REIMBURSEMENT UPDATE
KENTUCKY LEVEL-OF-CARE SYSTEM CHANGES
In early June 2017, members of the Association’s Billing Work Group were invited to hear about the Kentucky Level-of-Care System (KLOCS) transformation to “modernize the level-of-care determination policies and processes for nursing facilities, hospice providers and intermediate care facilities for individuals with intellectual disabilities” by implementing an electronic system to facilitate level-of-care submissions. Some of the changes announced include a shortened MAP-726A that will be entered online in the new system, a modified PASSR that will be used, and the MAP-350 that can be scanned and uploaded into the system. Recently, the Association was given a Benefind publication (click here) giving an overview of the proposed changes. Since then, there have been two (2) webinars given on August 23 & August 31, 2017, that described the system changes, and the Department for Medicaid Services has indicated they will provide educational sessions for providers to begin mid-October in 26 different locations. Following the two webinars, a FAQ document was also sent to the Association(click here) that contained questions and answers given during both sessions. The Association is continuing to address issues with this initiative, and more information will be forthcoming during the educational sessions beginning mid-October.
PROVIDER ISSUES WITH GUARDIANSHIP CASES
The Association has held several meetings with the Department for Aging and Independent Living (DAIL) regarding guardianship cases pending. On June 27, 2017, the Association held a meeting with Dep. Commissioner Lala Williams to discuss cases that were submitted by the Billing Work Group. A listing of guardianship cases as of July 31 & August 31 have been shared with Dep. Commissioner Williams and her staff. The Association will compile another listing as of September 30, 2017. Facilities that are having issues with guardianship cases are encouraged to contact the Association to add their cases to the list. Please call Sharon Netherton at the Association office or by email at to add your cases to the listing.
MLN CONNECTS QMB CONFERENCE CALL
CMS experts will present the Qualified Medicare Beneficiary program billing rules call (click here) on Tuesday, September 19th from 1:30 – 3:00 p.m. ET. The call will reiterate that Medicare providers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays. The target audience includes Medicare Part A and B providers, medical billing specialists, practice administrators, IT vendors, health care industry professionals, and other interested stakeholders. During this call, CMS experts will discuss the Qualified Medicare Beneficiary (QMB) billing rules and their implications. Find out about upcoming changes to the HIPAA Eligibility Transaction System (HETS) and remittance advice to identify the QMB status of your patients and exemption from cost-sharing. Go to the CGS site (click here) to obtain additional information.
NEW MEDICARE CARD PROJECT
As mentioned in previous Members Only issues, Medicare is taking steps to remove Social Security numbers from Medicare cards. CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019. Providers should work with their billing vendor to make sure that providers’ system will be able to accept the new MBI format by April 2018. Click here to go to the CMS site and click here to view a document on how providers can prepare for the new Medicare cards.
CMS ISSUES UPDATES ON OVERPAYMENT LIMITATION ON RECOUPMENT
Change Request (CR) 9815 updates the Centers for Medicare & Medicaid Services (CMS) “Medicare Financial Management Manual,” Limitation on Recoupment Overpayments. This Change Request is the first of four that are forthcoming and incorporated into this manual. The MAC will cease recoupment or not begin recoupment when the MAC receives a valid redetermination or reconsideration request timely on an overpayment subject to these limitations. Make sure your billing staffs are aware of these updates that relate to the limitation on recovery of certain overpayments. Click here to read the MLN article.
CMS TO OFFER SPECIAL ODF CONFERENCE CALL ON IMPACT ACT
“The IMPACT Act and Improving Care Coordination” is the title of a Special Open Door Forum being hosted by the Centers for Medicare & Medicaid Services at 2:00 p.m. ET on Sept. 28, 2017. The hour-long webinar will deliver information and solicit feedback pertaining to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT). The act's goals, pilot test results and plans for the upcoming national field test, and how stakeholders can be involved in the coming year, will be discussed. Organizers encourage questions to be sent in, before and during the presentation. They can be emailed to:.
To participate in the national conference call, dial (800) 837-1935 and use conference ID number 66557294. Presentation materials and additional information can be obtained by clicking here.
ANNUAL CONSOLIDATED BILLING HCPCS CODE UPDATE
In a recent MLN Matters article, CMS announced the 2018 annual update of Healthcare Common Procedure Coding System (HCPCS) codes for skilled nursing facility consolidated billing. The updates and more information can be viewed by clicking here.
Please contact Wayne Johnson or call 502-425-5000 with any questions regarding the Reimbursement Update.