A Bimonthly Publication
August 3, 2010
- DSHS Begins DSH Audit Process
- CMS Mandatory Quality Data Reporting Deadline - August 15
- Federal HRSA Begins Enrollment of Newly Eligible Hospitals in 340B Program, Recorded Webinar Available
- DSHS Considers Changes to the ProviderOne Remittance Advice
- CMS Releases Final IPPS Rule/No Relief From Coding Offset
DSHS Begins DSH Audit Process
On July 21, The Washington Department of Social and Health Services (DSHS) and its contracted audit firm, Clifton Gunderson LLP, began the federally mandated audit of Medicaid Disproportionate Share Hospital (DSH) payments for state plan years 2007 and 2008. Information request lists and Excel templates were sent to each hospital with a due date of August 18, 2010.
On August 2, WSHA hosted a webinar where Clifton Gunderson and DSHS staff discussed the findings from last year’s audit of DSH payments for 2005 and 2006 and the process for the current audit of state plan years 2007 and 2008. Links to a recording of the webinar will be sent to webinar participants and can be requested by hospital staff on our WSHA webcast web page. (andrewb@wsha.org)
CMS Mandatory Quality Data Reporting Deadline - August 15
Hospitals participating in the pay-for-reporting program under Medicare's inpatient prospective payment system must indicate whether they participate in systematic databases for cardiac surgery, stroke or nursing-sensitive care, and acknowledge the accuracy and completeness of their quality data in order to receive their full annual payment update for fiscal year 2011. Hospitals must submit this information by August 15 to receive their full payment update. Hospitals that fail to report will have 2 percent reduced from their update factor. Hospitals that do not perform cardiac surgeries must indicate that in their data submission. Also, hospitals must attest to the accuracy and completeness of the data they submit for the pay-for-reporting program.
As of July 27, more than one-third of hospitals nationally had not completed the reporting of their participation in the systematic databases and attested to the accuracy of the data. We urge you to have staff complete the reporting as soon as possible if you have not already done so. (andrewb@wsha.org)
Federal HRSA Begins Enrollment of Newly Eligible Hospitals in 340B Program, Recorded Webinar Available
The federal Health Resources and Services Administration (HRSA) will begin accepting applications the first week of August from critical access hospitals, sole community hospitals and other entities newly eligible to participate in the 340B discount program for outpatient drugs. The Patient Protection and Affordable Care Act (PPACA) extends the program to critical access and sole community hospitals, rural referral centers, and certain children's and cancer hospitals. The 340B program allows eligible facilities to purchase drugs at heavily discounted rates. HRSA held a webinar on July 28, providing information on enrollment timelines, forms, and procedures. Interested parties can view a recording of the webinar. Hospitals and providers can also sign up to receive e-mail updates on the PPACA’s 340B provisions. (andrewb@wsha.org)
DSHS Considers Changes to the ProviderOne Remittance Advice
The Department of Social and Health Services (DSHS) is considering improvements to the ProviderOne remittance advice (RA) used by many hospitals and providers for posting of Medicaid claims payment. The RA generated through the new ProviderOne system lacks the format and much of the information that had been provided through the legacy MMIS system. DSHS has provided a summary of the current status and changes that are being considered. To access this information, please click here and then select "Remittance Advice (RA) Reports Update Proposed Changes (08-02-2010)."
WSHA and its ProviderOne Task Force comprised of representatives of member hospitals continues to meet with the DSHS provider on a monthly basis to discuss continuing implementation issues. (andrewb@wsha.org)
CMS Releases Final IPPS Rule/No Relief From Coding Offset
On July 30, 2010, the Centers for Medicare and Medicaid Services (CMS) released its 2011 Medicare Inpatient Prospective Payment System (IPPS) final rule. In about a week, WSHA’s Health Information Program will publish a more detailed review of this rule as well as hospital-specific impact reports. Some of the important provisions adopted are:
Recoupment, over a two year period, for the IPPS 2008 and 2009 coding offset. This was adopted despite strong opposition by the Washington State Hospital Association and others in the hospital field. The 2011 adjustment more than offsets the market basket update, causing a decrease in overall IPPS payments from 2010 to 2011.
Four new quality measures. These were added to the pay-for-reporting program, and one measure was retired.
Changes to the outlier threshold. This was decreased 0.3 percent from $23,140 in 2010 to $23,075 in 2011.
Modifications in the three-day payment window. CMS clarified the Medicare payment policy regarding how hospitals may bill for outpatient non-diagnostic services related to an inpatient admission (other than ambulance and maintenance renal dialysis services) provided during the three days (72 hours) prior to admission. Effective for services furnished on or after June 25, 2010, such services must be bundled for payment. Outpatient non-diagnostic services unrelated to the inpatient stay should be billed separately under Medicare Part B; hospitals will be required to attest to the fact that services were unrelated. The law does not change the billing of diagnostic services during this period.
More details will be included in a Health Information Program bulletin and hospital-specific reports that will be mailed to hospital Chief Financial Officers next week. The bulletin will also be available upon request or on the WSHA website for others who are interested. (jimc@wsha.org)