Medicare Compliance & Reimbursement

Skilled nursing facilities will see a 2.9 percent increase in their Medicare payments next year under a new proposal from the Centers for Medicare & Medicaid Services. CMS also says it plans to stick with current resource utilization groups for at least another year, while it continues the long process of working out case-mix refinements. Case mix refinements will allow Medicare to pay more for patients that require complicated care, but CMS says its research on the subject isn't yet advanced enough for implementation in fiscal year 2004. The decision to stick with existing RUGs means that nursing homes will continue to receive about $1 billion a year in temporary add-on payments. According to CMS, the rate increase will up SNF payments by about $400 million. The payment proposal was published in the May 16 Federal Register. CMS announced a town hall meeting on refinement of the Minimum Data Set, to be held in Baltimore on June 2. In other Register notices, CMS announced a slew of actions regarding information collection efforts, including:
extension of the limitation of liability notice;
reinstatement of the Medicare/Medicaid Hospital Survey Report;
a new Pharmacy Plus template for ascertaining whether states may provide a drug benefit to elderly recipients;
revision of the Health Plan Employer Date and Information Set (HEDIS) and Health Outcome Survey (HOS) that "hold the Medicare managed care industry accountable for the care being delivered;"
extension of expanded coverage for diabetes outpatient self-management training services form;
extension of the Home Health Agency Survey and Deficiencies Report and the Home Health Functional Assessment Instrument;
extension of the Post Laboratory Survey Questionnaire;
reinstatement of the Hospice conditions for coverage form; 
 extension of the conditions of coverage for rural health clinics form; 
 extension of the SSO report of state buy-in problems; extension of the application for health insurance benefits under Medicare for individuals with chronic renal disease; and extension of the analysis of malpractice premium data.