Boot Camp! This event covers the industry changes that impact your clinical and financial operations while providing strategies for achieving and sustaining compliance in the future marketplace. Attendees can expect to learn best practices for leading and managing facilities to avoid survey issues, claims audits, and improper Medicare payments.
The Patient-Driven Payment Model (PDPM), as proposed, is designed to replace the current SNF payment methodology known as RUG-IV. Unless date changes, etc. are made by CMS post commentary review, the effective date of the change (from resource utilization groups to PDPM) is October 1, 2019. PDPM as an outgrowth of the initially proposed resident classification system (RCS) and received commentary is a simplified payment model designed to be more holistic in patient assessment, capture more clinical complexity, eliminate or greatly reduce the therapy focus by eliminating the minute levels for categorization, and simplifying the assessment process and schedule (reducing to three possible assessments/MDS tasks). Below is a summary of PDPM core attributes/features as proposed. Click here to access the PDPM Calculation Worksheet for SNFs that provides additional details beyond the reference points below.
CMS has started mailing new Medicare cards to people with Medicare who live in Wave 2 states and territories: Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, and Oregon. CMS continues to mail new cards to people who live in Wave 1 states, as well as nationwide to people who are new to Medicare.