Pete Harmon's HFS Blog

SNF, Transmittal 18

Pete Harmon — Wed, 01 Sep 2010 15:56:42 +0000

HFS received a Draft of the SNF T.18, on July 12, 2010. We commented back to CMS, and changes are being made – most significantly, there are 23 new RUGs instead of 22. The Draft T.18 removed the option for PPS SNFs to file using the “simplified method” of cost finding (lines 50-52 on S-2 are N/A). S-7 added lines 45.01 to 45.23 for the new RUGs. These are to be effective for Services on or after 10/1/2010. Med Ed and GME for SNF is proposed to be removed. T.18 is to be effective for FYE after 9/30/2010. Once we see the Final transmittal, I will update this post.

Implantable Devices

Pete Harmon — Wed, 01 Sep 2010 15:49:40 +0000

Transmittal 21 for the Hospital, introduced line 55.30 for Implantable Devices. There have been questions about whether this is “optional” or “required”. The Federal Register of 8/27/2009, page 43781, says this cost center MUST be used in the 2552-96, for FY Begin 5/1/2009 and after; and for the 2552-10, line 72 MUST be used for FY Begin 5/1/2010 (the effective date of the 2552-10). Therefore, the costs and charges for Implantable Devices must be accounted for separately from Medical Supplies.

Hospital Transmittal 22

Pete Harmon — Wed, 01 Sep 2010 15:43:57 +0000

HFS received a Draft of T.22 for the Hospital on 8/13/2010. We commented back to CMS about changes needed and received the T.22 Test Case, so we can get CMS approval for our Version 22 software, on 8/23/2010. We are awaiting CMS approval.

T.22 changed from our original understanding, to have 23 new RUGs, instead of 22. The TOPS extension for small, rural, and all SCH, necessitated the addition of column 2, to S-2 line 21.07. SCH MUST answer this “Y” to get the TOPS calculation, for the period 1/1/2010 to 12/31/2010. Charges will also need to be split on W/S D part V, columns 5.01 and 5.03, as well as split payments on E part B, line 1.02. W/S E part A line 24.97 was designated (hard coded) for the Health Care and Education Reconciliation Act (HCERA) Payments, which are one time payments in Federal Fiscal Year 2011 and 2012. They are recorded on E-1 as “interim payments”, and also on E part A line 24.97.

MAC Update

Pete Harmon — Tue, 27 Jul 2010 22:42:04 +0000

On July 8, 2010, CMS rescinded the J-15 (Ohio and KY) award to Highmark, and awarded it to CIGNA, due to a protest. We now hear this has been protested by Highmark and Cahaba. When the “dust settles”, I’ll let you know!

MAC “Round II” Procurements

Pete Harmon — Tue, 27 Jul 2010 17:11:22 +0000

CMS is changing the MAC bidding/award process to compress the original 15 MACs down to 10. The current Jurisdictions 1, 9, 10, 11, and 12, will remain as is. Jurisdictions 2 and 3; 4 and 7; 5 and 6; 8 and 15; 13 and 14; will be combined into 5 bids/awards. For the details on this change, see the link below, or go to www.hfssoft.com, and click on the News Tab.

http://www.hfssoft.com/pdfs/MAC-Round2-Special-Notice.pdf

SNF 2540-10

Pete Harmon — Tue, 27 Jul 2010 16:57:47 +0000

CMS has indicated the new 2540-10 for SNFs, will be effective for FY Begin 12/1/2010 and after. We have not seen the “Final” forms yet, so when we do, I will update this post. We know the “final” we have seen to date, must change for the addition of 22 new RUGs, effective for Services on or after 10/1/2010.

Hospital Transmittal 22

Pete Harmon — Tue, 27 Jul 2010 16:37:26 +0000

CMS must issue Transmittal 22 for the 2552-96, to incorporate changes required by the Patient Protection and Affordable Care Act (ACA). The TOPS extension for small rural hospitals, and Sole Community hospitals, through 12/31/2010 is the most significant change. CMS is also changing the “effective date” for the use of line 29, on S-3 part I, for the Labor/Delivery Days, which need to be included in the DSH calculation, per the CMS 1498R Ruling. FI/MAC will be able to use line 29 for FY prior to 10/1/2009 (currently line 29 can only be used for FY Begin 10/1/2009 and after). There are also 22 new RUGs for hospital based SNFs. These are effective for Services on or after 10/1/2010. When we receive T.22, I will post the details.

