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New Provider Relief Funding Available

Posted by Admin Posted on Sept 23 2021

The Department of Health and Human Services (HHS) announced Friday September 10th, $25.5 billion in new funding for health care providers affected by COVID-19 pandemic will be available.

Phase 4 General Distribution - $17 billion will be available to a broad range of providers who can document revenue loss and expenses associated with the pandemic.

American Rescue Plan (ARP) Rural - $8.5 billion will be available to providers who serve Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy (FORHP)-defined rural areas.

Phase 3 Reconsiderations – The methodology utilized to calculate Phase 3 payments is now available and an opportunity to request a reconsideration. Further details of the reconsideration process are forthcoming.

Grace Period for Reporting Period 1- HHS has announced a 60-day grace period to help providers struggling to meet the deadline of September 30, 2021 for Period 1 PRF Reporting. The deadlines to use the funds and the reporting time period did not change. HHS will not initiate collection activities or similar enforcements for noncompliant providers during the grace period.

Click here for more details on this.

Do you have questions? Call us at (270) 726-4033.

Rhonda Houchens, Director of Operations

 

 

Resources: Vaccine Mandate, CMS Updates, KY General Assembly Session Bills Passed and more

Posted by Admin Posted on Sept 23 2021

President Biden Announces New Vaccine Mandate- On September 9, 2021

President Biden announced new vaccine requirements including requiring vaccinations for nursing home workers, hospitals, dialysis facilities, ambulatory surgical settings, home health agencies and others as a condition to participate in Medicare and Medicaid programs. CMS is developing an Interim final Rule with Comment Period that will be issued in October. The compliance deadline is unknown but excepted to be by the end of 2021.  

Read the full CMS release here.​

In addition to the CMS mandate for vaccinations of Medicare and Medicaid health care providers, the U.S. Department of Labor will issue requirement for employers with over 100 employees to have vaccine mandates and/or testing. Also, all federal employees and contractors will need to be vaccinated.  

 

CMS Updates Medicare COVID-19 Billing Guidance

On September 8, 2021 the Centers for Medicare and Medicaid Services (CMS) updated MLN Matters SE2011. Please take note in this guidance CMS DID NOT change the longstanding blanket 3-day qualifying stay or spell of illness waivers for beneficiary eligibility for SNF Part A coverage.   

Click here to view the MLN Matters SE2011.​

Reference Waiver guidance is available here.​

 

Proposal to Increase Tax Revenue Through Financial Information

Banks having been notifying their customers of a Biden administration proposal released to increase tax revenue through a more comprehensive collection of financial information on banking customers. If approved financial institutions would be required to report all financial information on accounts with inflow/outflows or balances above $600. Banking institutions are deeply opposed to this proposed legislation. They are concerned about their customers privacy as well as the burden of expense this would place on banks to comply which would ultimately cost their customers. Banks are encouraging their customers to contact their legislators and ask them to oppose this legislation. For more information we encourage you to contact your banking institution.   

 

KY General Assembly Session Bills Passed

As a result of last week’s special session 3 bills were passed including: HJR1, which extended the state or emergency and other special rules until January 15, 2022, SB2, allowing Personal Care Aides to transition to state-registered nurse aides to aide the workforce shortage as well as other provisions and SB3, which appropriates $69 million of American Rescue Plan Act funds to be used for health care, long-term care, and school system COVID-19 testing and management of monoclonal antibody treatment.   

Click here to view HJR1.

Click here to view SB2.

Click here to view SB3.

 

Medicaid Add-On Attestation Statement

Posted by Admin Posted on Sept 23 2021

Medicaid Add-On Attestation Statement

On August 20, 2021, Myers & Stauffer’s help desk emailed providers regarding the attestation of the $29 Medicaid rate add-on. Each nursing facility should return the signed form to Myers & Stauffer by September 30, 2021.

Click here for the Attestation Form.

 

Hospice & $29 Rate Add-On

Posted by Admin Posted on Sept 23 2021

Hospice and $29 Rate Add-On

Hospice providers have been approved to receive the $29 Medicaid add-on. If you have not received the $29 Add-on, check with your hospice provider to see when the mass adjustment will be received.

 

FY 2022 SNF Final Rule Released

Posted by Admin Posted on Aug 13 2021

FY 2022 SNF Final Rule Released

The Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (CMS-1746-F) was released July 29, 2021. Key updates in the rule includes a net 1.2 percent market basket increase, updates to PDPM ICD-10 Code Mappings, SNF QRP additional measures, and SNF VBP changes to FY 2022 and future expansion.

Click here to visit www.CMS.gov for a full overview.

To receive a copy of PDPM rates effective October 1, 2021, please verify your FY 2022 VBP multiplier of .9920 or 1.0 if low volume and contact one of our client managers today.

Blog by Rhonda Houchens, Director of Operations

 

 

CY 2022 Medicare B Therapy

Posted by Admin Posted on Aug 13 2021

CY 2022 Medicare B Therapy

CMS is proposing implementation of the final part of section 53107 of the Bipartisan Budget Act of 2018. Implementation would require CMS, through the use of modifiers (CQ and CO), to identify and make payment at 85% of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), for dates of service on and after January 1, 2022. Currently, Part B provider are using modifiers CQ and CO for data collection purposes only.

Remember, these changes are for Part B therapy only. CMS will accept comments on the proposed rule until September 13, 2021, and will respond to comments in a final rule.

Click here to learn more.

 

Resources: ABN Form Renewal and Electronic Plan of Correction (ePOC)

Posted by Admin Posted on Aug 13 2021

ABN Form Renewal

The Office of Management and Budget approved the Advance Beneficiary Notice of Noncoverage, (ABN). See form CMS-R-131 and link to instructions below for renewal. You must use the renewed form with the expiration date of June 30, 2023, beginning August 31. There are no other changes to the form.   

Click here for Form CMS-R-131 (ZIP).

Click here for renewal instructions (PDF).

Click here to visit the CMS ABN Webpage.

 

Electronic Plan of Correction (ePOC)

Office of Inspector General is encouraging Skilled Nursing Facilities to sign up and begin utilizing Electronic Plan of Correction (ePOC). The plan is to convert everyone over to the ePOC system by January 1, 2022.   

Click here for details from www.chfs.ky.gov.

 

NEW Billing Consultant Packages: Medicare Replacement Insurance

Posted by Admin Posted on July 16 2021

NEW Billing Consultant Packages: Medicare Replacement

Have you considered contracts with Medicare Replacement plans in order to add to your census? We recently helped a facility increase admissions by getting contracts with multiple Medicare Replacement insurances.

Introducing our NEW Billing Consultant Packages...

We offer packages that are made to fit your facility's individual needs. So, whether you need just a little bit of help and guidance to get back on track or someone to step in to take it over, we have a package for you!

Click here to learn more.

Do you have questions? Call us with your questions at (270) 726-4033.

Blog by Leah Shoulders, Billing Manager

 

 

Important Changes to the Child Tax Credit

Posted by Admin Posted on July 16 2021

Important changes to the child tax credit; Please contact our office

Recently, there were changes made to the child tax credit that will benefit many taxpayers. As part of the American Rescue Plan Act that was enacted in March 2021, the child tax credit:

•    Amount has increased for certain taxpayers
•    Is fully refundable (meaning you can receive it even if you don’t owe the IRS)
•    May be partially received in monthly payments

The new law also raised the age of qualifying children to 17 from 16, meaning some families will be able to take advantage of the credit longer. The IRS will pay half the credit in the form of advance monthly payments beginning July 15. Taxpayers will then claim the other half when they file their 2021 income tax return. Though these tax changes are temporary and only apply to the 2021 tax year, they may present important cashflow and financial planning opportunities today. It is also important to note that the monthly advance of the child tax credit is a significant change. The credit is normally part of your income tax return and would reduce your tax liability. The choice to have the child tax credit advanced will affect your refund or amount due when you file your return. To avoid any surprises, please contact our office.

Qualifications and how much to expect:

The child tax credit and advance payments are based on several factors, including the age of your children and your income.

•   The credit for children ages five and younger is up to $3,600 –– with up to $300 received in monthly payments.
•   The credit for children ages six to 17 is up to $3,000 –– with up to $250 received in monthly payments.

To qualify for the child tax credit monthly payments, you (and your spouse if you file a joint tax return) must have:

•   Filed a 2019 or 2020 tax return and claimed the child tax credit or given the IRS your information using the non-filer tool
•   A main home in the U.S. for more than half the year or file a joint return with a spouse who has a main home in the U.S. for more than half the year
•   A qualifying child who is under age 18 at the end of 2021 and who has a valid Social Security number
•   Income less than certain limits

You can take full advantage of the credit if your income (specifically, your modified adjusted gross income) is less than $75,000 for single filers, $150,000 for married filing jointly filers and $112,500 for head of household filers. The credit begins to phase out above those thresholds.

Higher-income families (e.g., married filing jointly couples with $400,000 or less in income or other filers with $200,000 or less in income) will generally get the same credit as prior law (generally $2,000 per qualifying child) but may also choose to receive monthly payments. Taxpayers generally won’t need to do anything to receive any advance payments as the IRS will use the information it has on file to start issuing the payments.

IRS’s child tax credit update portal

Using the IRS’s child tax credit and update portal, taxpayers can update their information to reflect any new information that might impact their child tax credit amount, such as filing status or number of children. Parents may also use the online portal to elect out of the advance payments or check on the status of payments.

The IRS also has a non-filer portal to use for certain situations. With any tax law change, it’s important to revisit your full financial roadmap. We can help you determine how much credit you may be entitled to and whether advance payments are appropriate.

Please contact our office today at 270.726.4033 to discuss your specific situation. As always, planning ahead can help you maximize your family’s financial situation and position you for greater success.

Sincerely,

Hargis and Associates LLC

Resources: Provider Relief Reporting & CMS Updates

Posted by Admin Posted on July 16 2021

Provider Relief Fund (PRF) Reporting

The PRF Portal is now open. Reporting Period 1 data is to be reported between July 1 and September 30, 2021. For more information regarding PRF reporting requirements visit Reporting Requirements and Auditing | HHS.gov. If you would like assistance with this reporting contact one of our staff.   

 

COVID-19 Accelerated and Advance Payment & Recover

CMS recently updated the COVID-19 Accelerated and Advance Payment Repayment & Recovery FAQS.   

