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   April 14, 2005 The following attached documents have been given to us by AHCA. U.S. Representatives Shelly Moore Capito (R-WV) and Earl Pomeroy (D-ND) have begun circulating a sign-on letter to encourage other members of Congress to join with them in order to ask Health and Human Services Secretary Leavitt to preserve Medicare funding for RUG reimbursement in order to ensure the viability of skilled nursing care in our nation. The letter below could be an essential part of our efforts to oppose the proposed Medicare cuts. I have also included below the House sign-on letter, and a state-by-state breakdown of the Medicare losses if the money is pulled out of the RUG system. I encourage everyone to contact their members of Congress to whom you may have personal relationships to encourage them to participate. You may wish to use the attached documents to assist in this effort. Letter to Secretary Leavitt >>
April 13, 2005 On March 25, 2005, the Department of Health and Human Services (HHS) issued a notice describing procedures for investigating and resolving alleged violations of the administrative simplification rules under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). These enforcement procedures apply to enforcement of the HIPAA Security Rule applicable to group health plans. The HIPAA Privacy Rule is enforced by the HHS Office for Civil Rights and is not affected by this enforcement notice. The HIPAA Security Rule goes into effect on April 20, 2005, except for small health plans, which must comply no later than April 20, 2006. The HIPAA Security Rule requires group health plans and other covered entities to protect the confidentiality, integrity and availability of “electronic protected health information” (“ePHI”) that is created, received, maintained or transmitted by a group health plan. The HHS has delegated HIPAA Security enforcement powers to the Centers for Medicare & Medicaid Services (“CMS”). CMS will investigate allegations of noncompliance as well as make decisions regarding the interpretation, implementation and enforcement of all HIPAA administrative simplification rules other than the HIPAA Privacy Rule. HHS has outlined the following procedures for HIPAA Security and other HIPAA administrative simplification complaints:
CMS will review the complaint and contact the complainant if any additional information is required. If, when examining the facts as alleged in the complaint, CMS determines that no violation has occurred, the complaint will be rejected. If the complaint alleges facts that could constitute a violation, CMS will notify the covered entity that the complaint has been filed and investigate the complaint. HHS will seek voluntary compliance with HIPAA administrative simplification. To that end, CMS will request the “covered entity” to respond to the complaint with one of the following:
The “covered entity” should receive at least thirty days to submit this response, but extensions may be granted at CMS’s discretion. If CMS accepts the corrective action plan, it will actively monitor the situation to ensure compliance, and the covered entity will be required to periodically report to CMS its compliance progress. Once compliance has been verified, CMS will notify the complainant and the case will be closed. If a covered entity refuses to cooperate with CMS and a violation is determined to exist, CMS will pursue other options, including monetary penalties.
January 3, 2005 Transmittal 412 in summary clarifies that an executed contract is not a requirement of consolidated billing. This has been a particular that has been under scrutiny and questioned over the past two years, especially in the context of Medicare Part A patients being seen by a provider with which the (SNF) did not have a formal agreement. Transmittal 412 specify that the SNF and the outside provider must have a form of an agreement which creates the basis for reimbursement. It further stipulates that there is nothing in consolidated billing that will relieve the SNF of financial responsibility for those products and services that are subject to consolidated billing. Transmittal 413 clarifies correct indexes for certain geographic areas. Please click here to review "Transmittal 412" for further clarification >>
January 3, 2005 Congress Allows 75% Rule Implementation The so-called “75% Rule” ensures that patients receive their rehab care in either Inpatient Rehabilitation Facilities (IRF) or a Skilled Nursing Facility (SNF). What is great for the nursing home industry is that SNFs will have more access to more Part A patients with the implementation of the Rule. The 75% Rule phases the clinical criteria to distinguish those patients who should undergo rehabilitation in either SNFs or IRFs. Hal Daub, President and CEO of AHCA concluded, “In the end, the patients are the winners because they will be able to get the right care in the right setting”.
November 2, 2004 There is a huge battle currently being waged over an estimated $5.7 million dollars in reallocated Medicare reimbursement for inpatient rehabilitation services. The debate is over whether a new rule should be allowed to go into effect in 2005. There is a scramble to attach a moratorium in both the House and Senate on appropriations bills. The new rule is very favorable for SNF's, as it would steer more Medicare Rehabilitation patients their way. AHCA is among those group lobbying against the moratorium on this rule. According to the new payment rule, rehabilitation hospitals applying for higher reimbursement would need to show that during the prior year 75% of their patients were being treated for at least one (1) of twelve possible conditions. These conditions include multiple traumas, brain injury, amputation, neurological disorder, spinal-cord injury, stroke, congenital deformity, femur fracture, burns, and three arthritis related ailments. Rehabilitation hospitals that fail to meet the 75% criteria would be disqualified from receiving higher reimbursement. This rule according to CMS seeks to provide services to beneficiaries in the most appropriate and cost-effective setting. This rule would be phased in over a three year period: 50% first year, 60% second year, 65% third year, and 75% thereafter. Stay tuned!
CMS just recently launched its “THERAPY BILLING” web page. CMS’s goal for this site and direct link is to provide insight into Part B billing issues with relation to Physical, Occupation and Speech Pathology services. The site also contain links to CMS manuals and has 11 Therapy Part B scenarios. |
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