Category: IP CAH

From: CMS MLN Matters Article – MM8666 – 3/21/14

Provider Action Needed

This article is based on Change Request (CR) 8666, which implements revised policies related to payment of hospital Part B inpatient services from the Fiscal Year 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) final rule, CMS-1599-F. This includes several conforming changes to the “Medicare Benefit Policy Manual” for payment of Part B inpatient services in skilled nursing facilities (SNFs). CR8666 is a   companion piece to the recently issued CR 8445 (see the related MLN Matters® Article, MM8445, available at http://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network- MLN/MLNMattersArticles/Downloads/MM8445.pdf on the CMS website.). Be sure your billing staffs are aware of these changes.

Implementing the Part B Inpatient Payment Policies from CMS-1599-F

From CMS MLN Matters Article MM8426 – 1/17/2014 

Summary – Key Points

 This article is based on Change Request (CR) 8426 and alerts providers that:

• Beginning January 1, 2014, outpatient therapy services furnished by a CAH are subject to the therapy cap and related policies;
• Pursuant to statute, the exceptions process, including the use of the KX modifier to attest the medical necessity of therapy services above the caps, applies to services furnished by a CAH in CY2014;
• Similarly, pursuant to statute, the manual medical review of claims in excess of the $3,700 threshold applies to services furnished by a CAH in CY2014; and
• MACs will no longer automatically apply the KX modifier to CAH services, effective January 1, 2014.

Please be sure your billing staffs are aware of this fee update. See the Background and Additional Information Sections of this article for further details regarding these changes

Applying the Therapy Caps to CAHs

From: CMS MLN Matters MM8458 Revised – 1/14/14

What You Need to Know

This article is based on Change Request (CR) 8458, which updates portions of the “Medicare Benefit Policy Manual” (MBPM) to clarify key components of SNF, IRF, HH, and OPT coverage requirements pursuant to the settlement agreement in the case of Jimmo v. Sebelius. Nothing in this settlement agreement modifies, contracts, or expands the existing eligibility requirements for Medicare coverage.

Manual Updates to Clarify SNF, IRF, HH, & Outpatient Coverage Pursuant to Jimmo vs. Sebelius