Harmony Healthcare Blog

CMS Proposed Final Rule FY2014 - Medicare Payment Rates

Posted by The Harmony Team on Wed, Jun 05, 2013


Edited by Kris Mastrangelo

On May 1,2013 the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule [CMS-1446-P] outlining the proposed Fiscal Year 2014 Medicare payment rates for skilled nursing facilities (SNFs).  The proposed rule outlines an estimated increase in SNF payments of 1.4%.  This estimated increase is attributable to the 2.3% market basket increase, which is then reduced by the 0.5% point forecast error correction, and further reduced by the 0.4% point multifactor productivity adjustment required by law.

Also noted in the Final Rule is the addition of MDS item O0420, “Distinct Calendar Days of Therapy”.  The purpose of this item would be to record the number of distinct calendar days of therapy provided by all the rehabilitation disciplines to a beneficiary during the seven day ARD look back period.  This item is being added to ensure that providers will meet all qualifying conditions for a rehabilitation category RUG-IV group. 

Proposed item O0420 would require providers to enter distinct calendar days of therapy provided by all the rehabilitation disciplines to a beneficiary during the seven day ARD look back period.  CMS also clarified that the qualifying condition for the Rehab Medium (RM) groups requires five distinct calendar days of therapy, and the qualifying condition for the Rehab Low (RL) category requires three distinct calendar days of therapy.

The Final Rule also discusses presumption of coverage.  The requirements for presumption of coverage will remain unchanged, and will continue to apply to the upper 52 RUG-IV categories.  Presumption of coverage only applies to the 5 day PPS assessment, and is only a consideration if the patient is discharged directly from the hospital to the SNF. 

The Proposed Final Rule announces that CMS has initiated a SNF Therapy Research Project. 

The project will review past research studies and policy issues related to SNF PPS therapy payment, and options for improving or replacing the current system of payment for SNF therapy services received.

The proposed final rule, in its entirety, may be found at http://www.federalregister.gov/inspection.aspx.  

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Tags: CMS, Denial Management, Medical Record Review

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