Cost Report Blog

The combined effects of a 75% reduction to the Budget Neutrality Factor in FY 2010 and a estimated 2.1% hospital market basket update are estimated to decrease payment to hospices in FY 2010 by 1.1%.  

More information can be found here.

Medicare changed their system to ensure that episode sequence is enforced accurately under the Home Health Prospective Payment System (HH PPS).  Episodes are paid differently depending upon whether the episode is an early episode (the first or second episode in a sequence of related episodes) or a later episode (the third or later episode in such a sequence). 

Payments for episodes with 20 or more therapies are identical regardless of whether the episode is early or later but they were being processed incorrecly into the wrong payment group.  This transmittal documents the system changes to prevent these payment errors.

The revised Ambulatory Surgical Center Fee Schedule Fact Sheet (January 2009), which provides general information about the Ambulatory SurgicalCenter (ASC) Fee Schedule, ASC payments, and how ASC payment amounts are determined, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network.

Medicare may hold funds from court settlement judgments in excess of past Medicare payments made for the victim, until it determines how much needs to be recouped by Medicare.

Medicare OPPS payments for 2009 will be increased by a 3.6% inflationary adjustment. Outliers will be calculated for procedures whose cost exceed 175% of the APC payment . There is an $1800 loss threshold. Hospitals which did not participate in Medicare’s quality reporting initiative will have a 2% reduction in their payments.

For more information, please see the November 18, 2008 Federal Register Vol 73 No 223

CMS will send disclosure reports to several hundred hospitals to disclose their physician investments, to determine compliance with Stark regulations.

http://www.cms.hhs.gov/PhysicianSelfReferral/05b_Disclosure.asp

CMS has issued a press release stating that the OPPS payments will increase by 3.6% effective 1/1/09. Hospitals that did not participate in quality reporting will only receive a 1.6% inflationary increase.

The coinsurance for many of the OPPS services will also now reach the follow phase-in of 20% of Medicare’s fee schedule.

CCH (Sept. 30) Medicare and Medicaid Guide reports:
The Part B standard premium will remain unchanged at $96.40/month in 2009. Likewise, the Part B deductible will be unchanged at $135. The new hospital deductible will increase to $1068 , effective 1/1/09.

CCH reports in their August 19, 2008 Medicare and Medicaid Guide that IRF (Internal Rehab Facilities) are expected to receive 0.7% less reimbursement in Federal Fiscal Year 2009 (starting 10/1/08.)

CCH reports in their Medicare and Medicaid Guide of August 19, 2008 that the hospice wage index effective 10/1/08 will incorporate a 3.6% inflation adjustment.