Experience the Eide Bailly Difference Your Painless Medicare
Experience the Eide Bailly Difference Your Painless Medicare Update Mike Everson, Director Reimbursement, Froedtert Health Eddie Phibbs, Director, Eide Bailly
Electronic Health Records (E. H. R) Continue to meet Meaningful Use Audits of I/T assets are still on-going Many new alternative payment models have I/T component Is there potential similar program for SNF’s Physicians and reporting requirements for MACRA – what happens if you haven’t invested in E. H. R. www. eidebailly. com
Wage Index Non-PPS hospitals are still competing for the same employees so you should understand your market Wage index factor impacts SNF and other provider types for Medicare payments One of the few remaining areas that you can directly impact your Medicare reimbursement www. eidebailly. com
Occupational Mix Survey Completing this accurately could help you significantly for PPS hospitals Surveys are due by July 1 (which means Friday, June 30) Forms and instructions are available on the CMS website www. eidebailly. com
New Mandatory Medicare Bundles The Models • Acute Myocardial Infarction (AMI) Model • Coronary Artery Bypass Graft (CABG) Model • Surgical Hip and Femur Fracture Treatment (SHFFT) Model • Cardiac Rehabilitation (CR) Incentive Payment Model The first performance period for the new episode payment models will begin on July 1, 2017 The duration of the models is until December 31, 2021 www. eidebailly. com
Mandatory Cardiac Bundles Two new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries The AMI and CABG Models will be implemented in 98 geographic areas, defined by MSAs Acute Myocardial Infarction (AMI) Model Coronary Artery Bypass Graft (CABG) Model www. eidebailly. com
Updates of Joint Replacement Bundles One new payment model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement. In addition, CMS is finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016 The SHFFT Model will be implemented in the 67 MSAs where the CJR Model is currently underway Surgical Hip and Femur Fracture Treatment (SHFFT) Model www. eidebailly. com
Cardiac Rehab Incentive New payment for cardiac rehabilitation following a heart attack or heart surgery • Cardiac Rehabilitation (CR) Incentive Payment Model CMS will pay hospitals $25 per rehabilitation service provided to Medicare beneficiaries who receive care after a heart attack or bypass surgery That payment rate will apply to 11 services per patient. CMS will pay $175 per service for those provided beyond those first 11 services www. eidebailly. com
MSA’s for New Bundles 98 MSA’s for Cardiac Bundles (AMI, CABG) • 1, 120 hospitals Wisconsin & Minnesota impacted MSA’s include: • • Madison Milwaukee-Waukesha-West Allis * Chicago-Naperville-Elgin, IL-IN-WI * La Crosse-Onalaska, WI-MN * Also Cardiac Rehab Incentive Market www. eidebailly. com
Bundles Other Considerations What impact are bundles having on you? • Wisconsin “narrow networks” • National employers, e. g. Walmart or Lowe's employees www. eidebailly. com
Hospital Outpatient Departments (HOPD) HOPD's restriction on new department s • If you want to relocate an existing dept. what are the risks • Can you add new services • How will these get paid • Exception if you can demonstrate it's an ER www. eidebailly. com
HOPDs 21 st Century Cures Act passed in December 2016 newly built offcampus outpatient departments that were poised to accept patients prior to December 2, 2015, and submitted proper attestation to CMS are exempted from this siteneutral payment provisions www. eidebailly. com
DSH Factor 3 DSH has been paid using Medicaid days and SSI days to estimate Factor 3 (DSH Uncompensated care) CMS indicates they will begin using S-10 Bad Debt and Charity amounts no later than FFY 2021 How are you tracking these amounts (Logs) Can be a weak area for some facilities www. eidebailly. com
Medicare Outpatient Observation Notice (MOON) Enacted August 6, 2015, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires hospitals and Critical Access Hospitals (CAH) to provide notification to individuals receiving observation services as outpatients for more than 24 hours explaining the status of the individual as an outpatient, not an inpatient, and the implications of such status All hospitals and CAHs are required to provide the MOON beginning no later than March 8, 2017 www. eidebailly. com
340 B Drug Discount Program Qualifications/Timing to Participate in 340 B January 2017 rule authorizes penalties for drug-makers who are found to be deliberately overcharging providers for drugs purchased under the 340 B program • Fine up to $5, 000 • Also must offer refunds for the overcharges • New guidance on how the ceiling price is calculated The new rule takes effect February 28 and will be enforced as of April 1 www. eidebailly. com
2017 Hospital Outpatient Prospective Payment November 2015 Budget billed proposed Hospital Outpatient Departments (HOPDs) that began billing OPPS after November 1, 2015, would no longer be paid for most services under the OPPS after January 1, 2017 Reimbursed at a site -specific MPFS rate that is 50% of the OPPS rate starting January 1, 2017 www. eidebailly. com
Medicare Compare Websites Compare websites – are you reporting data here on quality or somewhere else Same for your physicians and that is one component with MACRA More consumers will use the web to choose where to go www. eidebailly. com
NGS Milwaukee Office Closing in summer 2017 – losing the personal connection Cost report filing – can’t deliver in person www. eidebailly. com
MAC (Audit) Issues Home office costs – definitely a risk area with any MAC and seem to be scrutinized more and more Commingling of visiting specialists space within RHC’s, Provider based clinics, other hospital space Preventative visits, HCC Coding and everything around the move to value www. eidebailly. com
CMS Innovation Center New models for you to consider Medicare Diabetes Prevention Program (MDPP) Expanded Model – begins January 1, 2018 The MDPP core benefit is a 12 -month intervention that consists of at least 16 weekly core hour-long sessions, over months 1 -6, and at least 6 monthly core maintenance sessions over months 6 -12, furnished regardless of weight loss. Oncology Care Model – began June 29, 2016 OCM-FFS episodes include all Medicare Part A and Part B services that FFS beneficiaries receive during the episode period; certain Part D expenditures are also included. Episodes will terminate six months after a beneficiary’s chemotherapy initiation. www. eidebailly. com
Experience the Eide Bailly Difference Questions? This presentation is presented with the understanding that the information contained does not constitute legal, accounting or other professional advice. It is not intended to be responsive to any individual situation or concerns, as the contents of this presentation are intended for general informational purposes only. Viewers are urged not to act upon the information contained in this presentation without first consulting competent legal, accounting or other professional advice regarding implications of a particular factual situation. Questions and additional information can be submitted to your Eide Bailly representative, or to the presenter of this session.
Experience the Eide Bailly Difference Thank You! Mike Everson, Director Reimbursement, Froedtert Health michael. everson@froedtert. com Eddie Phibbs, Director, Eide Bailly ephibbs@eidebailly. com
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