Click here for details from www.cms.gov.

 

Resources: Browser Support Changes for MCReF and PS&R, COVID-19 Vaccination Data Submission and MACs Resume

Posted by Admin Posted on June 16 2021

Resources Browser Support Changes for MCReF and PS&R

News from CGS: Beginning, Monday, June 21, 2021, the supported browser for MCReF and PS&R is changing from Microsoft Internet Explorer (IE) to Google Chrome. With this change, MCReF and PS&R will no longer actively support the IE browser.   

Please work with your organization / IT support to ensure that you have access to Google Chrome on all devices necessary to continue using MCReF and PS&R.

 

COVID-19 Vaccination Data Submission

Effective May 21, 2021, nursing homes are required to report resident and staff vaccination information through the NHSN module per CMS' Interim Final Rule-3414. Any nursing homes that are not reporting this information weekly should do so immediately. Nursing homes that do not submit vaccination data for both residents and staff by 11:59pm June 13, 2021, will be imposed a civil money penalty. Furthermore, a higher civil money penalty will be imposed for each subsequent week that a facility does not report the required information.   

CMS' Interim Final Rule-3414

CMS memorandum QSO-21-19-NH.

Click here for information and instructions on how to submit data, please view CDC's webpage Weekly HCP & Resident COVID-19 Vaccination | LTCF | NHSN | CDC

For questions, please contact the CDC at: NHSN@cdc.gov

 

MACs Resume Medical Review on a Post-payment Basis

Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020.   

Click here for information.

 

HHS Reporting Requirements

HHS revised the Post-Payment Notice of Reporting Requirements - PDF* as of June 11, 2021. There are now multiple reporting periods based on dates payments were received.   

Click here for Reporting Requirements and Auditing details from HHS.gov.

 

Bed Reserve Reimbursement

Posted by Admin Posted on June 09 2021

Bed Reserve Reimbursement

CMS approved Kentucky State Plan Amendment (SPA) 21-0001. SPA 21-0001 provides for bed reserve reimbursement at 75% of the facility’s rate if the facility occupancy is 95% or greater for any census quarter of 2019.

Department of Medicaid Services (DMS) determined the reimbursement percentage for claims filed for bed reserve days with dates of service between the quarters of April 1, 2020 through June 30, 2021. Facilities that were eligible received a letter with updated Bed Reserve percentage for each quarter.

DMS processed the eligible bed reserve claims on Friday, June 4.

Do you have questions about the Bed Reserve Reimbursement? Call us with your questions at (270) 726-4033.

Blog by Sarah McIntosh, Director of Operations

 

 

Reporting Data to NHSN by June 13

Posted by Admin Posted on June 09 2021

Reporting Data to NHSN by June 13

CMS published an Interim Final Rule and a QSO that requires nursing homes to submit COVID-19 vaccination rates and treatments given to residents. CMS will start to enforce compliance and issuing Civil Money Penalties (CMPs) for facilities that did not report data to NHSN by midnight on June 13.   

Click here to visit the CMS site.​

 

Medicaid Rate Increased by $29

Posted by Admin Posted on June 09 2021

Medicaid Rate Increased by $29

CMS approved the Department for Medicaid Service’s request to increase Medicaid rate by $29 per day effective January 1, 2021 through the end of the quarter in which the Public Health Emergency (PHE) ends.   

 

Accelerated and Advance Payments - Repayment Process Reminders

Posted by Admin Posted on May 10 2021

Accelerated and Advance Payments - Repayment Process Reminders

Providers who received an accelerated or advance payment during COVID-19 should have received a notification letter from CGS regarding the repayment process. The letter listed the advanced amount, the receivable transaction number and the repayment start date.

The Medicare remits will list the recoupments in the following format: WO/CVDAR000XXXXX

Click here to view the CGS Frequently Asked Questions.

Do you have questions about what this means for your facility? Call us with your questions at (270) 726-4033.

Blog by Kyle Fritsch, Billing Manager

 

 

Resources: KyHealthNet Updates

Posted by Admin Posted on May 10 2021

KyHealthNet Updates

You may or may not have noticed but KyHealthNet has not been allowing access to Account Management application. Facilities have not been able to edit user access, create new user access or change passwords prior to the expiration date. KyHealthNet now has a new link. You will need to make a new link and delete your old link.  

Click here to visit the Kentucky Medicaid Site.​

 

Program for Evaluating Payment Patterns Electronic Reports (PEPPER)

Posted by Admin Posted on May 10 2021

Program for Evaluating Payment Patterns Electronic Reports (PEPPER)

Fourth quarter fiscal year 2020 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for Long-Term Care Hospitals (LTCHs), Critical Access Hospitals (CAHs), Inpatient Rehabilitation Facilities (IRFs), Inpatient Psychiatric Facilities (IPFs), hospices, and Skilled Nursing Facilities (SNFs).

Click here for guidance on accessing your report from www.pepper.cbrpepper.org.

Fiscal Year 2022 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1746-P)

Posted by Admin Posted on May 10 2021

Fiscal Year 2022 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1746-P)

•    CMS estimates proposed rule that would result in increase of 1.3% to the Medicare rates for FY 2022.
•    CMS is seeking comments on whether any necessary adjustment should be implemented to provide payment stability due to the PDPM not being budget neutral when implemented on October 1, 2019.
•    CMS is proposing to suppress the SNF 30-Day All-Cause Readmission Measure for the FY 2022 SNF VBP Program. The reason is that circumstances caused by COVID-19 have affected the measure and the resulting scores.

Click here to view the related article to the aforementioned items.

Posted by Admin Posted on Apr 29 2021

KY Legislative Updates HB276 & HB278

Posted by Admin Posted on Apr 14 2021

House Bill 276

HB 276 passed out of the Senate today. 96-0 in house and 36-0 in Senate. HB 276 is an act relating to temporary personal care attendants transitioning to state registered nurse aides after the end of the public health emergency. HB 276 creates an “open door” for individuals who joined the long-term care workforce during the COVID-19 pandemic by recognizing their “on-the-job training” as a pathway toward certification as a nurse aide. Certified nurse aides are the backbone of the long-term care profession and the position is often the first step in the long-term care career ladder leading to jobs such as licensed practical nurses, registered nurses, directors of nursing, and corporate compliance.  

HB 276 will now move to Governor Beshear to sign.

Click here to learn more.​

 

House Bill 278

HB 278, which made eligible expenses of an approved PPP loan deductible, was officially signed into law by Governor Beshear.   

Thank you to everyone who reached out to their legislators on this bill. Your support helped get HB 278 across the finish line.

Click here to learn more.​

 

Resources: Tax Day Extension, 2021 Economic Impact Payment Status and more

Posted by Admin Posted on Apr 14 2021

Tax Day for Individuals Extended to May 17

Tax Day for individuals extended to May 17: Treasury, IRS extend filing and payment deadline The Treasury Department and Internal Revenue Service announced that the federal income tax filing due date for individuals for the 2020 tax year will be automatically extended from April 15, 2021, to May 17, 2021. Individual taxpayers can also postpone federal income tax payments for the 2020 tax year due on April 15, 2021, to May 17, 2021, without penalties and interest, regardless of the amount owed. This postponement applies to individual taxpayers, including individuals who pay self-employment tax. Penalties, interest and additions to tax will begin to accrue on any remaining unpaid balances as of May 17, 2021. Individual taxpayers will automatically avoid interest and penalties on the taxes paid by May 17. Individual taxpayers who need additional time to file beyond the May 17 deadline can request a filing extension until Oct. 15 by filing Form 4868. This relief does not apply to estimated tax payments that are due on April 15, 2021. These payments are still due on April 15.  

Click here for additional details and updates.​

 

2021 Economic Impact Payment Status Available

Find when and how the IRS sent your 2021 Economic Impact Payment with the Get My Payment tool.   

Click here for details.​

 

UnitedHealthcare delegated to naviHealth

Most of you are familiar with naviHealth. Beginning April 1, 2021, UnitedHealthcare has delegated post-acute care management for UnitedHealthcare Medicare Advantage Members to naviHealth.  

Please follow this link below for additional info.

 

Reminder: Kentucky Medicare Cost Report Filing Extension

Due to the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) delayed the cost report filing deadlines for all provider types with a fiscal year ending March 1, 2020 through December 31, 2020.  

Please follow this link below for additional info.

 

PPP Deadline Extension

The Paycheck Protection Program (PPP) application deadline formally changed from March 31 to May 31.  

Please follow this link below for additional info.

 

Medicare Credit Balance Quarterly Reminder

Reminder to submit the Quarterly Medicare Credit Balance Report by April 30, 2021, for the quarter ending March 31, 2021. Each provider must submit a quarterly Medicare Credit Balance Report (CMS-838) and certification for each PTAN.  

Form CMS-838 is available here.

 

Fiscal Year (FY) 2022 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1746-P)

On April 8, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility (SNF) prospective payment system (PPS) for fiscal year (FY) 2022. In addition, the proposed rule includes proposals for the SNF Quality Reporting Program (QRP), and the SNF Value-Based Program (VBP) for FY 2022. CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for SNFs on an annual basis. The fact sheet discusses the major provisions of the proposed rule.  

Click here to view the fact sheet.

 

KY Medicaid $29 Add-On

Posted by Admin Posted on Apr 09 2021

KY Medicaid $29 Add-On

HB192 includes a proposed $29 Medicaid Rate Add-On. Our state healthcare associations worked diligently to assure a State Plan Amendment was filed by March 31 requesting the add-on. These are the 4 areas covered:

•    The add-on will be for all price-based nursing facility providers and will be effective January 1, 2021, once the SPA is approved and continue through the last day of the quarter in which the PHE ends or 12/31/21.
•    The add-on will be applied to bed reserve days and, once the SPA is approved by CMS, days will be computed by increasing the facility rates by the $29 per day add-on, and then adjusting bed reserve rates by 50% or 75%, depending on the facility occupancy criteria.
•    Providers will attest to expenditures only being used for PPE, COVID-19 testing, and staffing costs. Additional issues that may arise will be discussed in a future TAC meeting.
•    The July 1st inflationary adjustment to the urban and rural price will be calculated first, followed by the addition of the $29 add-on to determine rates for Medicaid fiscal year 2022.
 