WPS/Legacy Part A Workload Transfer

Pete Harmon — Tue, 30 Mar 2010 23:43:25 +0000

West Coast Providers (CA, HI, NV) formerly serviced by Mutual of Omaha.

Mutual of Omaha served the Medicare program as a fiscal intermediary for several decades. The Mutual of Omaha fiscal intermediary workload was, and still is, identified in Medicare data systems as “workload number 52280.” Wisconsin Physician Services (WPS) took over the legacy Mutual workload in 2006. Providers serviced by WPS under that fiscal intermediary contract have remained in that workload pursuant to 42 CFR 421.104. We refer to that body of providers as “the legacy WPS workload.” This set of providers has been serviced under a distinct contract and maintained in a WPS workload separate from the Jurisdiction 5 A/B MAC workload. CMS is currently planning to move a limited set of the providers in the 52280 legacy WPS workload to their destination assignments.

The first set to move will be those providers destined to be assigned to the Jurisdiction 1 MAC pursuant to the geographic assignment rule and its exceptions. A broad discussion of geographic assignment rule and its exceptions can be found in Medicare Learning Matters article number “MM5979.”

The CMS is currently transitioning the Jurisdiction 1 providers out of the legacy WPS workload and expects to complete the transition no later than April 2010. The balance of legacy Mutual of Omaha providers will remain in workload number 52280 until further notice.

MAC Award Status

Pete Harmon — Tue, 30 Mar 2010 23:39:21 +0000

The table below gives the current status of all MAC jurisdictions.

Jurisdiction	Contractor	Status
A	National Heritage Insurance Corp. Fully Implememted	Fully Implemented
B	National Government Services Fully Implememted	Fully Implemented
C	CIGNA Government Services Fully Implememted	Fully Implemented
D	Noridian Administrative Services Fully Implememted	Fully Implemented
1	Palmetto Government Benefits Administrators Fully Implememted	Fully Implemented
2	PROTEST OF CONTRACT AWARD Bid Corrective Action	Bid Corrective Action
3	Noridian Administrative Services Fully Implememted	Fully Implemented
4	TrailBlazer Health Enterprises Fully Implememted	Fully Implemented
5	Wisconsin Physicians Services Fully Implememted	Fully Implemented
6	PROTEST OF CONTRACT AWARD Bid Corrective Action	Bid Corrective Action
7	PROTEST OF CONTRACT AWARD Bid Corrective Action	Bid Corrective Action
8	PROTEST OF CONTRACT AWARD Bid Corrective Action	Bid Corrective Action
9	First Coast Service Options, Inc Fully Implememted	Fully Implemented
10	Cahaba Government Benefit Administrators Fully Implememted	Fully Implemented
11	PROTEST OF CONTRACT AWARD Bid Corrective Action	Bid Corrective Action
12	Highmark Medicare Services Fully Implememted	Fully Implemented
13	National Government Services Fully Implememted	Fully Implemented
14	National Heritage Insurance Corp. Fully Implememted	Fully Implemented
15	PROTEST OF CONTRACT AWARD Bid Corrective Action	Bid Corrective Action

CMS will not transition providers from legacy fiscal intermediaries and carriers to the following MACs until procurement corrective action on the respective contract awards has concluded.

A/B MAC Jurisdiction 2
A/B MAC Jurisdiction 6
A/B MAC Jurisdiction 7
A/B MAC Jurisdiction 8
A/B MAC Jurisdiction 11
A/B MAC Jurisdiction 15

The legacy fiscal intermediaries and carriers will continue to service the providers in those workloads until further notice.

DME Info Update

Pete Harmon — Tue, 30 Mar 2010 23:27:56 +0000

DME Re-compete:

In 2006, the Centers for Medicare and Medicaid Services (CMS) awarded the first MAC contracts to administer Medicare claims for DME benefits in jurisdictions A and B. Under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) the Secretary of Health and Human Services must re-compete its Medicare Administrative Contractors contracts every five (5) years. Therefore, on Thursday, December 30, 2009, CMS issued a solicitation for the first “second generation” MAC contractors for DME Jurisdictions A and B. Currently, National Heritage Insurance Company (NHIC) is serving as the DME MAC in Jurisdiction A, and National Government Services (formerly doing business as AdminaStar Federal Inc.) is serving as the DME MAC in Jurisdiction B. CMS anticipates awarding these contracts and fully transitioning the workloads to new MAC contracts by no later than December 2010.