CMS Issues Final Changes for Medicare Reimbursement Programs
CMS issued several final rules in July to update certain Medicare reimbursement rates and quality reporting requirements.
By - CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its website.
Healthcare providers in the Medicare Inpatient Psychiatric Facilities, Inpatient Rehabilitation Facilities, Skilled Nursing Facilities Prospective Payment Systems, and Hospice Benefit Program can expect an overall increase in Medicare reimbursement revenue and new quality reporting requirements in 2017.
The final rules and updates from CMS are designed to facilitate the transition of Medicare payments to value-based care by enacting payment adjustments and adding relevant quality measures to each reporting program.
The following Medicare reimbursement programs were targeted for payment and policy changes starting in the fiscal year 2017.
Medicare Inpatient Psychiatric Facilities Prospective Payment System
New payment adjustments to the Medicare Inpatient Psychiatric Facilities Prospective Payment System will increase aggregate claims reimbursements by 2.2 percent, or $100 million, in the 2017 fiscal year, according to a CMS fact sheet.
The boost in claims revenue stems from an updated net market basket of 2.3 percent. CMS determined the new market basket by deducting the productivity adjustment (0.3 percentage point) and the required reduction by law (0.2 percentage point) from the 2016 market basket value of 2.8 percent.
CMS also adjusted the wage indexes for 2017, which follows the full adoption of the Office of Management and Budget area delineations as stipulated in the 2016 Inpatient Psychiatric Facilities Prospective Payment System.
As part of the 2016 area delineations, some facilities in the program were changed from rural to urban status. The affected providers will receive one-third of the rural adjustment in 2017, rather than two-thirds from the current fiscal year.
Medicare Inpatient Rehabilitation Facilities Prospective Payment System
In a final rule issued on July 29, CMS stated that providers in the Inpatient Rehabilitation Facilities Prospective Payment System will receive an overall 1.9 percent, or $145 million, increase in payments in fiscal year 2017.
CMS calculated the overall increase by using a 1.65 percent increase factor, which reflected an updated market basket value, and a 0.3 percent boost to aggregate payments due to new outlier threshold results.
The federal agency also reported that providers who were switched to urban status under the new Office of Management and Budget delineations in 2016 will receive a reduced rural adjustment. The amount is part of the two-year phase-out of the 14.9 percent rural adjustment.
CMS added three measures to the Inpatient Rehabilitation Facilities Quality Reporting Program that will go into effect in fiscal year 2018. The measures, which are part of the resource use domain, are Medicare Spending Per Beneficiary for Post-Acute Care, Discharge to the Community, and Potentially Preventable 30-day Post-Discharge Readmission.
The program will also require providers to report on potentially preventable within stay readmissions starting in 2018.
Additionally, CMS included a new medication reconciliation measure for payment determinations in the fiscal year 2020. The measure assesses drug regimen reviews conducted with follow-up for identified issues.
The final rule also mandated CMS to publish quality data from the program starting in the fall of 2016. CMS also extended the time frame for submitting exception and extensions requests from 30 to 90 days.
Medicare Skilled Nursing Facilities Prospective Payment System
On July 29, CMS published a final rule that would update payment rates under the Medicare Skilled Nursing Facilities Prospective Payment System in fiscal year 2017. The federal agency estimated that total payments to skilled nursing facilities will increase by $920 million, or 2.4 percent.
In addition to Medicare payment adjustments, the final rule enacted changes to the Skilled Nursing Facilities Quality Reporting Program. The final rule adopted three quality measures, including Medicare Spending Per Beneficiary for Post-Acute Care, Discharge to the Community, and Potentially Preventable 30-day Post-Discharge Readmission, starting in fiscal year 2018.
Providers will also be required to report on drug regimen reviews conducted with follow-up for identified issues starting in fiscal year 2020.
Under the final rule, CMS included updates to the Skilled Nursing Facilities Value-Based Purchasing Program. The rule identifies the 30-day potentially preventable readmission measure as the “all-cause, all-condition risk-adjusted potentially preventable hospital readmission measure” as required by law.
The measure will be used to determine value-based incentive payments for potentially preventable hospital readmissions for skilled nursing facilities patients within 30 days of discharge from a prior admission reimbursed under the Inpatient Prospective Payment System, a critical access hospital, or a psychiatric hospital.
CMS also finalized policies associated with the value-based care program, including the development of performance standards, establishment of baseline and performance periods, implementation of a performance scoring methodology, and additions of confidential feedback reports to skilled nursing facilities.
Medicare Hospice Benefit Program
Hospices in the Medicare Hospice Benefit Program can expect to see a 2.1 percent, or $350 million, boost in aggregate reimbursements for the fiscal year 2017, reported CMS.
Under the final rule from July, CMS also updated the hospice cap amount as stipulated by the Improving Medicare Post-Acute Care Transformation Act of 2014. The amount will increase to $28,404.99 in fiscal year 2017.
Additionally, CMS updated policies relating to the Hospice Quality Reporting Program in the new final rule. The rule includes provisions for implementing the Hospice CAHPS Survey, including participation requirements for the annual payment updates in 2019 and 2020.
The federal agency also added two quality measures to the program that will evaluate hospice staff visits to patients and caregivers in the last three to seven days of life and determine the percentage of hospice patients who received care consistent with established guidelines.
CMS announced that it plans to publish hospice quality measures via a Compare website starting in 2017.
Participating hospices may also start using a new data collection instrument that aligns with other post-acute care settings, CMS reported. Rather than using the current chart abstraction tool, hospices will employ a comprehensive patient assessment system.
“By integrating a core standard data set into a comprehensive assessment system, hospices can use such a data set as the foundation for valid and reliable information for patient assessment, care planning, and service delivery,” CMS stated.
“This will enable greater accuracy in quality reporting; decrease provider burden; help surveyors ensure hospices are meeting Conditions of Participation (CoP) and providing high quality patient care; and, in the future, enable payment determinations.”
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