CMS Medicare Final Rule 2012

 

CMS Medicare Final Rule changes were finalized on July 29, 2011.  Identified changes in the Final Rule require facilities to perform systems analysis to embrace changes in effect October 1, 2011.

 Federal Rate Changes :

• CMS has stated that the payments for SNFs in FY 2012 are projected to decrease by $3.87 billion, or 11.1 percent, compared with those in FY 2011. This reflects a $600 million increase from the update to the payment rates and a $4.47 billion reduction from the recalibration of the case-mix adjustment. CMS estimates that under RUG-IV, SNFs in urban areas would experience, on average, an 11.3 percent decrease. In the Final Rule, CMS points out that the FY 2012 payment rates are still 3.4 percent higher than the FY 2010 rates and that this decrease from 2011 rates is an attempt to return reimbursement to the appropriate level for SNF payments.
• Harmony provides facility specific analysis of current, projected, and goal rates to aide in aligning facility with budgetary requirements and embracing solutions to positively impact reimbursement.

Click the link below for a list of the 2012 Federal Rates listed from Highest to Lowest!!

Management of New MDS Assessment Schedule:

• Per the Final Rule, as of October 1, 2011 the SNF PPS MDS assessment schedule will have fewer days available for capture of clinical indicators. This new schedule is much less forgiving for facilities when focusing on RUG management to accurately code the MDS.
• Harmony works intensively with  MDS Coordinators and Therapy team to implement systems and provide close oversight resulting in the optimal RUG leveling under both Medicare and Medicaid reimbursement systems. The communication process is vital and will be monitored and refined.

Click the link below for a list of the New MDS Assessment Schedule!!

 

 End of Therapy OMRA (EOT):

• CMS clarified the end of therapy requirements and have eliminated the distinction between facilities that deliver 5 or 7 days of therapy for purposes of setting the ARD for the EOT OMRA.  EOT OMRA must be completed once therapy services cease for three consecutive days, planned or unplanned, regardless of the reason. ARD must be set 1 to 3 days after the discontinuation of ALL the therapy services.
• The therapy team must be aware of scheduling conflicts and how to manage patient resistance to prevent dips in Medicare Part A revenue. Harmony provides insight and solutions for managing this risk especially during periods of low staff levels and with “difficult to treat” patient populations.

 End of Therapy-Resumption OMRA (EOT-R):

• CMS has introduced an optional End of Therapy-Resumption OMRA.  This assessment will take the place of an End of Therapy and Start of Therapy OMRA when the therapy resumes at the same level of intensity and RUG IV category after a break in coverage of 5 calendar days or less. 
• Harmony works closely with the therapy team and MDS Coordinators to map minutes necessary to restore the daily Medicare Rate to the prior rehab level.

 Change of Therapy OMRA (COT):

• An additional unscheduled required assessment has also been added known as a Change of Therapy OMRA and will be completed following a rolling 7 day look back period.  What this means to providers, is that the first day following the ARD of a scheduled assessment becomes day 1 in the 7 day look back for the change of therapy OMRA.  When the patient reaches this day 7, the facility must analyze the minutes delivered by this date.  If the minutes provided are not equivalent to the intensity of the RUG captured during the last scheduled assessment, the facility must complete a change of therapy OMRA.  This can be due to an increase or decrease in the therapy intensity provided.  The resulting RUG rate will then be billed from the start of the 7 day look back period.  Once this is completed, the rolling 7 day window will begin again on the day following this ARD.  If no change in intensity is noted and the RUG level remains the same, no assessment is required and the rolling 7 day window begins again.
• The Government is enforcing that all RUG levels are supported clinically and reviewed every seven days from the ARD.  This mandate puts enormous pressure on the clinical team to stay consistent with service delivery.  Harmony’s audit process will be an automatic oversight of these criteria. The Change in Therapy (COT) OMRA rules apply whether the change in therapy delivery is scheduled/planned or unscheduled/unplanned and whether the RUG category is higher or lower. Harmony intensive audits are aimed at identification of opportunity to increase reimbursement when clinical care levels rise to patient needs.

Group Therapy:

• CMS has also changed the allocation of treatment minutes when group therapy has been provided and group definition. The new definition of Group therapy is defined as “therapy provided simultaneously to four patients (regardless of payer source) who are performing the same or similar activities and are supervised by a therapist (or assistant) who is not supervising any other individuals.” The allocation of group therapy minutes is distributed among the four participants.  For example, if a 60 minute group was performed, each member of the group will receive 15 minutes of billed group treatment time.  There was no change to the 25% allocation of group therapy per patient.
• Harmony trains staff to maintain compliance with physician orders, best patient care practices, and vigilant case management for seamless delivery. In addition, Harmony assess therapy operations in association with group utilization and provides recommendations for operational enhancements e.g. (productivity goals, space, staffing, etc.)

 Therapy Documentation requirements:

• The Final Rule enforces “documentation must include explicit justification for using group therapy as part of the patient’s plan of care.”This justification should include specific benefits to that particular patient, the type, and amount of group treatment that will be used, and how that type and amount will meet the patient’s needs and further their progress toward their goals.
• Harmony audits identify medical records where improvements are warranted in documentation for all therapy services to insulate revenue against take-backs related to Medical Review. In addition, Harmony will assess current and future usage of group treatments.

 Therapy Student Supervision:

• Therapy students are no-longer required to be under line-of –sight supervision. In reviewing the regulations for supervision of therapy students, CMS stated that each SNF will determine for itself the appropriate manner of supervision of therapy students consistent with State and local laws and practice standards. 
• Harmony provides insight of state and local laws determination of Therapy students in addition to billing requirements. Time students spend with a patient will continue to bill as if it were the supervising therapist alone providing the therapy. For purpose of billing, the therapy student is treated as an extension of the supervising therapist.