The Votes Are In For RUG-IV
During the CMS Open Door Forum, December 9, 2010 Sheila Lambowitz, Director of the Division of Institutional Post Acute Care for the Centers for Medicare & Medicaid Services stated "We're not going to have to reprocess [RUG-IV] claims," "We're not going to have to change to a new [temporary] grouper." She went on to say that passage of the bill "gives us some clarity to move forward and work on transition issues and make sure we have the RUG-IV and MDS 3.0 system working properly."
Additionally this legislation extends Medicare's Therapy Cap Exception process until December 31, 2011. Therapy caps apply an annual cap per beneficiary on expenses incurred for both outpatient physical therapy and speech therapy services combined and a separate cap for outpatient occupational therapy services under Medicare Part B. For CY 2011, the therapy cap amount has increased slightly from $1,860 to $1,870.
The Medicare and Medicaid Extenders Act of 2010 also eliminates the expected 25% reduction in Medicare payments to physicians that was to be initiated in January 2011. This is great news for the LTC industry.
"This agreement is an important step forward to stabilize Medicare, but our work is far from finished," President Obama said in a statement. He added that it's time "for a permanent solution that seniors and their doctors can depend on."
Additional information on this soon to be law can be obtained on the United States Senate Committee on Finance site: http://finance.senate.gov/legislation/details/?id=9f97aa2e-5056-a032-52d4-8db158b12b11
CMS Speaks: CMS has posted the following guidence for facilities regarding coding Section A, 0310E to report if the assessment is the fist assessment since the most recent admission.
MDS 3.0 Coding Clarification for Item A0310E - CMS has re-evaluated the guidance outlined in the "MDS 2.0 to MDS 3.0 Transition Document" dated October 2010 for the coding of item A0310E. The transition document indicated that the item should be coded as "1" for the initial MDS 3.0 assessment for all existing residents; however, this guidance was overlooked on many of the assessments that were submitted.
During the November 9, 2010 National Provider Call direction was provided indicating that assessments that were coded as a "0" would need to be corrected and resubmitted.
CMS has reconsidered the matter and has concluded that providers Do Not need to submit corrected assessments where item A0310E may have been miscoded. Providers should follow the directions outlined in Chapter 3 Section A of the MDS 3.0 RAI Manual for the coding of A0310E from this point further.