When the Medicare program for hospitals was authorized in 1965 it originally reflected the structure of the traditional indemnity insurance models that it was based on, and was also required to reimburse hospitals on a “reasonable cost” basis.
The Medicare Payment Advisory Commission (MedPAC) yesterday approved final recommendations for Medicare payment updates for 2015. The recommendations will be closely watched by Congress as it looks for savings to fund a long-term repeal of the Medicare sustainable growth rate for physician payments. A complete list of specific MedPAC recommendations follows.
The Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network has issued an article titled “Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter.” The article is designed to provide education on the required narrative for documenting the home health face-to-face encounter, and includes information and examples to help health care professionals avoid insufficient documentation errors and HH PPS improper payments. A copy of the article is attached.
The Medicare Payment Advisory Commission (MedPAC) has released draft recommendations on Medicare fee-for-service payment and policy changes for Congress to consider for calendar and federal fiscal year (FFY) 2015. MedPAC will meet in January to vote on its recommendations and will be watched closely by Congress as it looks for payment mechanisms for a long-term repeal of the Medicare sustainable growth rate for physician payments. For the second consecutive year, MedPAC has refused to consider the implications of sequester.
Home health (HH) agencies paid under Medicare’s prospective payment system (PPS) will see a 1.05 percent decrease in payments in calendar year (CY) 2014 as compared to CY 2013 under a final rule released by the Centers for Medicare & Medicaid Service (CMS). The decrease reflects the combined effects of an increase in the home health market basket update percentage of 2.3 percent, offset by a rebasing adjustment of negative 2.7 percent as required by the Affordable Care Act (ACA), and a .62 percent decrease due to a refinement of the HH PPS Grouper. The ACA requires CMS to begin phasing in rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine supply conversion factor to reflect changes since the inception of the HH PPS. For hospital-based facilities, CMS estimates the reduction will be smaller, negative .58 percent, for CY 2014.
Hospital-based dialysis facilities paid under the end-stage renal disease (ESRD) prospective payment system (PPS) will see an estimated 0.8 percent increase in payments for calendar year (CY) 2014 compared to CY 2013, according to a final rule issued by the Centers for Medicare & Medicaid Services (CMS). CMS estimates that independent ESRD facilities will see no increase in payments in CY 2014 as compared to CY 2013. The update reflects the effect of a 3.2 percent ESRD bundled market basket update; the Affordable Care Act-required productivity adjustment of 0.4 percent; the American Taxpayer Relief Act (ATRA)-required drug utilization adjustment of negative 3.3 percent; a 0.4 percent overall estimated increase in outlier payment from the updates to the fixed-dollar loss threshold and Medicare Allowable Payment amounts; and a 0.2 percent overall estimated increase in payments from the change in the blend of payments.
The Centers for Medicare & Medicaid Services (CMS) has notified hospitals regarding possible delays in the release of final rules for calendar year (CY) 2014 Medicare fee-for-service payment regulations as a result of the federal government shutdown. The affected regulations were expected to be released by Nov.1. However, CMS now expects them to be released by Nov. 27 to be effective Jan. 1, 2014. Affected regulations include the CY 2014 outpatient prospective payment system (PPS), CY 2014 end-stage renal disease PPS, CY 2014 home health PPS and CY 2014 physician fee schedule.