Medicare

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In 2010, Medicare's policy for payment of outpatient services provided on either the date of a beneficiary's admission or during the three calendar days immediately preceding the date of a beneficiary's inpatient admission to a “subsection (d) hospital” subject to the inpatient prospective payment system, “IPPS” (or during the one calendar day immediately preceding the date of a beneficiary's inpatient admission to a non-subsection (d) hospital) became effective.   A Medicare Subsection D (d) hospital is an acute care, short-term hospital.

There are numerous Medicare & Medicaid review programs which have been created to stop the problems of improper payments, fraud and abuse within these federal programs. CMS is currently working with Integrity Management Services to consolidate and simplify. The resulting Unified Program Integrity Contractors (UPIC) aims to coordinate audits, investigations, and data analyses. Additionally, the official stated intent is to also lower the burden on providers who are trying to meet all the requests of different auditing agencies.

The Affordable Care Act of 2010 established the Hospital VBP Program, which

applies to payments beginning in FY 2013 (discharges on or after October 1, 2012)

and affects payment for inpatient stays in hospitals across the country.  Under the

Hospital VBP Program, Medicare makes incentive payments to hospitals based on

either:

     How well they perform on each measure, or

     How much they improve their performance on each measure compared to their

                performance during a baseline period

As you know, the PQRS (Physician Quality Reporting System) includes the reporting of particular G codes to communicate with Medicare, details of the Functional Outcome Assessment and Pain Assessment and Follow-Up measures. These measures must be completed on at least 50% of an eligible professional's active patients to avoid penalty.

Recently, letters have been sent out to practices informing practices that they have not satisfactorily reported those PQRS measures and therefore, a negative payment adjustment (penalty) will be assessed from 2016 Medicare reimbursements.

Proposed FY 2016 Medicare Payment And Policy Changes For Inpatient Psychiatric Facilities

OVERVIEW: On April 24, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).

Medicare has updated their provider educational tools for the Initial Preventive Physical Examination (IPPE) and the Annual Wellness Visit (AWV). These tools were designed to help providers gain a greater understanding of these services. Learn what the required elements for these services as well as important coverage and coding information.

CLICK HERE to download "The ABCs of the Initial preventive Physical Examination (IPPE)" booklet.

On April 14, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed the Senate by an overwhelming vote of 92-8. Although President Obama has not officially signed the bill into law, weeks ago he indicated his full support when H.R. 2 passed the House of Representatives.

Mac Jurisdictions Resources (Resource 396)

The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called

Medicare Improper Payment Report for Behavioral Health Services

The following information is from the 2014 Medicare Improper Payments Report by the Department of Health and Human Services.

This table shows the Improper Payment Rates by Provider Type and Type of Error for Medicare Part B claims:

    Provider Type

    Improper Payment Rate

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