Tag: Correction

From: Federal Register – CMS-1655-CN2; Filed 9/30/16; Published 10/5/16

CMS posted a final rule correction this morning on the Federal Register public inspection website.  In review of the 47 page document, there a significant number of corrections that were mostly typographical.  More significant however were errors made in the DSH Uncompensated Care Factor 3 calculation that required the recalculation of the budget neutrality factors that impacted:

• PPS Base Rates
• Outlier Threshold Calculation
• Wage Index Tables
• DSH Factor 3 Allocation

As of this writing, CMS has not updated the website containing the spreadsheet tables.  I would expect this to be updated later today or Monday (10/3).  The impact overall appears to be quite minor, but required a significant re-run of the data tables.  Based on the corrections detailed in the Federal Register document, below is a comparison of the impact to the PPS Base Rates & PPS Capital Rate

IP PPS Acute Final Rules FY2017 – Correction

From: Federal Register CMS-3310 & 3311-F3 – 6/1/16

Summary

This document corrects certain technical and typographical errors that appeared in the October 16, 2015 final rule with comment period titled ‘‘Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017.’’

Read more:

EHR Incentive Program – Stage 3 & Modifications to Meaningful Use in 2015-2017 – Correction & Correcting Amendment

From: CMS – MLN Articles – MM9608 – 4/4/16

Background

The Centers for Medicare & Medicaid Services (CMS) has identified an error in the Home Health (HH) Pricer program that causes incorrect Original Medicare payments to Home Health Agencies (HHAs).

The HH Pricer program routinely validates whether the Health Insurance Prospective Payment System (HIPPS) code on a claim is supported by the appropriate number of therapy services. If the number of therapy services is higher or lower than what is reflected in the HIPPS code, the Pricer recodes the claim and a HIPPS code corresponding to the actual therapy services is paid.

Since the January 2016 update to the HH Pricer, the program performed this action incorrectly when the provider-submitted HIPPS codes began with 5, or when 20 or more therapy visits were provided and the provider-submitted code was recoded to a HIPPS code beginning with 5. As a result of this error, claims that were recoded to a different payment group were assigned incorrect HIPPS codes.

To correct these errors, CMS has revised the HH Pricer; this revision will be implemented on April 25, 2016. After this implementation is completed, your MAC will correct your payments by adjusting HH claims that meet the following criteria:

• Type of Bill 032x other than 0322,
• APC-HIPPS codes in the 5xxxx range, and
• Claim receipt dates on or after January 1, 2016.

Further, the MACs will complete these claims adjustments within 30 days of the installation date of the revised HH Pricer.

Correction to Recoding in the HHA PC Pricer Program