MDS Alert
Stop Sending ABNs To Residents Exceeding The Therapy Cap
PDF
Plus: CMS is tweaking the PPS Part A Discharge item set.
Because the recently-passed legislation repealing the Sustainable Growth Rate (SGR) formula also extended the Medicare Part B therapy caps exception process, you should no longer issue advance beneficiary notices (ABNs).
The SGR provisions included an extension for the therapy cap exceptions through Dec. 31, 2017. This means that issuing ABNs to your residents receiving medically necessary services beyond the $1,940 therapy cap is no longer appropriate, according to an April 21 announcement by the American Health Care Association (AHCA)/National Center for Assisted Living (NCAL).
Instead, use the exceptions process for therapy services that exceed the threshold. For more information about ABNs related to the therapy cap, visit www.cms.gov/Medicare/Billing/TherapyServices/Downloads/ABN-Noncoverage-FAQ.pdf.
In Other News …
Check Out 3 New Draft MDS 3.0 Documents
Changes are afoot for several MDS assessments, but don’t get too excited yet — only drafts are available at the moment.
On April 16, the Centers for Medicare & Medicaid Services (CMS) posted three drafts of the MDS 3.0:
1. MDS 3.0 Nursing Home Comprehensive (NC) Version 1.14.0 — www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Draft-of-the-MDS-30-Nursing-Home-Comprehensive-NC-Version-1140.pdf;
2. Sections A and GG of the MDS 3.0 — www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS-30-SECTIONS-A-AND-GG-DOCUMENT.pdf; and
3. The New MDS 3.0 Prospective Payment System (PPS) Part A Discharge (End of Stay) Version 1.14.0 — www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Draft-of-the-new-MDS-30-PPS-Part-A-Discharge-End-of-Stay-NPE-SPE-Version-1140.pdf.
You can also access these draft documents by visiting www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/SNF-Quality-Reporting-Program-Measures-and-Technical-Information.html and scrolling down to the bottom of the page for the Downloads section. Note that CMS has not yet determined a proposed effective date for these drafts.
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Stop Sending ABNs To Residents Exceeding The Therapy Cap
Plus: CMS is tweaking the PPS Part A Discharge item set. Because the recently-passed legislation [...]