Medicaid Level-Of-Care Webinars

Medicaid Level-Of-Care Webinars



In the June 13, 2017, Members Only, Association members were notified of changes the Department for Medicaid Services (DMS) was anticipating making to Medicaid level-of-care processes. Association staff and a number of representatives from the Billing Work Group and Survey & Regulatory Committee attended a meeting on August 10, 2017, to obtain an update on these changes. The Department for Medicaid Services announced that they will delay implementation for proposed level-of-care changes until December 1, 2017. The changes announced included a shortened MAP 726A that providers will be able to enter online and a modified PASSR that will be used. There will be two (2) webinars given on August 23 & August 31 from 10:00 a.m. – 12:00 p.m. ET to provide an overview of the new system and processes. To join the webinars on the day of presentation, go to the DMS website by clicking here. Providers should register as a “guest” and it should be noted access to the webinar is blocked until the webinar room opens at 9:30 a.m., Eastern Time, on the day of the webinar.


On August 15, 2017, CMS announced a proposed rule to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s Comprehensive Care for Joint Replacement (CJR) model from 67 to 34 and to offer greater flexibility and choice for hospitals in orthopedic care for Medicare beneficiaries. In addition, CMS proposes to allow CJR Participants in the 33 remaining areas to participate on a voluntary basis. It should be noted the Cincinnati MSA is one of the 34 mandatory MSAs that will continue with CJRs. CMS also is proposing through this rule to cancel the Episode Payment Models and the Cardiac Rehabilitation incentive payment model, which were scheduled to begin on January 1, 2018. In this rule, CMS proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas. “Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals,” said CMS Administrator Seema Verma. For More Information click on the Fact Sheet, the CJR Model webpage, Episode Payment Models: General Information webpage, and the full text of the Press Release issued on August 15, 2017.


On July 31, 2017 CMS issued a final rule outlining fiscal year 2018 Medicare payment rates and quality programs for Skilled Nursing Facilities (SNFs). Based on changes contained in the final rule, CMS projects aggregate payments to SNFs will increase in fiscal year 2018 by $370 million or 1.0 percent, from payments in fiscal year 2017. This estimated increase is attributable to a 1.0 percent market basket increase required by section 411(a) of the Medicare Access and CHIP Reauthorization Act of 2015. The final rule also includes explanations of:

  • SNF Quality Reporting Program (QRP)
  • End-Stage Renal Disease Quality Incentive Program, including updated PY 2020 performance period
  • National Healthcare Safety Network Healthcare Personnel Influenza Vaccination Reporting Measure
  • Survey team composition

For more information, click on the Final Rule (CMS-1679-F), SNF PPS website, SNF VBP web page, the Proposed Specifications for SNF QRP Quality Measures and Standardized Data Elements, and the Fact Sheet, issued on July 31, 2017.


On September 6, 2017 from 1:30 pm – 3:00 pm ET, CMS and measure developers will present information on the adopted Medicare Spending per Beneficiary Post-Acute Care (PAC) resource use measures, focusing on the components of each measure, as well as public reporting. Click here to register for this important call.


The MLN Matters Article referenced is for therapists, physicians, and other practitioners billing Medicare Administrative Contractors (MACs) for therapy services provided to Medicare beneficiaries, and contains no new policy changes. Change Request (CR) 10176 implements revised editing of Part B “Always Therapy” services to require the appropriate therapy modifier in order for the service to be accurately applied to the therapy cap. Instead, the guidelines presented in the CR improve the enforcement of longstanding, existing instructions. In order to accrue incurred expenses to the correct therapy cap; the use of one of the three therapy modifiers (GN, GO, or GP) is required on a certain set of Healthcare Common Procedure Coding System (HCPCS) codes in order to identify when each OPT service is furnished under an SLP, OT, or PT plan of care, respectively. Medicare recognizes the services furnished under the OPT services benefit as either “always” or “sometimes” therapy and publishes this list as an Annual Update on the Therapy Services Billing page. The MedLearn Matters article can be viewed by clicking here. Make sure your billing staffs are aware of these revisions.


Providers and those accessing CMS' QIES system should feel free to contact the agency's QTSO Help Desk due to new security requirements. CMS recently notified vendors that new security procedures now require QIES application users to login every 60 days (click here to read the “QIES Security Notice). Failure to do so will disable the user's QIES account, which may be re-enabled by contacting CMS' QTSO Help Desk at (800) 339-9913. Accounts that have no activity for more than 365 days will be deleted. These new procedures took effect on June 26, 2017, so providers and other QIES users should login before August 25, 2017 to ensure access is not disabled due to inactivity.


The Medicare Part A annual Direct Data Entry (DDE) recertification process began on August 1, 2017, and the deadline for all Medicare Part A DDE users to recertify is September 30, 2017. The recertification process has changed this year, so please review the instructions (click here). Association staff obtained this information from the Provider Outreach Educational Advisory Group recently. Please share this with your billing staff and make them aware of this information.


In the October quarterly update to the 2017 annual HCPCS codes used for consolidated billing, Change Request (CR) 10163 provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS). The CR corrects an error impacting certain claims with dates of service on or after January 1, 2015, that Medicare mistakenly denied rejected prior to implementation of CR10163. Click here to obtain additional information.


Change Request (CR) 10196 provides instructions for payment and edits for the Common Working File (CWF) and the Fiscal Intermediary Shared System (FISS) to include and update new or existing influenza virus vaccine codes for claims processed with dates of service on or after January 1, 2018. Click here to obtain additional information. In addition, a recent Change Request (CR) informs MACs about the payment allowances for seasonal influenza virus vaccines, which are updated on August 1 of each year. The Centers for Medicare & Medicaid Services (CMS) will post the payment allowances for influenza vaccines that are approved after the release of CR10224 here. Make sure your billing staffs are aware that the payment allowances are being updated. Click here to read the Medlearn Matters article.

Please contact Wayne Johnson or call 502-425-5000 with any questions regarding the Reimbursement Update.