On March 10, the Centers for Medicare & Medicaid Services (CMS) took further action to ensure patients have access to the critical healthcare services they need in the wake of the 2019 Novel Coronavirus (COVID-19) outbreak. Following a meeting with President Trump and Vice President Pence, many leading insurance companies and their industry associations announced they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost sharing that would otherwise apply to the test. The President also directed CMS to provide more flexibility to Medicare Advantage and Part D plans to ensure they have the tools they need to provide seniors with the best coverage. As a result, CMS published a memorandum to Medicare Advantage (MA) and Part D health and prescription drug plans informing them of the flexibilities they have to provide healthcare coverage to Medicare beneficiaries for COVID-19 testing, treatments, and prevention.
CMS is delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020, in response to stakeholder concerns. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.
As COVID-19 spreads throughout the U.S., LTC providers face unique challenges to keep their high-risk residents safe. In an effort to fully understand the challenges SNFs are currently facing as a result of the virus, we’d like readers to complete a survey to tell us about their challenges.
One quarter down, and PDPM appears to be mostly positive for SNFs. CMS is reporting a higher average per diem payment level than under RUGs. Despite some added coding complexity, paperwork burdens are down for providers (for example, we have two MDSs during most stays now vs. many more under RUGs).
In a recent report, the Office of Inspector General (OIG) determined that Medicare made Part B payments to ambulance suppliers for transportation services that were also included in Medicare Part A payments to Skilled Nursing Facilities, as part of consolidated billing requirements. CMS developed the Ambulance Fee Schedule and Medicare Transports (PDF) Booklet to help you bill correctly
In its latest MLN Connects newsletter, CMS stated that the Office of Inspector General (OIG) determined that payments for Inpatient Rehabilitation Facility (IRF) services did not comply with Medicare billing requirements.