Tuesday, July 12, 2016

Physician Fee Schedule Proposed Rule and Three-Day Stay Issue

Dana Halvorson and James Michel

On July 7, the Centers for Medicare and Medicaid Services (CMS) released its physician fee schedule proposed rule. CMS will accept comments on the proposed rule until September 6, 2016, and will respond to comments in a final rule.

According to CMS, included in this proposal are “changes that would improve beneficiary protections when ACOs are approved to use the skilled nursing facility (SNF) 3-day waiver rule.” Noted by Emily Mongan in a July 10, 2016, McKnight’s article on the proposed rule, “the provisions would add extra time for CMS to tell ACOs about any beneficiaries' financial liability for non-covered skilled nursing services that may be linked to use of the 3-day stay waiver. That added ‘grace period’ would allow ACOs to communicate any beneficiary exclusions to skilled nursing facilities, CMS said. The fee schedule also includes a provision that would limit 3-day stay waiver use to ACOs in Track 3.”

For more information about observation stays and the three-day stay requirement, please visit AHCA/NCAL.

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