Wednesday, April 23, 2014

Billing Changes from CMS

Daniel Ciolek

From CMS, AHCA learned that providers should take note because the Coordination of Benefits Contractor (COBC) is now the Benefits Coordination and Recovery Center (BCRC). For new contact, address, and Web address information, please visit this website. Other CMS billing changes, include:
  • PC Print software version 4.3.0, released in April 2014, is not compatible with Windows XP because Microsoft support for Windows XP ended on April 8. Providers using Windows XP. should continue to use version 4.2.6 of PC Print until they upgrade their operating system. Read more here.
  • SNF Consolidated Billing: Exclusion of HCPCS Code G0463 for Certain Outpatient Hospital Clinic Visits. If you previously received a SNF CB rejection for HCPCS G0463, you should contact your MAC to verify if you can adjust or resubmit your previously processed claim. Read more here.

Tuesday, April 22, 2014

Paul Ryan to Speak at Congressional Briefing

Drew Thies

AHCA/NCAL is excited to announce that Rep. Paul Ryan (R-WI) will be speaking at the annual Congressional Briefing on Tuesday, May 20th.

Ryan, a young star in the Republican Party, is currently Chairman of the House Budget Committee as well as a member of the Ways and Means Subcommittee on Health. He is considered a top contender to take over chairmanship of Ways and Means after the 2014 election, when current Chairman Dave Camp retires.

Often the face of the Republican fiscal agenda, Ryan was at the forefront of the December 2013 budget agreement, alongside Senate Budget Chairwoman Patty Murray, to keep the government funded through 2015.

Prior to his recent work on the budget, Ryan became a household name when he ran as Vice President alongside Mitt Romney in the 2012 Presidential election.

Come visit Washington, D.C. see Ryan, Sen. Ron Wyden, and Charles Kauthammer speak; and meet with your representatives at AHCA/NCAL’s Congressional Briefing, May 20-21.

Registration is extended and hotel rooms are booking fast, so make your plans today!

Check Updated LEIE Database - March 2014

Dianne De La Mare

The US Department of Health, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in March 2014.

This new file is meant to replace the updated LEIE database file available for download last month.  Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

The updated files are posted on OIG’s website, and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines.

Instructional videos explaining how to use the online database and the downloadable files are available online. Given the penalties and recent government warnings, long term care providers should check the LEIE on a regular basis.

2014 SNF PEPPERs Available in May Via Electronic Portal

Dianne De La Mare

TMF Health Quality Institute, the Centers for Medicare & Medicaid Services (CMS) contractor responsible to produce and distribute the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for various professional groups, including skilled nursing facilities (SNFs), has just announced a WebEX entitled The SNF Program for Evaluating Payment Patterns Electronic Report (PEPPER) on May 8, 2014, at 2:00PM, Central Daylight Time.

The WebEX will focus on:
  1. Updates for the new SNF PEPPER, summarizing statistics for FYs 2011-2013; and 
  2. the new method for accessing the 2014 SNF PEPPER via the Secure PEPPER Access portal on 
Registration is not required to join the event. Simply go to this link about 15 minutes prior to the start time of the WebEX. The event number is: 924 457 628 and the event password is: flower.

AHCA has advocated strongly for this process and is pleased that CMS is making this change.

Currently, the SNF PEPPERs are scheduled for release on May 5, 2014; however, TMF will send an email to announce the formal release when the SNF PEPPERs are available to access. To receive this email, join the email list at

SNFs do not have to register to receive a PEPPER report; however, TMF has asked us to share the following specific information:
  • Access to the SNF PEPPER will be restricted to the provider’s Chief Executive Officer, President or Administrator. Note: Corporate offices and/or facility management companies will need to obtain PEPPERs from each individual provider in their organization.
  • Requestors will be required to enter their 6-digit CMS certification number (also referred to as a provider number or PTAN) (third digit of “5” or “6” for SNFs). This is *not* the same number as the tax identification number or national provider identification number. 
  • For verification purposes, requestors will be required to enter either a Patient Control Number (form locator 03a on the UB04 claim form) *or* a Medical Record Number (form locator 03b on the UB04 claim form) for a patient who received services at the provider during September 2013 (“from” or “through” date is between September 1-30, 2013).
Note: If providers use only letters in both of these fields they must contact TMF to request assistance. Patient names cannot be entered due to patient privacy laws.

If you have individual or specific questions regarding the 2014 PEPPER reports, please visit to submit questions.

CMS to Implement Fingerprint-Based Background Checks for High-Risk Providers and Suppliers in 2014

Reed Smith, AHCA/NCAL General Counsel

Check out a recent posting to Health Industry Washington Watch by Reed Smith, AHCA/NCAL's General Counsel:
More than three years after publication of final regulations to implement Affordable Care Act (ACA) provisions that strengthen provider and supplier enrollment screening provisions under federal health care programs, the Centers for Medicare & Medicaid Services (CMS) has selected a Fingerprint-Based Background Check Contractor (FBBC) and intends to phase in fingerprint-based background checks beginning in 2014.  


