Thursday, February 4, 2016

CMS Updates Remittance Advice and Physician Fee Schedule Lookup Educational Resources

Dan Ciolek

 In January, the Centers for Medicare and Medicaid Services (CMS) Medicare Learning Network (MLN) updated two provider education resource documents as described below. Provider billers should review both documents, and clinicians that use Part B procedure codes should review the fee schedule booklet. 

Remittance Advice Information: An Overview Fact Sheet — Revised
The revised Remittance Advice Information: An Overview Fact Sheet included updated information about:

• What types of Remittance Advice (RA) are available

• What information is included in an RA

• How to view an RA

How to Use the Searchable Medicare Physician Fee Schedule Booklet — Revised  The revised How to Use the Searchable Medicare Physician Fee Schedule Booklet includes updated information about:

• Payment information

• Pricing

• Relative value units

• Payment policies

Wednesday, February 3, 2016

New Report on Financing Long Term Care

Lilly Hummel

The Bipartisan Policy Center (BPC) released a report this week, “Initial Recommendations to Improve the Financing of Long-Term Care.” BPC’s Long-Term Care Initiative formulated a number of recommendations to attempt to address the sustainability of financing long-term services and supports (LTSS).

These recommendations cover issues including:
  • Increasing the Availability and Affordability of Private Long-Term Care Insurance to Extend Existing Resources
  • Expanding Options at Home and in the Community for Older Americans and Individuals with Disabilities under Medicaid
  • New Option for Working Individuals with Disabilities
  • Addressing the Needs of Americans with Significant LTSS Needs
In late 2016 or early 2017, BPC will release additional recommendations for new approaches to finance LTSS, to reform LTSS delivery, and to improve integration of care for persons with multiple chronic conditions and functional limitations.

AHCA/NCAL Submits Comments on IMPACT Act Resource Use Measure

Dan Ciolek

Last week AHCA/NCAL submitted comments to the Centers for Medicare and Medicaid Services (CMS) measure development contractor, Acumen, LLC. In response to the Draft Specifications for the Medicare Spending Per Beneficiary – Post-Acute Care (MSPB-PAC) Resource Use Measures provided for public comment on January 13, 2016.  

The stated goal of this project is to develop resource use measures for PAC settings as mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. These measures apply to skilled nursing facilities (SNFs), home health agencies (HHAs), long-term care hospitals (LTCHs), and inpatient rehabilitation facilities (IRFs). The stated purpose of the measures is to provide actionable, transparent information to support PAC providers’ efforts to gauge and improve the efficiency and coordination of patient care. A given PAC provider’s efficiency is evaluated relative to the efficiency of the national median PAC provider in the same setting. 

The objectives of the project are to 1) Produce MSPB-PAC measures that use a framework similar to the hospital MSPB measure used in the Hospital Value-Based Purchasing program, and 2) Prepare the measure for SNF, HHA, LTCH, and IRF quality reporting programs (QRPs).  

From a SNF perspective, the MSPB-PAC measure as proposed would use risk-adjustment to compare the total costs of care similar patients from the date of admission to the SNF, until 30 days after discharge. While there are certain costs that are being considered for exclusion, the proposed approach would permit resource use setting-specific cost comparisons (e.g. SNF-SNF). The proposed measure is not designed to compare care resource use between different PAC settings for similar patients (e.g. between SNF and IRF of hip fracture).

Per the IMPACT Act, this MSPB-PAC resource use measure is to be specified, and data collection to start on October 1, 2016. This will be followed by feedback reports being provided to providers starting October 1, 2017. Finally, the law requires the public reporting of MSPB-PAC resource use measures comparing individual providers performance against a national median starting October 1, 2018.

In the AHCA/NCAL submitted comments, we identified numerous concerns with the draft MSPB-PAC measure specifications, requested specific additional information, and provided recommended alternative solutions. The primary AHCA/NCAL concerns were related to 1) The alignment of the proposed measures with the IMPACT Act, 2) The lack of sufficient information and time provided to stakeholders to be able to provide informed and thoughtful comments, and 3) Inconsistencies in the draft measure specifications that confuse the terms “resource use” measures with “efficiency” measures.