Do you have questions about what this means for your facility? Call us with your questions at (270) 726-4033.

Blog by Sarah McIntosh, Director of Operations

 

 

Medicare 2% Sequestration Cuts Delayed

Posted by Admin Posted on Apr 09 2021

Medicare 2% Sequestration Cuts Delayed

The House and Senate voted to delay the 2% across-the-board cut to Medicare through December 31, 2021. CMS has communicated there will be a temporary claims hold pending Congressional action to extend the 2% sequester reduction suspension. In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, CMS instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary.

Do you have questions about what this means for your facility? Call us with your questions at (270) 726-4033.

Humana Reimbursement Switching from PDPM to Levels

Posted by Admin Posted on Mar 11 2021

Humana - PDPM to Levels

Humana is in the process of switching their reimbursement from PDPM to Levels. This change has occurred on 1/1/21 for some SNF’s and 6/1/21 for other SNF’s. For the SNF’s that have received notification from Humana regarding the reimbursement change at 1/1/21, we have noticed facilities receiving approvals at Level 1 or Level 2. Navihealth has approved some residents at Level 1 when they met Level 2 requirements. Please review your residents to ensure the level they are assigned is accurate and to avoid missing out on much needed revenue. Based on Humana’s standard level payments, the difference between Level 1 and Level 2 is $70 per day.

Do you think you might be missing out on revenue? Give us a call, we're happy to review.

 

Medicare B Credits

Posted by Admin Posted on Mar 11 2021

Medicare B Credits

You may have noticed your Medicare B payments were higher than your expected Accounts Receivable for January 2021. After reviewing multiple facilities, we confirmed overpayments are due to the 97535 HCPC code being paid in full when the MPPR should be applied. We will notify you once CMS and MAC’s implement a fix.

If you were a facility whose Medicare B payments were higher than the Accounts Receivable, we are available to discuss what your next steps should be.

 

Updates to SNF PDPM Claims

Posted by Admin Posted on Mar 11 2021

Updates to SNF PDPM Claims

MLN Matters MM11992 was recently published regarding a change to Medicare Claims Processing Manual, Chapter 6. The change addresses claims that are billed containing both covered days and noncovered days.

Click here to learn more.

Economic Stimulus and Residents

Posted by Admin Posted on Mar 11 2021

Economic Stimulus and Residents

A very common question has been “if a nursing home patient receives a stimulus payment, will this affect Medicaid eligibility?” The Office of Inspector General recently published a newsletter with a link to a very helpful document published by NCLER. Please read the attached document to clear up any confusion.

Click here for details.​

If you would like clarity on how the stimulus payment may affect medicaid eligibility, contact us today.

Blog by Leah Shoulders, Billing Manager

 

 

Resources: CMS MLNMatters

Posted by Admin Posted on Feb 10 2021

CMS MLNMatters is discontinuing the MLN Products and MLN Matters electronic mailing lists.

Subscribe to your Medicare Administrative Contractor's (MAC) mailing list for all national and local Fee-For-Service (FFS) program news, including your MAC's news, MLN Connects® content, and MLN Matters® Article and MLN product updates.

Subscribe to our MLN Connects weekly email newsletter for all national FFS program news, including MLN Matters Article and MLN product updates.  

Click here to subscribe to your Medicare Administrative Contractor's (MAC) Mailing List.

Click here to subscribe to our MLN Connects weekly email newsletter.

2021 Tax Filing Season Begins February 12

Posted by Admin Posted on Feb 10 2021

2021 Tax Filing Season Begins Feb. 12

The Internal Revenue Service announced that the nation's tax season will start on Friday, February 12, 2021, when the tax agency will begin accepting and processing 2020 tax year returns.

The February 12 start date for individual tax return filers allows the IRS time to do additional programming and testing of IRS systems following the December 27 tax law changes that provided a second round of Economic Impact Payments and other benefits.

This programming work is critical to ensuring IRS systems run smoothly. If filing season were opened without the correct programming in place, then there could be a delay in issuing refunds to taxpayers. These changes ensure that eligible people will receive any remaining stimulus money as a Recovery Rebate Credit when they file their 2020 tax return.

To speed refunds during the pandemic, the IRS urges taxpayers to file electronically with direct deposit as soon as they have the information they need. People can begin filing their tax returns immediately with tax software companies, including IRS Free File partners. These groups are starting to accept tax returns now, and the returns will be transmitted to the IRS starting February 12.   

Click here to continue reading this information from IRS.gov.

SBA COVID-19 Funding Options

Posted by Admin Posted on Feb 10 2021

SBA COVID-19 Funding Options

The Paycheck Protection Program (PPP) is now offering Second Draw PPP Loans as well as First Draw PPP Loans for first time program participants. To find out if you qualify visit Paycheck Protection Program. SBA also offers other Coronavirus Relief Options, visit Coronavirus Relief Options to find out more or contact one of our staff to discuss.   

If you have not filed your Loan Forgiveness Application for your first round PPP loan and would like assist contact us today.

Click here to view the SBA Paycheck Protection Program.

Click here to view the SBA Coronavirus Relief Options.

HHS Reporting Requirements and Auditing

Posted by Admin Posted on Feb 10 2021

HHS Reporting Requirements and Auditing

Recipients of PRF payments exceeding $10,000 in aggregate must register in the Provider Relief Fund Reporting Portal. At present, there is no deadline for completing registration in the portal. Recipients will later receive a notification about when they should complete the second step of submitting reporting requirements information on the use of funds. HRSA will send a broadcast email to the email address you provide during the registration process. Below is the link for the portal registration.

Click here for details.​

If you would like assistance with the HHS reporting requirements or portal registration, please contact our office.

Blog by Sarah McIntosh, Director of Operations

 

 

Resources: 2021 Annual Update to the Therapy Code List, Prior Authorization and More

Posted by Admin Posted on Jan 15 2021

2021 Annual Update to the Therapy Code List

This MLN Matters Article is for physicians, therapists, providers, and suppliers billing Medicare Administrative Contractors (MACs) for therapy services provided to Medicare beneficiaries.

This article informs you of updates to the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the Calendar Year (CY) 2021 CPT and Level II HCPCS. Make sure your billing staffs are aware of these updates.  

Click here for details.​

 

Prior Authorization

Department for Medicaid Services mailed a provider letter dated January 7 regarding changes to the Ancillary Authorization Process.

Click here to view the provider letter.​

Click here to view the provider form.​

ATTENTION ALL PROVIDERS: Effective with dates of service beginning 11/17/20, prior authorizations will be suspended for all provider types except for the following: EPSDT, Nursing Facility must continue to submit LOC via KLOCS and call Carewise Health at 1-800-807-8842 for ancillary services. Additionally, the 1915 c. Waivers - ABI, ABI LTC, Model II, SCL, HCB and Michelle P will require a prior authorization.  

 

Quality Incentive Payments

If you have questions relative to the QIP payments, you should contact the following:

1. If you have issues with data submitted to the National Healthcare Safety Network, contact: NH_COVID_Data@cms.hhs.gov

2. If your data appears complete and you believe you have erroneously not received payment, you should contact: ProviderReliefContact@hrsa.gov  

 

HHS Increases and Begins Distributing Phase 3 Provider Relief Funding

HHS Increases and Begins Distributing Over $24 Billion in Phase 3 COVID-19 Provider Relief Funding.  

Click here for details.

$900 Billion Stimulus Package

Posted by Admin Posted on Jan 11 2021

$900 Billion Stimulus Package

Congress passed the $900 billion Stimulus package. Highlights of what this means for Skilled Nursing Facilities is as follows:

•    2% sequestration relief extended thru March 31, 2021
•    Some Medicare B cuts eliminated
•    Budget vs Actual Lost Revenue calculations for Provider Relief Funds  

The stimulus package is a mixed bag for the long term care sector. Learn more of what this bill means for Skilled Care Facilities.

Click here for details.​

Do you have questions about what this means for you? Call us with your questions at (270) 726-4033.

Blog by Sarah McIntosh, Director of Operations

 

 

2021 Medicare Part A & B Premiums and Deductibles

Posted by Admin Posted on Jan 08 2021

2021 Medicare Part A & B Premiums and Deductibles

On November 6, 2020, the Centers for Medicare & Medicaid Services (CMS) released the 2021 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.  

•    Skilled Nursing Facility coinsurance for 2021 - $185
•    Medicare B deductible for 2021 - $203.00  

Click here for details.​

Phase 3 Funding

Posted by Admin Posted on Jan 08 2021

Phase 3 Funding

In October 2020, Department of Health and Human Services (HHS) announced application process for Phase 3 funding of $20 billion. The application deadline was November 6, 2020. HHS has now decided to boost its Phase 3 funding total from $20 billion to $24.5 billion. HHS will be distributing the Phase 3 funding from December thru January 2021.   

Click here for details.​

Kentucky is reported to receive $141 million of the $24.5 billion. Below is the reference.  

Click here for details.

Resources: COVID-19 Performance Payments and More

Posted by Admin Posted on Dec 10 2020

HHS awards nursing homes $523M in COVID-19 performance payments

HHS awards nursing homes $523M in COVID-19 performance payments Federal authorities announced that it will be distributing $523 million in the second round of performance payments. More than 9,000 nursing homes that have successfully reduced COVID-19-related infections and deaths between September and October will receive the payments. HHS found that 69% of the eligible facilities met the infection control criteria for the incentive program, while 68% met the mortality criteria.  

Click here for details.​

 

CMS finalizes ‘shocking’ 9% therapy cuts, while affirming vast expansion of telehealth pay provisions

The Centers for Medicare & Medicaid Services formally announced Tuesday afternoon that it has finalized its calendar 2021 physician pay rule, which cuts physical, occupational and speech/language therapy payments for nursing homes patients by 9%.   

Click here for details.​

 

Kentucky Medicaid - New Enrollment, Revalidation or Maintenance

Posted by Admin Posted on Dec 10 2020

Kentucky Medicaid - New Enrollment, Revalidation or Maintenance

Kentucky Department for Medicaid Services (DMS) has the Kentucky Medicaid Partner Portal Application (KY MPPA) system allowing all provider types to enroll, revalidate and/or perform maintenance electronically. Paper forms are NO longer accepted.

The KY MPPA system is available here.

The 2021 Provider Application Fee is $559 effective January 1, 2021.

