News Tagged as FY 2012

Tentative ‘Doc Fix’ Deal Would Cut Health Law’s Prevention Fund by $5B

From: Kaiser Health News – 2/15/12

Article Excerpt

After wrangling for weeks over how to finance a Medicare “doc fix,” House and Senate conferees have a plan.  The proposal would cut Medicare payments to hospitals and other providers for “bad debt,” Medicare payments to clinical laboratories and Medicaid “disproportionate share” payments to hospitals that serve many poor patients, and divert $5 billion  from the health law’s $15 billion prevention fund.

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Inpatient Prospective Payment System FY2012 Pricer File Update

From: CMS E-mail – 2/8/12

Text of E-mail

The FY2012 Inpatient Prospective Payment System (INP PPS) PC Pricer has been updated with newer provider data, and is now available on the CMS website at http://www.CMS.gov/PCPricer/03_inpatient.asp. This Pricer is for claims dated from 10/01/2011 to 09/30/2012, and the update is dated 02/07/2012.

From: Federal Register – 2/1/12

CMS issued corrections to the Final FFY 2012 rules on February 1, 2012.  The changes were very minor in nature.

Summary from Federal Register

This document corrects technical errors that occurred in the Addendum of the final rule entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates” which appeared in the August 18, 2011 Federal Register.

From: CMS E-mail Notification – 1/10/12

Text of CMS E-mail:

On Fri Dec 23, President Obama signed into law the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA). This new legislation contains a number of Medicare provisions which change or extend Medicare Fee-For-Service policies. Included in these provisions is an extension of a moratorium that allows certain practitioners and suppliers (such as pathologists and Independent Laboratories) to bill for the Technical Component (TC) of physician pathology services furnished to hospital patients through Wed Feb 29.

Under previous law, including, most recently, §105 of the Medicare & Medicaid Extenders Act of 2010, a statutory moratorium allowed certain pathologists and independent laboratories meeting specific criteria to bill a carrier or an A/B MAC for the TC of physician pathology services furnished to hospital patients. This moratorium was set to expire on Sat Dec 31. However, Section 305 of the TPTCCA extends that moratorium beginning Sun Jan 1 through Wed Feb 29. Therefore, qualified pathologists and independent laboratories that provide the TC of physician pathology services furnished to hospital patients may continue to bill for and receive Medicare payment for these services. This policy is effective for claims with dates of service Sun Jan 1 through Wed Feb 29.

For background and policy information regarding payment to independent laboratories for the TC of physician pathology services furnished to hospital patients, refer to CR 5347, Transmittal 1221, issued on Wed Apr 18, 2007, and CR 5943, Transmittal 1440, issued on Thu Feb 7, 2008.

From: CMS E-mail Notification – 1/10/12

Text of CMS E-mail:

Section 302 of the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA) extends Section 508 reclassifications and certain special exception wage indexes for 2 months, from October 1, 2011, through November 30, 2011. For the period beginning on October 1, 2011, and ending on November 30, 2011, Section 302 also requires removing Section 508 and special exception wage data from the calculation of the reclassified wage index if doing so raises the reclassified wage index. All hospitals affected by Section 302 of the TPTCCA shall be assigned a special wage index effective for only October and November 2011. We will apply the provision to both inpatient and outpatient hospital payments. For hospital outpatient payments only, special exception hospitals and other reclassified hospitals that would have a higher wage index based on the removal of section 508 and special exception hospitals’ wage data will receive a special exception wage index from January 1, 2012, through February 29, 2012.

IPPS and OPPS claims from section 508 hospitals, IPPS special exception hospitals and IPPS non section 508 hospitals affected by section 302 with discharge dates on or after October 1, 2011, through November 30, 2011, will be reprocessed no later than December 31, 2012, in accordance with the TPTCCA.

OPPS claims for hospitals reclassified for special exceptions and other affected reclassified hospitals that completed processing before the wage index was updated will be reprocessed by early February, 2012.

Please note that for OPPS hospitals, a section 508 hospital that has geographic reclassification extended from October 1, 2011, to November 30, 2011, will revert to its previously scheduled October 1, 2011, reclassification or its home area wage index from December 1, 2011, to December 31, 2011. OPPS special exception hospitals and reclassified hospitals that benefit based on removal of section 508 and special exception hospital data shall revert to the CY2012 rule wage index, beginning March 1, 2012. IPPS hospitals shall revert to their wage index promulgated in the FY2012 rule located on our website at http://www.CMS.gov/AcuteInpatientPPS/FR2012/itemdetail.asp?itemID=CMS1250520.

Transmittal 3 – December 2011

This transmittal impacts SNF cost reporting periods beginning on or after January 1, 2012.  It incorporates a revision required by ACA Section 6104 “Reporting of Direct Care Expenditures.” 

This ACA provision requires SNFs to separately report expenditures for wages and benefits for direct care staff (breaking out (at a minimum) registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff).  A new cost report form was added S-3, Part V for the collection of this data.  Several other changes/clarification were made in and described in this transmittal.

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SNF Cost Report Forms CMS-2540-10

From: MLN 7654 – 12/9/11

CMS published this MLN Matters article describing the change in clinical laboratory fees for calendar year 2012.  The update for 2012 is a 0.65%.  The update to local clinical laboratory fees reflects an additional multi-factor productivity adjustment and a (1.75%) reduction as prescribed by the Affordable Care Act. 

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Annual Update for Clinical Lab Fee Schedule – CY 2012

From: MLN MM7666 – 12/9/11

This article informs Medicare contractors about corrections to be made for several Inpatient PPS Pricer problems.  Contractors will reprocess affected claims from October 1, 2011 through the implementation of the revised Pricer that is anticipated to be released on January 3, 2012.  The article provides specifics about the problems found in the FFY 2012 Pricer.

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Off-Cycle Release of Inpatient PPS Pricer – FFY 2012

Inpatient Psych PPS PC Pricer Update

From CMS 12/1/11

CMS E-mail:

The Inpatient Psychiatric Facility (IPF) PPS PC Pricers for RY 2012 for claims dates from 7/01/11 to 09/30/11, and for claims dates from 10/01/11 to 09/30/12, have been posted to the CMS website with October 2011 provider data.

Final Rules – OPPS & ASC for CY 2012, Value-Based Purchasing, Physician Self-Referrals & Patient Notification Requirements

CMS-1525-FC Federal Register 11/30/11

The final rule federal register was released on November 30, 2011.  Click here to view our previous post about these final rules.