AHCA/NCAL members with questions or comments can contact Dan Ciolek at    

AHCA/NCAL Submits Comments on Chronic Care

Senators Wyden & Hatch (Photo courtesy Pro Publica)
Drew Thies
The American Health Care Association and National Center for Assisted Living submitted comments to the Senate Finance Chronic Care Working Group.

The Working Group released a series of proposals in December and called for stakeholder input. The proposals primarily call for changes targeting Medicare beneficiaries with multiple chronic conditions.

AHCA/NCAL urged the group to take into account the “unintended consequences” the policies could have on current payment systems and access to care. Community-level quality metrics, for instance, could potentially put some residents at risk by taking control away from providers, the comments argue.

Clifton J. Porter II, senior vice president of government relations for AHCA, said, "This issue is of vital importance to AHCA/NCAL, since a majority of the individuals our members care for have multiple chronic medical conditions — and the number is growing rapidly."

Porter said that Medicare spending for beneficiaries with chronic conditions can reach $300 billion each year. Spending on beneficiaries with six or more conditions is three times higher than that of an average Medicare patient. Comments suggested that the working group distinguish between the two very different populations of patients with many chronic conditions and those with just one or two.

AHCA/NCAL will continue to work closely with the Working Group as the Senate Finance committee moves forward on its signature Medicare reform package.

AHCA/NCAL Adds Spectacular Evening Venue for IO Leadership Conference

If you haven’t yet registered for the IO Leadership Conference, now is the time. AHCA/NCAL is excited to announce that RoofTop600 at Andaz will be the sight of the Thursday dinner for all attendees. With great views, a unique atmosphere, and excellent SoCal cuisine, RoofTop600 at Andaz sets the scene for a fantastic night of networking. It’s just one of the many opportunities you will have to share ideas and connect with your peers at the IO Leadership Conference.

Register today so you don’t miss out on any of the great opportunities that we are planning. Earn 11.5 CEUs, take part in education sessions geared just for you, enjoy the ever-popular Owner to Owner Town Hall Meeting, and walk away energized and inspired.

The deadline is February 17, 2016.

Sponsors as of February 1, 2016:

American HealthTech, Cambridge, CapitalOne, Carpenter Bus Sales, DirectSupply, eHealth Data Solutions, Kronos, Evans Senior Investments, Greystone, Insurance Solutions, Kronos, MatrixCare, McCullom Consulting/Health Care Advisory Group, Mueller Prost, MobilexUSA, My InnerView, Oxford Finance ,PointClickCare, Schryver Medical, Walker & Dunlop, Yadkin, Ziegler

Tuesday, February 2, 2016

Provider Magazine Next Twitter Chat February 23rd

Bill Myers

By the time the sun sets today, another 8,000 baby boomers will have celebrated their 65th birthday.

And, even if we haven’t met all these elders yet, we already know a lot about them: Nearly one in seven of them are already poor (or barely above the poverty line); nearly 3 million of them will have dementia or Alzheimer’s disease by the time they’re 85; they’ll make up nearly three-quarters of new HIV cases in the next few years.

So why is it, in a presidential election year that might well be boomers’ last chance to put one of their own in the White House, that so little time and space has been given to the problems (and rewards) of an aging population?

That’s why Provider Magazine and the Bipartisan Policy Center are proud to announce our next #ProviderChats on Tuesday, February 23, from 1-2 p.m. EST to discuss the Politics of Aging, 2016.

We’re thrilled to be joined by an all-star panel of experts, including:

Clif Porter, senior vice president for government relations at the American Health Care Association/National Center for Assisted Living. His group’s constructive, “We Are The Solution” approach to lobbying has won praise from both sides of Congress and the public, helping to win victories in the long-vexing Medicare “doc fix” problem, a clean payment resolution, and passage of IMPACT. Porter has spent nearly three decades in elder care, rising from administrator-in-training to the head of HCR ManorCare’s government relations department for more than a decade.

Don Redfoot, Dementia Action Alliance. Don spent nearly three decades with AARP, most recently as its senior strategic policy adviser. He conducted and supervised public policy research on domestic and international issues related to assisted living, long-term care financing options, and reverse mortgages.  Don was a founding member and former chair of the board of the Center for Excellence in Assisted Living, and he currently sits on the board of the Pioneer Network, as well as the steering committee for the Long-Term Care Financing Collaborative.