If you need to make an update or revalidate your current Medicaid Provider information, such as license update, address change, EFT change, NPI/taxonomy change, change of ownership, name change, or revalidate you should use the KY MPPA system.

When Kentucky Medicaid providers update their licenses, they must submit a copy of the license to Kentucky Medicaid through KY MPPA to keep their provider information updated.

 

Blog by Sarah McIntosh, Director of Operations

 

 

3 Day Qualifying Stay and Benefit Period Waiver

Posted by Admin Posted on Dec 10 2020

3 Day Qualifying Stay and Benefit Period Waiver

These waivers have been renewed by the Secretary of Health and Human Services multiple times, most recently on October 2, 2020. Therefore, these waivers will continue to apply until at least January 20, 2021, unless the Secretary signs another extension of the PHE.

Click here for details.​

 

Testing for Long-Term Care Facilities - Modification

Posted by Admin Posted on Dec 10 2020

Testing for Long-Term Care Facilities - Modification

A contract was entered into by the Commonwealth of Kentucky and qualified vendors for COVID-19 Testing Services. This contract provides reimbursement to staff and residents of LTC for expenses incurred during the state of emergency. As of November 20, 2020, the Commonwealth of Kentucky received an additional $63M in federal funding. The revised contract amount is now $93M. The end date of the contract remains to be 12/30/2020.

 

Resources: Long Term Care Provider Newsletter, Joint Cybersecurity and More

Posted by Admin Posted on Nov 11 2020

KY Cabinet for Health & Family Services Office of Inspector General Division of Health Care Long Term Care Provider Newsletter

The Long Term Care Provider Newsletter published by the Cabinet for Health & Family Services Office of Inspector General Division of Health Care is a great resource for KY facilities.  

Click here to view the October 2020 newsletter.​

 

Joint Cybersecurity Advisory

CISA, FBI, and HHS have credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers. CISA, FBI, and HHS are sharing this information to provide warning to healthcare providers to ensure that they take timely and reasonable precautions to protect their networks from these threats.   

Click here for details.​

 

HHS Updates Provider Relief Fund FAQs

Click here for details.​

 

MLN Matters

Posted by Admin Posted on Nov 11 2020

MLN Matters

MLN Matters SE20011 was revised on 11/9/2020 to clarify the Skilled Nursing Facility (SNF) Benefit Period Waiver.

Statements worthy of reviewing regarding the Benefit Period Waiver:

1. Providers may utilize the additional 100 SNF days at any time within the SAME SPELL OF ILLNESS.

2. Ongoing skilled care in the SNF that is unrelated to the PHE does NOT qualify for the Benefit Period Waiver.

Click here to view the article.

 

Blog by Kyle Fritsch, Billing Manager

 

 

Medicaid Oxygen Fee Screens Based on DME Fee Schedule Amounts

Posted by Admin Posted on Nov 09 2020

Medicaid Oxygen Fee Screens Based on DME Fee Schedule Amounts

The Medicaid oxygen fee screens are based on the DME fee schedule amounts. The email below is from Cabinet for Health and Family Services and addresses the effective date for the oxygen fee screen amounts.

Each year Kentucky Medicaid is required to provide an Upper Payment Limit demonstration for CMS on DME codes covered by Kentucky Medicaid. This demonstration must reflect reimbursement rates for Kentucky Medicaid are set at or below the rates for the same codes listed by Medicare. Kentucky Medicaid was notified by CMS that we were out of compliance and must make adjustments to our fee schedule. To bring Kentucky Medicaid into compliance the Department for Medicaid Services immediately ordered a rate change adjustment to the 2020 DME fee schedule retroactive to 1/1/2020. This resulted in paid claims with any codes having rate decreases to automatically trigger a recoupment. The recoupment was in error. The recouped amounts will be reprocessed and repaid. Kentucky Medicaid apologizes for the late notice and any inconvenience that this has or may cause. The new effective date of the rates is 11/15/20.  

Click here for details.​

 

Humana Medicare Advantage Change to Reimbursement Methodology

Posted by Admin Posted on Nov 09 2020

Humana Medicare Advantage Change to Reimbursement Methodology January 1, 2021

Humana recently mailed a letter to providers notifying them of their new payment methodology change effective January 1, 2021. Humana is changing the reimbursement methodology to Levels. Please see the attached memo and if you wish to object, notify Humana at the address listed in the memo. 

Click here for details.​

Video: Medicaid Oxygen Reimbursement Change

Posted by Admin Posted on Oct 05 2020

Medicaid recently updated the oxygen reimbursement amounts the week of September 14th. The website states the oxygen reimbursement changes are effective 1/1/20. The reimbursement amounts are below and reflect the amounts listed on the website (link below). Watch Sarah's video for more details.

Click here for additional information.​

 

In-Person Visitation Aid Grant Details

Posted by Admin Posted on Oct 05 2020

Civil Money Penalty (CMP) Reinvestment Application – In-Person Visitation Aids

The Centers for Medicare and Medicaid Services (CMS) recognizes that considerations allowing for visitation in each phase of re-opening may be difficult for residents and their families, CMS has developed this application template for request for the use of CMP funds to provide nursing homes with in-person visitation aids.

Funding for tents and Plexiglas (or similar product), are limited to a maximum of $3,000 per facility. Note, when installing tents, facilities must ensure appropriate Life Safety Code (LSC) requirements found at 42 CFR 483.90 are met, unless waived under the Public Health Emergency (PHE). All applicants must agree to the requirements defined in the project application.  

Click here for details.​

Click here for FAQs.​

 

Resources: Phase 3 Relief Details and More...

Posted by Admin Posted on Oct 05 2020

Trump Administration Announces $20 Billion in New Phase 3 Provider Relief Funding

Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.  

Click here for details.​

 

How is the $2 billion incentive payment to skilled nursing facilities and nursing homes being determined?

In order for a facility to be eligible for payment, they must pass two initial gateway qualification tests on both their rate of infection and rate of mortality. First, a facility must demonstrate a rate of COVID infections that is below the rate of infection in the county in which they are located. This benchmark requirement for infection rate reflects the goal of the incentive program to recognize and reward facilities that establish a safer environment than the community in which they are located. Second, facilities must also have a COVID death rate that falls below a nationally established performance threshold for mortality among nursing home residents infected with COVID.  

Click here for more details.​

 

Public Health Emergency (PHE) Extension

Secretary Azar used his authority in the Public Health Service Act to declare a public health emergency (PHE) in the entire United States on January 31, 2020 giving us the flexibility to support our beneficiaries, effective January 27, 2020. The PHE was renewed on April 21, 2020, July 23, 2020, and October 2, 2020, effective October 23, 2020.  

Click here for more details.​

 

HHS Reporting Requirements Change as of September 19, 2020

This notice informs recipients of the categories of data elements that recipients must submit for calendar years 2019 and 2020 as part of the reporting process.  

Click here for more details.​

 

KY Medicaid Lab Fee Screen Amounts Updated

For SNF’s that have Medicaid only patients, Medicaid has recently updated the Lab fee screen amounts. SNF’s will need to update their software accordingly for the changed fee screen amounts.   

Click here for the fee screen amounts.​

 

Clarification on KY Medicaid add-on billing

Posted by Admin Posted on Oct 05 2020

Questions about the COVID-19 $270 add-on

There has been much discussion about billing Medicaid for COVID-19 patients and receiving the $270 add-on. The original FAQ document stated the Skilled Nursing Facility (SNF) had to receive a negative test result before the add-on billing ceased. There have been multiple discussions between SNFs due to the Office of Inspector General (OIG) stating residents were not required to be given the COVID-19 test to show a negative result.

Click here for clarification on Medicaid add-on billing.

 

Blog by Sarah McIntosh, Director of Operations

 

 

Hargis and Associates Team Members LeadingAge Virtual Conference Presenters

Posted by Admin Posted on Sept 08 2020

LeadingAge Kentucky 2020 Annual Conference

Join LeadingAge Kentucky for the 2020 Annual Conference on October 15-16, 2020. We'll have 2 team members as featured presenters during this virtual conference. More info on the conference coming soon!

Program Title: Make the Most of Your Provider Relief Funds: Tips to Successfully Account for Expenses
Date: October 15, 1:00-2:00 EST
Presenter: Sarah McIntosh, Director of Operations

Program Title: 7 Tips to Improve Your Accounts Receivable
Date: October 16, 10:30-11:30 EST
Presenter: Leah Shoulders, Billing Manager

Click here for details.

Resources: IRS Notices, Nursing Home Relief and more

Posted by Admin Posted on Sept 08 2020

IRS temporarily stops mailing notices to taxpayers with balances due

The IRS has suspended the mailing of three notices – the CP501, the CP503 and the CP504 – that go to taxpayers who have a balance due on their taxes. Although the IRS continues to make significant reductions in the backlog of unopened mail that developed while most IRS operations were closed due to COVID-19, this temporary adjustment to processing is intended to lessen any possible confusion that might be associated with delays in processing correspondence received from taxpayers.  

Click here for details.​

 

Trump Administration Announces $2 Billion Provider Relief Fund Nursing Home Incentive Payment Plans

Under the leadership of President Trump, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to nursing homes. This distribution is the latest update in the previously announced $5 billion in planned support to nursing homes grappling with the impact of COVID-19. Last week, HHS announced it had delivered an additional $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs. Other resources are also being dedicated to support training, mentorship and safety improvements in nursing homes.  

Click here for details.​

 

Nursing Home Infection Control Distribution

Posted by Admin Posted on Sept 08 2020

Infection Control Distribution is to be spent for costs associated with COVID-19

HHS distributed an initial $2.5 billion of the Nursing Home Infection Control Distribution funding on Thursday, August 27, 2020. Eligible nursing homes and skilled nursing facilities received a per-facility payment of $10,000 plus a per-bed payment of $1,450 in the first round of this distribution.

The Infection Control Distribution is to be spent for costs associated with administering COVID-19 testing for both staff and residents; reporting COVID-19 test results to local, state, or federal governments; hiring staff to provide patient care or administrative support; incurring expenses to improve infection control, including activities such as implementing infection control “mentorship” programs with subject matter experts, or changes made to physical facilities; and providing additional services to residents, such as technology that permits residents to connect with their families if the families are not able to visit in person.