Two More Organizations Join Observation Stays Coalition Efforts

Dana Halvorson

AHCA/NCAL continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), along with Sen. Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.

Currently, S. 569 has 25 bipartisan cosponsors, while H.R. 1179 currently has 140 bipartisan cosponsors.

AHCA/NCAL also continues its work as part of the Observation Stays Coalition, which now consists of 30 organizations advocating for this important legislation. The National Council on Aging and the Catholic Health Association of the United States are the most recent organizations to add their names to the Coalition efforts. The updated Coalition fact sheet can be found here.

For more information about observation stays, please visit the AHCA/NCAL website.

ACA Webinar this Thursday

Dana Halvorson 

This month, the health care industry saw its first round of open enrollment numbers for the Affordable Care Act (ACA) and next month many expect insurers to release their prices for 2015 exchange policies. What does this data tell us about the state of the industry today? Where do we go from here?

Bloomberg Government will be holding a free webinar this week on Thursday, April 24, at 2pm EST, on these topics where their health care analysts will offer an exclusive look at this month’s data and preview what lies ahead for the ongoing reform effort.

According to the Bloomberg Government website on the webinar, specific topics covered will include:
  • An analysis of the first open enrollment numbers under the ACA
  • Detail of the law’s Medicaid expansion and what it means for industry 
  • A preview of insurers pricing decision for exchange policies 
Further details about the webinar, including registration, can be found here.

If you have any questions relating to the ACA, please submit them to, and be sure to check out AHCA/NCAL's ACA website.

Updates to and New ACA Materials

Dana Halvorson

April 15, 2014, marked the end of the “in-line” Special Enrollment Period for those enrolling in the federally-facilitated marketplace. As a result, several changes have been made to New information has been added that you may find helpful.

New Blog Posts:
Updates to
If you have any questions relating to the Affordable Care Act (ACA), please submit them to, and be sure to check out AHCA/NCAL's ACA website.

Recognize Your Champion of Quality Care

Courtney Bishnoi

AHCA is now accepting applications for the 2014 Mary K. Ousley Champion of Quality Award! This award recognizes an individual who has made significant national contributions to advancing quality performance in long term and/or post-acute care, including either skilled nursing or assisted living settings. Previous recipients have demonstrated exemplary achievements in long term and post-acute care, including, but not limited to:
  • leadership in education and advocacy for quality improvements,
  • dedication to performance improvement, 
  • significant additions to long term and post-acute care research or interventions, and 
  • initiative in innovation for quality care.
Recipients of the award are not required to be AHCA/NCAL members, but the nomination must be submitted by an individual with an organization that is in a member of good standing of AHCA/NCAL.

In addition, the nomination must demonstrate how the nominee has made a significant impact on a national scale.

The recipient will be honored at the 2014 AHCA/NCAL Annual Convention & Expo in Washington, DC. Nomination forms can be found on the Champion of Quality Award page, and must be submitted via email to Courtney Bishnoi by June 13, 2014.

Please contact Courtney Bishnoi for questions, or visit the Champion of Quality Award page for more information.

AHRQ Expands Data Collection Period on Patient Safety Culture

Lyn Bentley

Earlier this month we alerted you that the Agency for Healthcare Research and Quality (AHRQ) was collecting data related to a patient safely culture in nursing centers. AHRQ has extended its data collection date for the Nursing Home Survey on Patient Safety Culture until May 31 (see notice from the AHRQ below). According to the AHRQ, “One of the purposes of the database is to produce comparative results to help nursing homes identify strengths and opportunities for improvement in their patient safety culture.” Topics covered in the survey include:
  • Teamwork; Training & Skills;
  • Non-Punitive Response to Mistakes; 
  • Communication Openness; and 
  • Feedback & Communication About Incidents. 
Results of the survey are made public in the aggregate with no identifying information about specific nursing centers or staff who responded. Centers are able to compare their individual responses to the results in the data base, providing an opportunity to assess their strengths and opportunities for improvement.

Note: This tool and the results are helpful for a center moving forward in its QAPI efforts – they may provide ideas for improvement projects.

Here's the notice from AHRQ...

Data Submission Extended to May 31 for AHRQ Nursing Home Survey

Data submission has been extended for the Agency for Healthcare Research and Quality (AHRQ) Nursing Home Survey on Patient Safety Culture Comparative Database until May 31, 2014. Nursing homes that have administered the AHRQ nursing home safety culture survey can now voluntarily submit their data.

To submit data, please go to
  • Data submission is open from April 1 - May 31, 2014;
  • Nursing homes must have licensed nursing home beds;
  • Nursing homes must be in the U.S. or U.S. territories; and
  • Assisted living, community care, or independent living facilities are not eligible to participate.
This database is a central repository for survey data from nursing homes, or survey vendors, that have administered the AHRQ nursing home survey instrument. One of the purposes of the database is to produce comparative results to help nursing homes identify strengths and opportunities for improvement in their patient safety culture. Comparative results are reported in the aggregate and do not include any information identifying participating nursing homes.

Please feel free to contact us with any questions or concerns at or 1-888-324-9790.
Thank you,
The Nursing Home Survey Database Submission Team