Katherine Hayes is the director of health policy at the Bipartisan Policy Center. Prior to joining BPC, Hayes worked as an associate research professor in the Department of Health Policy at the George Washington University School of Public Health and Health Services and served as co-director of Health Reform GPS: Navigating Health Reform Implementation, a website jointly sponsored by the Robert Wood Johnson Foundation and GW’s Hirsh Health Law and Policy Program. She also taught graduate courses in federal advocacy and policymaking and the federal budget process.

It’s February and Gero Nurse Prep is on Sale!

Dave Kyllo

This is the month to take advantage of special sale on the AHCA/NCAL Gero Nurse Prep program. Save $100 on each training spot through February 29 by entering promo code QS2016 (all caps) when registering.

This unique program prepares RNs for the American Nurses Credentialing Center board certification test in gerontological nursing. Board certification (RN-BC) is the gold standard for demonstrating clinical excellence in geriatric patient care. Less than one percent of nurses have this prestigious credentialing, so investing in this program can give providers a competitive edge when negotiating with ACOs, MCOs and hospitals.

Gero Nurse Prep is also a smart and effective use of training dollars. Gero Nurse Prep Alums can boast a 96% pass rate on the ANCC gerontological nursing certification exam. RNs can study on their own schedules and earn 30 CEUs by completing the program.

Help your RNs boost their clinical competence. Check out the AHCA/NCAL Gero Nurse Prep program and try a free demo today!

Be Compliant: Know Your Workforce Numbers

Dave Kyllo

The Internal Revenue Service issued another reminder last week to employers about the importance of knowing the exact size of their workforce under the Affordable Care Act (ACA).

This is essential because two provisions of the ACA apply only to applicable large employers – those employers with 50 or more employees in the previous calendar year.

Those employers with fewer than 50 full time equivalents are not subject to the employer shared responsibility provisions and the information reporting provisions for offers of minimum essential coverage. The IRS Tax Tip contains more information for employers about calculating workforce size.

AHCA/NCAL members are encouraged to check out AHCA/NCAL Insurance Solutions several months before their renewal dates before making a final decision about their employee plan coverage. Our “Members Only” program is designed to give AHCA/NCAL members access to brokers who understand long term care and who will work to save AHCA/NCAL members money. For more information, contact Dave Kyllo (202-898-6312) or Nick Cianci (202-898-2841) or email us at AHCA/NCAL Insurance Solutions.

Free Emergency Preparedness Training

Peggy Connorton

The National Center for Disaster Medicine and Public Health (NCDMPH) has just released its newest resource for health educators and trainers, “Caring for Older Adults in Disasters: A Curriculum for Health Professionals.”

Developed through the support of the U.S. Department of Veterans Affairs, the Caring for Older Adults in Disasters (COAD) curriculum is comprised of 24 lessons in 7 modules covering topics ranging from special considerations for older adults in specific types of disasters to ethical and legal issues related to the care of the senior population during a disaster.

The COAD curriculum’s lessons range from 30 to 120 minutes in length based on the particular learning context. They include suggested learning activities for educators to engage their learners, as well as required and supplemental readings for both learners and educators. The curriculum can be used in its entirety, teaching all lessons in the order provided, or trainers may select individual lessons or portions of lessons most relevant to their learners. The curriculum’s material can be adapted to best meet a specific setting and learner needs by substituting resources, modifying activities, or augmenting content.

Health Inspection Survey Score Now Available in LTC Trend Tracker 

AHCA members can now find their Health Inspection Survey Score in LTC Trend Tracker. Survey Score is the basis of your five star rating, and it includes both health and complaint inspection data. CMS uses the following methodology for calculating your survey score:

· Based on the most recent three standard surveys

· Results from any complaint investigations during the most recent three-year period

· Any repeat revisits (no points assigned for the first revisit)

· Points are assigned to individual health deficiencies according to their scope and severity

· More points are assigned for more serious, widespread deficiencies

· Fewer points for less serious, isolated deficiencies

· If the deficiency generates a finding of substandard quality of care, additional points are assigned. If the status of the deficiency is “past non-compliance” and the severity is “immediate jeopardy” (i.e., J-,K- or L-level), then points associated with a G- level deficiency are assigned.

You can find your survey score in the CASPER Combined Report in the LTC Trend Tracker System. Login today to see your data!