Just like the other Provider Payment Relief payments, providers will have 90 days from receipt of payment to attest to the terms and conditions. The terms and conditions were wrongly placed under the link for the 2.5 billion SNF distribution.

Click here for details (pdf).

 

Blog by Sarah McIntosh, Director of Operations

 

 

Kentucky COVID-19 testing, reimbursement, and support details

Posted by Admin Posted on Aug 26 2020

Get all the Kentucky COVID testing details, instructions, links and answers to your FAQs in this blog.  

 

Kentucky COVID-19 testing, reimbursement, and support details:

To aid in advancing ongoing COVID-19 surveillance testing, the Kentucky Department for Public Health issued an order on July 9, 2020 indicating that a licensed clinician’s order is not required for a clinical laboratory to perform or bill for a COVID-19 FDA-approved diagnostic test. This guidance is intended to demonstrate Governor Andy Beshear’s continuing commitment to protect our most vulnerable citizens residing in Kentucky’s Long Term Care Facilities from COVID-19. Accordingly, effective immediately, the CHFS will continue its financial support of ongoing COVID-19 surveillance testing for residents and staff of LTC providers. The guidelines are based on what is currently known about the transmission and severity of COVID-19..  

Details about testing, reimbursement, support and duration here. (Pdf)​

 

Team Kentucky Reimbursement Instructions:

This contract is established to provide for reimbursement to providers, clinics and/or laboratories for testing costs of COVID-19 on non-insured and non-Medicaid eligible citizens of the Commonwealth, staff and residents of Long-Term Care Facilities, or any other population identified by the Secretary of the Cabinet for Health and Family Services.   

Click here for details (pdf).​

 

CHFS Surveillance COVID-19 Testing for Long-Term Care Facilities Frequently Asked Questions (FAQs):

Click here for details (pdf).​

 

Resources: Flu Vaccines, Prior Authorization, and more

Posted by Admin Posted on Aug 06 2020

Apply Now: CARES ACT Provider Relief Fund Application Portal Now Open for Certain Medicare Providers

The U.S. Department of Health and Human Services (HHS) is distributing payments in the Phase 2 General Distribution of the Provider Relief Fund as part of ongoing efforts to offer financial relief to providers impacted by coronavirus disease 2019.  

Click here for details.​

 

Allocations of CARES Act Provider Relief Fund for Nursing Homes

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of the next CARES Act-authorized nursing home Provider Relief Fund (PRF) distribution.  

Click here for details.​

 

Flu Vaccine Amounts have been published for 2020-2021 Season

The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department. When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost. Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.   

Click here for details.​

 

PRIOR AUTHORIZATION TO RESUME AUG. 1st

Effective with dates of service beginning 8/1/2020, prior authorizations will resume with the exception of Behavioral Health and Substance Use Disorder (SUD) services. Behavioral Health and SUD services are defined as services provided by any Behavioral Health Provider type (02, 03, 04, 05, 06, 23, 26, 30, 62, 63, 66, 67, 81, 82, 83, 84, 89, 92), services listed on the Behavioral Health and Substance Abuse Services Inpatient and Outpatient fee schedules, and services listed on the Community Mental Health Center (CMHC) Mental Health Substance Abuse Codes and Units of Service fee schedule.  

Medicare Payment Rates and SNF VBP Program Updates

Posted by Admin Posted on Aug 06 2020

Medicare payment rates and SNF VBP Program..

CMS issued final rule for Fiscal Year (FY) 2021 that updates Medicare payment rates and the value-based purchasing program for SNFs.  

Click here for details.

August Performance Score Reports now available to download

The August Performance Score Reports (PSRs) for the fiscal year (FY) 2021 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download. The PSRs provide SNFs with their performance information for the third year of the SNF VBP Program, including the incentive payment multiplier that will be applied to SNF Medicare fee-for-service claims from October 1, 2020 through September 30, 2021. The PSRs are distributed to SNFs via the Quality Improvement and Evaluation System (QIES) Certification and Survey Provider Enhanced Reports (CASPER) reporting system.  

You may review illustrated steps for accessing your facility`s PSR here.

To receive your Medicare Rates for FY 2021, contact one of our client Managers today!  

Flu and Pneumonia Billing in a Skilled Nursing Facility

Posted by Admin Posted on Aug 06 2020

Flu and Pneumonia Billing in a Skilled Nursing Facility (SNF)

For SNF’s, Medicare B pays for patients that receive the influenza, pneumococcal and Hepatitis B vaccines. As a reminder, the vaccines are a separate Part B inpatient benefit when rendered to beneficiaries in a covered Part A stay. Therefore, the SNF can be reimbursed for the vaccines given to all patients that have Medicare B, regardless if the patient is using Medicare A benefits or not.

Reference the Medicare Claims Processing Manual, Chapter 6, Section 20.4 for details.

Click here for details.

 

Blog by Sarah McIntosh, Director of Operations

 

 

HHS Reporting Instructions

Posted by Admin Posted on Aug 03 2020

**BLOG UPDATED 8/18/2020: HHS delayed the additional details regarding the reporting instructions. HHS stated providers will receive detailed instructions and data template well before the reporting system’s October 1 availability.

 

Department of Health and Human Services (HHS) to release reporting instructions by August 17, 2020.

Provider Relief Fund (PRF) recipients that received one or more payments exceeding $10,000 will be required to submit future reports of how the PRF were spent.  

•    All recipients must report on their expenditures through December 31, 2020 by February 14, 2021.
•    If there are remaining funds to be spent on December 31, 2020, a second and final report will be due July 31, 2021.
•    Recipients who have expended all their funds prior to December 31, 2020 may submit a single report any time after October 1, 2020 but before February 15, 2021. 

Click here to visit the HHS website.

Deadline extended for providers to apply for the Medicaid & CHIP Provider Relief Fund

Posted by Admin Posted on July 23 2020

** BLOG UPDATED 8/6/20: This deadline has now been extended to August 28, 2020.  

Dear Kentucky Medicaid & CHIP Leadership

I wanted to send you a note to follow up on the email that CMS sent out last Friday announcing HHS’ extension of the deadline for qualifying Medicaid & CHIP providers to apply for the Medicaid & CHIP Provider Relief Fund distribution.

CMS has been in continuous discussions with our partners at the Health Resources and Services Administration (HRSA) about the status of applications for this distribution. This email is intended to provide you with an update on the number of providers from your state that have applied.

As of July 15th, 143 qualifying Medicaid & CHIP eligible providers in Kentucky have applied for the Medicaid & CHIP Provider Relief Fund distribution out of the 22,751 providers identified in the data that your team supplied to CMS.  Of these, 91 Medicaid & CHIP providers have been paid from this distribution.  To ensure that all qualifying providers are aware of the opportunity, as well as the new application deadline, we are requesting that states reach out to your medical, dental, and long-term services and supports (LTSS) providers to remind them that they can begin the application process here

To support these efforts, we’ve included below some resources that the HRSA team has released on the Provider Relief Fund that you can share:

Program Overview:
The bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act provide $175 billion in relief funds to hospitals and other health care providers, including those on the front lines of the coronavirus response. A portion of these funds, under the Medicaid and Children’s Health Insurance Program (CHIP) Provider Distribution, provide help for providers and clinicians who treat our most vulnerable populations, including low-income and minority patients. This is allocated for eligible providers that participate in state Medicaid and CHIP Programs and that did not receive a payment from the Provider Relief Fund General Allocation. The payment to each provider will be approximately 2 percent of reported gross revenue from patient care.
 
Fact Sheet
The Health Resources & Services Administration (HRSA) released a Fact Sheet for Medicaid and CHIP Providers that is now available on the Provider Relief Fund website. 
 
Recorded Webcast
A recording of the June 25 webcast is now available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html.
 
Frequently Asked Questions (FAQs)
In order to better address your most important concerns, HRSA has updated their FAQs to address common questions, including those submitted during the previous webcasts. The FAQs include expanded information on eligibility, application, payment process, and more.
 
Application Instructions
Medicaid and CHIP Provider Distribution Instructions and the Medicaid and CHIP Provider Distribution Application Form are available at hhs.gov/providerrelief. HRSA recommends downloading and reviewing these documents to help you complete the process through the Enhanced Provider Relief Fund Payment Portal
 
Additional Information
For additional information, please call the Provider Support Line at (866) 569-3522; for TTY, dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday. Service staff members are available to provide real-time technical assistance, as well as service and payment support.

Summary of Provider Relief Fund Payments

Posted by Admin Posted on July 15 2020

Summary of Provider Relief Fund Payments.

General Distribution Payment:
Two separate payments on April 10-17 and April 24
Attestation deadline for April 10-17 payment was July 9
Attestation deadline for April 24 payment is July 23

Targeted SNF-Only Distribution:
Payment sent on May 22
Attestation deadline for May 22 payment is August 20

Targeted Medicaid/CHIP Distribution:
Eligible for Medicaid providers who have not received General Distribution payment
Applications must be submitted by July 20

Do I have to submit a quarterly report to HHS for April, May and June 2020 quarter?

No. All Recipients of the Provider Relief Fund payments who attest and agree to the Terms and Conditions, do not need to submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee. HHS will submit a report containing all information necessary to comply with the reporting requirements of the CARES Act. However, HHS will be requiring recipients to submit future reports of how the Provider Relief Funds were spent. HHS will notify recipients of the content and due date.

What type of Documentation do I need to provide for the Provider Relief Fund Payments?

All expenses and lost revenues should be linked to COVID-19. Providers should not only track the expense but record what the item was used for and how it related to COVID-19. HHS has clarified that the Provider Relief Fund payments can be used for expenses incurred after January 1, 2020. These expenses must be related to COVID-19. HHS has said it will reconcile payments to expenses and lost revenues at the end of the pandemic.

What if I have excess Provider Relief Fund Payments that I do not spend?

HHS will provide directions on how to return the unused funds.   

 

KENTUCKY LEVEL OF CARE SYSTEM (KLOCS)

Posted by Admin Posted on July 15 2020

KENTUCKY LEVEL OF CARE SYSTEM (KLOCS)

Starting August 3, 2020, all nursing and ICF/IID facilities will be required to use Kentucky Level of Care System (KLOCS) to submit Level of Care (LOC) applications and receive payment. Every facility will need a Kentucky Online Gateway (KOG) account to access KLOCS. Below is the TAKE ACTION NOW email that Department for Medicaid Services (DMS) has sent out.   

Your facility must provide the Department for Medicaid Services (DMS) the names of individuals (2 max) responsible for managing your organization and its users in Kentucky Online Gateway (KOG). DMS will assign those individuals the KOG role of Organization Administrator. The Organization Administrator is responsible for granting and removing access to KLOCS on behalf of your organization.

How do I provide DMS this information?

Email KLOCSOrgAdmin@ky.gov the following information by 7/17/2020:

- Organization
- Name First and Last Name (2 people max per facility)
- Their email addresses

Guides for KOG Account Creation, the Organization Administrator Role, and Multi Factor Authentication (MFA) Set-Up will be available on the DMS KLOCS training page prior to the August 3, 2020 go-live.

What happens if my facility does not identify an Organization Administrator?

Without an Organization Administrator, your staff will NOT be able to access KLOCS to submit new LOC applications, initiate a request for PASRR Level II evaluations, nor manage active LOCs. This will impact your facility’s ability to receive payment.

If you have already provided DMS this information, please follow-up to confirm they received the initial request.   

 

Resources: KLOCS, Medicaid Rates, PBJ and PDPM updates

Posted by Admin Posted on July 08 2020

Frequently Asked Questions about Taxation of Provider Relief Payments

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020, appropriated $100 billion for the Public Health and Social Services Emergency Fund (Provider Relief Fund). The Paycheck Protection Program and Health Care Enhancement Act, enacted on April 24, 2020, appropriated an additional $75 billion to the Provider Relief Fund. This funding will be used to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to the COVID-19 pandemic.   

Click here for details.​

 

Kentucky Department for Medicaid Services Update on MDS Requirements

Effective October 1, 2020, Kentucky Medicaid will be requiring the reporting of the PDPM payment codes on the OBRA assessments when not combined with a 5‐day SNF PPS assessment.  

Click to view the full details from Myers and Stauffer.​

 

CMS plans to end the emergency blanket waiver

CMS announced plans to end the emergency blanket waiver requiring all nursing homes to resume submitting staffing data through the Payroll-Based Journal (PBJ) system by August 14, 2020. The memorandum also provides updates related to staffing and quality measures used on the Nursing Home Compare website and the Five Star Rating System.   

Click here to visit the CMS website for details.

 

KLOCS Go-Live and Training

Kentucky Level-of-Care Systems (KLOCS) Go-Live and Training: AUGUST 3, 2020 Go to the following link for postings regarding web-based trainings.

Click here for details.

 

Important Update: MEDICAID RATES - July 1

*Estimated Medicaid 1.5% Inflation Adjustment effective July 1, 2020
*DMS will not apply rate sanctions to the per diem rates effective July 1, 2020 and October 1, 2020, unless the Public Health Emergency ends prior to these dates.

CMS Issued an Emergency Grant Program

Posted by Admin Posted on July 08 2020

CMS Issued an Emergency Grant Program

CMS issued an emergency grant program, Communicative Technology Project, to assist in alleviating communication limitations due to COVID-19. Certified nursing facilities can apply for a Civil Money Penalty (CMP) fund grant for up to $3,000 to cover the costs of certain communicative technology devises and accessories.

Reminder that the CMP Grant opportunity is set to expire in July 2020.

Click here for the website and application.

Blog by Rhonda Houchens, Director of Operations

 

 

Resources: Kentucky Department for Medicaid Services Update on MDS Requirements

Posted by Admin Posted on July 02 2020

Kentucky Department for Medicaid Services Update on MDS Requirements 

Click to view the full details from Myers and Stauffer.​

Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

CMS provided clarification on provider utilization of the three day waiver and the benefit period waiver. Additional billing instructions have been provided for troublesome benefit period waiver claims.  

Click here to visit the CMS website for details.

Provider Guidance: Phased Reduction of Restrictions for Long Term Care Facilities

This guidance is provided in accordance with the phased approach to resuming currently suspended services encouraged by the Centers for Medicare and Medicaid Services (CMS).

Click for details.

Resources: CMS-R-131

Posted by Admin Posted on July 02 2020

** BLOG UPDATED 8/6/20: Due to COVID-19 concerns, CMS is going to expand the deadline for use of the renewed ABN, Form CMS-R-131. The renewed ABN will be mandatory for use on 1/1/2021.  

CMS-R-131

The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on 8/31/2020. 

Click here to view the ABN form and instructions.

HHS - Medicare

Posted by Admin Posted on June 09 2020

HHS - Medicare

SIGN ATTESTATION

1.  Have you completed Attestation Process via HHS website for Tranche 1, Tranche 2 and SNF Relief Fund Pmt?
2.  Would you like for us to do this?
3.  If yes, send the following info
- Tax ID Number
- Last 6 digits of Bank Account Number that money was deposited in
- Exact amount of Tranche 1 pmt, Tranche 2 pmt and - SNF Relief Fund Pmt
4.  Sign the Attestation via the link:  https://covid19.linkhealth.com/#/step/1

SUBMIT FINANCIAL DATA

1.  Have you submitted Financial Data via HHS website? (Due by June 3, 2020)
2.  Would you like for us to do this?
3.  If yes, send the following info:
- Tax ID Number
- Last 6 digits of Bank Account Number that money was deposited in
- Exact amount of Tranche 1, Tranche 2 and SNF Relief Fund Pmt
- PD of most recently filed tax return to be uploaded
- Estimated Lost Revenue for March 2020
- Estimated Lost Revenue for April 2020
4.  Submit your revenue information to be verified via the portal: https://covid19.linkhealth.com/#/step/1

TRACK HHS FUNDS

1.  Do you want our assistance with HHS funds tracking?
2. Funds should be used on PREPARING, PREVENTING or RESPONDING to COVID-19 

 

Contact us to learn more:

www.hargisandassociates.com
accountants@hargisandassociates.com
(270) 726-4033

 

CARES Act Provider Relief Fund

Posted by Admin Posted on June 09 2020

What is eligible for reimbursement?

HHS has distributed money to SNFs to help them combat the devastating effects of this pandemic. A very common question has been, “What expenses or lost revenues are considered eligible for reimbursement?”

The HHS.gov website has a shared a list of Frequently Asked Questions concerning the CARES Act Provider Relief Fund, including a response to this question on page 6.

Click here to learn more.

Blog by Sarah McIntosh, Director of Operations

 

 

Resources: HHS Relief for Skilled Nursing Facilities (SNFs)

Posted by Admin Posted on June 01 2020

HHS Releases $4.9 billion in COVID-19 Relief for Skilled Nursing Facilities (SNFs)​

SNFs received a baseline payment of $50,000, plus an additional $2,500 per bed.  

As with other rounds of CARES Act funding, SNFs must agree to the terms and conditions in order to accept the cash.  

SNF’s must also comply with future audit and reporting rules.  Below is the link to the terms and conditions posted on HHS website. 

Click here to view the HHS website.

Articles referencing Relief funds:

Click here to learn more from McKnights Long-Term Care News.

Click here to learn more from Skilled Nursing News.

Small Business Administration (SBA) Payroll Protection Program (PPP)

Posted by Admin Posted on May 18 2020

Small Business Administration (SBA) Payroll Protection Program (PPP)​

Every borrower should begin preparing for the loan forgiveness process.  Make sure that you are documenting how you spend you PPP proceeds and have proper documentation.

Below is a list of some information that will be needed:

•  The number of full-time equivalent (FTE) employees on your payroll as of the following time periods
     1.  8 week “covered period”
     2.  2/15/19 to 6/30/19
     3.  1/1/20 to 2/29/20
•  Dollar amount of Payroll cost during the “covered period”
•  Dollar amount of non-payroll cost incurred during the “covered period”
•  Did you receive an SBA Economic Injury Disaster Loan (EIDL)

Click here to view the updated SBA Q&As.

The Department of Health & Human Services

Posted by Admin Posted on May 18 2020

HHS Provider Letters

The Department of Health & Human Services recently sent letters to providers regarding submitting revenue data to the General Distribution Provider Portal for verification. The letter states “All providers, including those paid based on the revenue data already submitted in CMS cost reports, are required under the Terms and Conditions to submit revenue information to the General Distribution Provider Portal for verification.“

There has been much confusion if Providers are required to submit their revenue information. The provider letter states that ALL providers must submit their revenue information. Click here to view the Provider Letter. 

 

Steps all Providers need to complete:

1. Sign the Attestation via the link:  https://covid19.linkhealth.com/#/step/1

Info needed:
A.  Tax ID number
B.  Last Six Digits of Bank Account Number
C.  Exact amount of the Relief Fund Payment

2. Submit your revenue information to be verified via the portal:  https://covid19.linkhealth.com/docusign/#/step/1

Info needed:    
A.  Tax ID number
B.  Last Six Digits of Bank Account Number
C.  Exact amount of the Relief Fund Payment
D.  Gross receipts of sales 
     a.    Box 1a of IRS Form 1120
     b.    Box 1a of IRS Form 1120S
     c.    Box 1a of IRS Form 1065
     d.    Part I, 9 “Program Services Revenue” of IRS Form 990
E.  Estimated Lost Revenue for March 2020
F.  Estimated Lost Revenue for April 2020
G.  Copy of IRS Form 1120 to upload

Resources: Relief Programs, CMS and Medicaid Updates

Posted by Admin Posted on May 13 2020

CARES Act Provider Relief Fund​

President Trump is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act that provide $175 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding supports healthcare-related expenses or lost revenue attributable to COVID-19 and ensures uninsured Americans can get testing and treatment for COVID-19. 

Click here to learn more.

Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions​

CMS is committed to taking critical steps to ensure America’s nursing homes are prepared to respond to the threat of the COVID-19.
Nursing Home Compare website & Nursing Home Five Star Quality Rating System: We are announcing that the inspection domain will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers.
Posting of surveys: CMS will post a list of the surveys conducted after the prioritization of certain surveys, and their findings, through a link on the Nursing Home Compare website.
Nursing Home Staff: CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home, each day. This information can be used to help direct adequate personal protective equipment (PPE) and testing to nursing homes.
Frequently Asked Questions (FAQ): We are releasing a list of FAQs to clarify certain actions we have taken related to visitation, surveys, waivers, and other guidance.

Click here to learn more.

CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program​

On April 26, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments.

Click here to learn more.

Kentucky News

See the latest news and updates from Governor Beshear.

Click here to learn more.

MEDICAID PROVIDER LETTER

This memo from the Kentucky Department for Medicaid Services gives details for the following updates.

Effective April 1, 2020, Medicaid Rate add-on of $270 for COVID-19 positive patients. 
Effective April 24, 2020, Medicaid is implementing a temporary process for Medicaid eligibility. 
Effective April 1, 2020 Medicaid will be increasing the bed reservation days to 30 per calendar year through the state of emergency.

Click here to learn more.

Resources: Long Term Care Provider News

Posted by Admin Posted on May 13 2020

COVID-19 Emergency Circumstances LTC Bed Change Requests​

As a result of the COVID-19 pandemic, CMS has demonstrated unprecedented flexibility to long-term care facilities in order to protect residents during the pandemic. CMS has released the “COVID-19 Long-Term Care Facility Guidance”, issued blanket waivers for certain CMS requirements of participation for LTC facilities, as well as offered flexibility regarding timeframes for COVID-19 emergency bed change requests. In response to the relaxed requirements offered by CMS and Governor Andy Beshear’s Executive Order 2020-215 declaring a state of emergency in the Commonwealth, a new bed change request process has been developed. The COVID-19 Emergency Circumstances LTC Bed Change Request Process allows for the faster processing of temporary bed change requests due to emergency circumstances related to the COVID-19 pandemic. This process waives all licensure and architectural review fees, allows for architectural desk reviews, removes the typical CMS timeframe requirements and eliminates the requirement for color coded floor plans when requesting certification status changes.

Click here to learn more.

Emergency CMP Grant Project​

It is with great pleasure that the Cabinet for Health & Family Services (CHFS) announces an emergency Civil Money Penalty (CMP) Grant Project opportunity for all certified nursing facilities within the Commonwealth. Specifically, CMS has notified the CHFS office that a grant program, Communicative Technology Project, has been approved to assist in alleviating communication limitations due to COVID-19. This grant program will allow Medicare-certified nursing facilities to apply for a CMP fund grant for up to $3,000 to cover the costs of certain communicative technology devices and accessories. More information can be found on the OIG Civil Money Penalty Funds website.

Click here to learn more.

Department for Medicaid Services Update on Optional State Assessment

On March 19, 2020, CMS announced that changes to the Minimum Data Set (MDS) 3.0 v1.18.1 are being delayed, therefore, an Optional State Assessment (OSA) is not needed on October 1, 2020, as originally anticipated, in order to continue Resource Utilization Group (RUG) based Medicaid reimbursement.
 
We continue to expect that in the future, CMS will remove items from the MDS item set that are needed for maintaining RUG case mix reimbursement. As CMS modifies the items on the MDS assessments in the future, DMS will evaluate if OSAs will be needed to continue its RUG‐III reimbursement system. Communications regarding any future OSA requirement will be issued at that time. We will continue to publish information as it becomes available.
 
Should you have any questions, please contact Jacob Wilson at (502) 564-8196, extension 2103. Questions regarding the coding of the MDS assessments may be directed to Chrystal Daugherty, RAI Coordinator with the Office of Inspector General at 606-330-2030, extension 283.

PDPM v1.0004​

A revision to the PDPM DLL Package (V1.0004 FINAL) was posted, and the previous version (V1.0003 FINAL) was removed. This version adds support for the new ICD-10-CM code for Coronavirus, U07.1. Note that this code is ONLY in effect for assessments with target date 04-01-2020 and later. The package contains updated test files and documentation.
 
Also, the lookup file for the allowable ICD codes in item I0020B has been updated to include U07.1, and it is posted as a separate ZIP file. Again, please note that this code is ONLY in effect for assessments with target date 04-01-2020 and later. The files are located in the Downloads section of the MDS 3.0 Technical Information site. 

Click here to learn more.

Audits are the new normal.

Posted by Admin Posted on May 06 2020

Audits are the new normal

CMS uses Comprehensive Error Rate Testing (CERT) audits to see if MACs are properly paying claims. CERT audits focus on logistical issues, such as whether or not the coding and billing are correct. CERT is looking for errors in payments made by carriers. Providers are affected because the CERT looks into a claim via Medical Records request. If the CERT uncovers an error, the CERT will recoup money from the provider. CERTs receive set amount outlined in their contract, regardless of the amount of payment errors they find.  

Recovery Audit Contractors focus on errors created by the providers. The primary purpose of RAC is to detect and correct improper payments. RACs are paid through contingency fees (money they uncover). The contingency fee payment system encourages RACs to find errors.   

Zone Program Integrity Contractors (ZPICs) are the most complex audits. ZPICs compare providers billing with similar providers. ZPIC reviews are not random. They are conducted under a presumption of fraud. ZPICs can be initiated by data analysis, frequency, whistleblowers or referred by MACs. Once an error is found they extrapolate the data in order to determine the amount of misappropriated funds. 

Blog by Sarah McIntosh, Director of Operations

 

 

Resources and Important Updates: Medicaid

Posted by Admin Posted on May 05 2020

MEDICAID​

All DCBS offices are closed for appointments.  Individuals may apply for Medicaid by calling the Kentucky Healthcare Customer Service line at (855)459-6328, visit the Benefind website (benefind.ky.gov) or by calling the DCBS Call Center at (855)306-8959.
 
During the COVID-19 State of Emergency, individuals who need special healthcare coverage should go to the kycovid19.ky.gov website and click on Services.  The special healthcare coverage is temporary and ends on 06/30/2020 unless an application for regular Medicaid is submitted.

Click here to learn more.

Resources and Important Updates

Posted by Admin Posted on Apr 13 2020

CARES ACT Provider Relief Fund to infuse $30 billion into healthcare system. ​

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.  These are payments, not loans, to healthcare providers, and will not need to be repaid.  The payments should be arriving via direct deposit beginning April 10, 2020.

Click here to learn more.

Fiscal Year 2021 Proposed Medicare Payment and Policy Changes

CMS projects aggregate payments to SNFs will increase by $784 million, or 2.3 percent, for FY 2021 compared to FY 2020.

Click here to learn more.

Kentucky and Ohio Part A News from CGS​

CGS is aware that certain eligible provider types may not have received the maximum eligible amount for their accelerated payment. We are identifying providers impacted by the 3-6 month max issue and determining a resolution. Please continue to monitor the CPIL for updates.

Click here to learn more.

Kentucky Department for Medicaid Services Update on Cost Report Extensions

CMS has directed MAC's to further extend the cost reporting deadlines for the following cost reporting fiscal year ends (FYE) for all provider types:

Cost Reporting Period Ending -- Extended Due Date
10/31/2019 -- 06/30/2020
11/30/2019 -- 06/30/2020
12/31/2019 -- 08/31/2020*
01/31/2020 -- 08/31/2020*
02/29/2020 -- 09/30/2020*
*Please note, these are new extensions.

While we have been told that CMS is considering the 03/31/2020 FYE providers that are currently due 08/31/2020, no extension has been posted at this time. 

The Advance Beneficiary Notice of Noncoverage​

The Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 is issued by providers to Original Medicare beneficiaries when Medicare payment is expected to be denied. Skilled Nursing Facilities (SNFs) issue the ABN to transfer potential financial liability for items/services expected to be denied under Medicare Part B only.  

Form CMS-R-131, will expire 03/2020. The form is currently awaiting OMB approval for renewal. CMS will provide instructions when it does get approved. In the meantime, continue to use the current form until further instruction is provided.  

CMS Flexibilities to Fight COVID-19​

CMS is waiving 42 CFR 483.70(q) to provide relief to long term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system.

Click here to learn more.

Tracking COVID-19 Related Costs

Posted by Admin Posted on Apr 03 2020

COVID-19 Expenses

In this unprecedented time, our firm strongly recommends that all additional costs, related to COVID-19, be tracked separately from all other costs/departments. We recommend setting up a "new" department in your general ledger (financial statements) to track as many COVID-19 related expenses as possible. In these uncertain times, we want to be cautious and proactive. Facilities might have to verify the additional costs due to, but not limited, to the following.

Loans (SBA and others) - example:  8 week tracking period for SBA loan
Potential Medicaid additional add-ons (currently under discussions)
Others

Below are examples of possible additional expenses:

Payroll - example:  new staff hired for infection control, replacement workers for those sick, OT, additional labor for cleaning, hazard pay to maintain staff, etc.
Personal Protective Equipment (PPE) - masks, gloves
Screening costs for employees to enter the building
Cleaning supplies and additional costs for everyday supplies
Building retro fittings - example:  putting in dividers to separate employees, staff, etc.

Please inform those responsible for your general ledger/financial statements. If you have any questions or need assistance, please contact our office. 

Blog by Robin Parker, CPA, Sr. Accountant

 

 

RESOURCES: Important Updates Concerning COVID-19

Posted by Admin Posted on Apr 01 2020

IMPORTANT UPDATE: From UnitedHealthcare

Suspension of prior authorization requirements to a post-acute care setting through May 31, 2020. Details: Waiving prior authorization for admissions to: long-term care acute facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF). Consistent with existing policy, the admitting provider must notify us within 48 hours of transfer and penalties still apply. Length of stay reviews still apply, including denials for days that exceed approved length. Discharges to home health will not require prior authorization. Prior authorization is not required for COVID-19 testing and COVID-19 testing related visits.

Click here to learn more.

IMPORTANT UPDATE: From Anthem Blue Cross Blue Shield

Anthem is committed to working with and supporting providers. As of March 16, Anthem is removing prior authorization requirements for skilled nursing facilities (SNF) for the next 90 days to assist hospitals in managing possible capacity issues. SNF Providers should continue admission notification to Anthem in an effort to verify eligibility and benefits for all members prior to rendering services and to assist with ensuring timely payments. In addition, Anthem is also extending the length of time a prior authorization is in effect for elective inpatient and outpatient procedures to 90 days. This will help prevent the need for additional outreach to Anthem to adjust the date of service covered by the authorization. This applies to members of all lines of business, as well as self-insured plan members.

Click here to learn more.

Kentucky Medicaid COVID-19 Information - Cabinet for Health and Family Services

The information on this page is specific to Medicaid beneficiaries and providers. For more information about COVID-19, refer to the state COVID-19 website.

Click here to learn more.

UPDATE: KLOCS Training

More information will be provided when the new "go-live date" is determined and training forums are rescheduled. Thank you for your understanding as well as your continued commitment to keep your communities and residents safe.

Click here to learn more.

Reference from PointClickCare: COVID-19 CMS Medicare Waivers

Posted by Admin Posted on Mar 20 2020

COVID-19 CMS Medicare Waivers

3/19/2020

Attention all Financial and Billing Staff

On March 13, 2020 the Centers for Medicare and Medicaid Services (CMS) issued a blanket waiver based on the declared public health emergency (PHE) COVID-19. This includes waivers for:
• 3 day qualifying hospital stay
• 60 day break in spell of illness. This extends an additional 100 day benefit period for residents who have recently exhausted Skilled Nursing benefits and must remain in a facility.

To view the full communication from CMS, click here.

PointClickCare is currently in communication with CMS to clarify billing and MDS requirements surrounding these waivers. To prepare for monthly billing, review the COVID-19 Waiver Billing Quick Reference Guide (QRG).

PointClickCare is currently working to bypass the UB Edit Check of missing occurrence span code 70 Qualifying Hospital Stay or the demonstration code if DR is on the claim. Continue to monitor the Home Page for more information.

Click here to view the COVID-19 Waiver Billing Quick Reference Guide (QRG) from PointClickCare.

If your SNF needs assistance with this setup, please contact our office.

SNF Coronavirus waiver

Posted by Admin Posted on Mar 16 2020

President Trump declared a national emergency on March 13, 2020. CMS issued Coronavirus 1812(f) waiver of the 3-Day Stay inpatient hospital requirement for Skilled Nursing Facilities (SNF). According to Administrator Verma’s press conference on March 13, 2020, the waiver takes effect retroactively to March 1, 2020. https://www.cms.gov/newsroom/press-releases/emergency-declaration-press-call-remarks-cms-administrator-seema-verma

FAQ link from CMS. https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/MedicareFFS-EmergencyQsAs1135Waiver.pdf

For billing under this waiver, the Disaster Related (DR) condition code should be used by SNFs (institutional providers). The DR condition code is used at the claim level when all of the services billed on the claim are related to the emergency/disaster. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c38.pdf

PLEASE NOTE THAT AN ADMITTING RESIDENT MUST MEET SKILLED CRITERIA IN CHAPTER 8 OF THE MEDICARE BENEFIT POLICY MANUAL. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c08pdf.pdf

COVID-19 MEMO

Posted by Admin Posted on Mar 16 2020

Hargis & Associates (H&A) places the health and safety of our clients, employees, and our health care community as our highest concern. As we continue to serve you, we are continuously monitoring the growing COVID-19 situation and those recommendations from World Health Organization (WHO) and the Center for Disease Control & Prevention (CDC). 

At the present time, H&A has not experienced any interruption to our services or hours. We are encouraging all clients and employees to practice safe measures regarding health including cleaning for disinfection, hand washing, stay home if you are sick, limiting exposure, etc. 

H&A is diligently reviewing all CMS and State guidance affecting health care coverage, billing and coding, and payment to our clients.

Please reference this CMS link for current guidance on these issues: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current- Emergencies/Current-Emergencies-page 

H&A recognizes the hardships you may be facing as a result of the COVID-19. We strive to continue to offer our services during these challenging times. If you find yourself needing assistance with billing or accounting functions due to staff shortages or the need to have all hands-on deck at your facility, please don’t hesitate to reach out to us for help. We are here to serve our elderly population every day and especially in times of crisis. 

H&A will provide updates regarding the above to our clients and health care community through numerous avenues including publications at our office, our website, social media, etc. For more information or assistance visit our website or call our office. 

Recurring Quarterly Submissions That SNFs Are Required to File

Posted by Admin Posted on Mar 06 2020

PBJ & Credit Balance Reports

Staffing Data Submission Payroll Based Journal (PBJ)

https://secure.emochila.com/swserve/siteAssets/site12840/images/HG_PBJ.png

 

Credit Balance Report (Form CMS-838)

A Medicare credit balance is an amount determined to b refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors. Each provider must submit a quarterly Credit Balance Report (Form CMS-838) If your facility has more than one provider number, a separate report should be submitted for each provider number. If you fail to submit a Credit Balance (CMS-838) form and/or certification page with all provider numbers identified, Medicare payments will be suspended as stated in 42 CFR 413.20(e) and 405.370. Providers with low Medicare utilization, as specified in the Provider Reimbursement Manual, CMS Pub. 15-1, Chapter 24 2414.4 B, or who file less than twenty-five Medicare claims per year, do not have to submit Form CMS 838. Providers that qualify should submit one, signed and dated certification page and a letter indicating that they are a low Medicare utilization provider. The following provides the reporting periods and associated due dates.

https://secure.emochila.com/swserve/siteAssets/site12840/images/HG_FormCMS838_1200x400.png

Has your facility received a letter from Alliant Health Solutions?

Posted by Admin Posted on Mar 06 2020

Quality Improvement Organizations (QIO)

Some nursing facilities have received a letter from Alliant Health Solutions and are questioning if Alliant is replacing KEPRO.  KEPRO is the CMS Beneficiary and Family Centered Care – Quality Improvement Organization (BFCC-QIO) for Kentucky. KEPRO assist Medicare patients in exercising their right to appeal discontinued Medicare benefits. KEPRO remains to be Kentucky’s BFCC-QIO.

Alliant is CMS Quality Innovation Network – Quality Improvement Organization (QIN-QIO). The QIN-QIO is responsible for working with health care providers and the community on data-driven projects to improve patient safety, reduce harm and improve clinical care at the local level.  

Click here for a reference to help providers to locate the BFCC-QIO and the QIN-QIO for each state. 

Blog by Sarah W. McIntosh, Director of Operations 

Don't Overlook Tax Credits & Incentives!

Posted by Admin Posted on Mar 04 2020

Build a Better Bottom Line with Our Tax Solutions

Our Services - Tax

Manage your tax department with the knowledge needed to efficiently and effectively build a better bottom line with our tax solutions. Reduce the risk of overlooking tax credits and incentives. Hargis & Associates works for your business to identify opportunities resulting in optimal tax savings. We do the work for you; saving you time and resources.

Our dedicated and experienced staff successfully works with your team and the IRS during any tax auditing process. Faithfully rely on us to provide value-added insight.  

Click here to learn more about our services.

Hot Topics

Posted by Admin Posted on Feb 26 2020

Hot Topics

A few Hot Topics in the news.

Publication of FY 2022 SNF Annual Payment Update (APU) Overview Table (Click here to read.)

CMS posts MDS 3.0 QM User’s Manual V13.0, Quality Measure Reporting Module Table V1.8 (Click here to read.)

2020 Physicians fee schedule has been revised (Click here to read.)

IRS Creates New, Large Print Tax Form for Seniors (Click here to read.)
 
New Inspector General named (Click here to read.)

MACs will bypass the edit that requires an occurrence code 50 AND update the edit that ensures the default HIPPS code (Click here to read.)

Publication of FY 2022 SNF Annual Payment Update (APU) Overview Table

Posted by Admin Posted on Feb 14 2020

Publication of FY 2022 SNF Annual Payment Update (APU) Overview Table

Article from Centers for Medicare & Medicaid Services (CMS)

CMS published the FY 2022 SNF Annual Payment Update (APU) table. This table indicates the data elements CMS will use for FY 2022 SNF QRP APU determinations. The SNF APU table is available in the document titled “FY-2022-SNF-QRP-APU-Table-for-Reporting-Assessment-Based-Measures-and-SPADEs-Finalized.pdf” in the Downloads section of the SNF Quality Reporting Program Measures and Technical Information webpage.

Click here to view the FY 2022 SNF Annual Payment Update (APU) table.

Posted by Admin Posted on Feb 13 2020

Coding for HIV/AIDS Patient

Posted by Admin Posted on Feb 13 2020

Coding for HIV/AIDS Patient

When billing Medicare A it is important to make sure you are checking your diagnosis when you have an HIV/AIDS patient. That diagnosis needs to be present on the claim in the first 9 diagnosis or you could miss that extra reimbursement. For example, a resident with HIPPS KAXD would be paid roughly $4500 for 9 days. With the AIDS NTA bump and Nursing addon, the reimbursement increases to $6,426.18.

Click here to view the Reference Medicare Claims Processing Manual (100-04), Chapter 6, Section 120.4.

Click here to view the CMS website, under Fact Sheet, PDPM Payments for SNF Patients with HIV/AIDS.

Unlike other healthcare tax accounting firms, Hargis & Associates, LLC has a widely respected reimbursement team. We are dedicated to being on the forefront of the ever-changing financial climate. We understand the need for billing, training and accounts receivables management facing nursing facilities; that is why we ease the process through our advanced, healthcare billing department. With our proven billing services in place, clients improve cash flow by reducing days in outstanding accounts receivables.

Our Billing Services Include:

• Medicare A & B Billing

• Medicaid Billing

• Medicare Replacement/Managed Care Billing

• Medicare A and B Co-Insurance Billing

• Hospice Billing

• Filing of Medicare Credit Balance Report

• Medicare Bad Debt Log for Cost Report

• Online Billing Analysis, Rebilling, and Collections

• Posting of Cash receipts, adjustments, etc.

• Posting of Ancillary charges

• Accounts Receivable Analysis

• Appeals

• On-Site Training

• Billing Assistance Program

 

Blog by Leah Shoulders, Billing Manager 

Updated Five-Star Ratings Released Today

Posted by Admin Posted on Feb 04 2020

Updated Five-Star Ratings Released Today

Article from LongTermCareLeader.com

NHC is usually updated the fourth Wednesday of every month, but the updates on the first month of the quarter (i.e. January, April, July, October) are more noteworthy. They include updated quality and staffing data. Other monthly updates only include updated survey data.

- Quality Measure Data for 2018-Q4 to 2019-Q3 (Oct’18 – Sep’19) Released

- Payroll-Based Journal (PBJ) Staffing Data for 2019-Q3 (Jul’19 – Sep’19) Released

- Table of Expected Nursing Home Compare Releases with Updated Quality and Staffing Data in 2020

- Expect This Newer Data on LTC Trend Tracker Within a Week

Click here to read this entire article.

Posted by Admin Posted on Feb 04 2020

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