We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services.
Hospitals Continue to Drop Medicare Advantage Plans
This hospital revenue cycle article in Becker’s Hospital Review includes results of a survey of 135 health system CFOs. It lists some of the health systems that plan on dropping Medicare Advantage contracts in 2024 and reports statistics around those that are considering dropping the plan as well as those who find collection from these plans difficult [1].
CMS Guidance on Federal Medicaid Renewal Requirements Released
This informational bulletin released by CMS covers federal renewal requirements and flexibilities intended to promote continuity of coverage for anyone eligible for home- and community-based services (HCBS) offered through Medicaid. The program is fundamental to long-term services and supports (LTSS) and supports enrollees remaining in their homes and communities rather than relying on an institution and should be on the radar of anyone in charge of home health billing [2].
Change Request on The Recovery and Adjustment of Medicare Claims-Department of VA
Under transmittal 12800, CMS released a change request that includes the recovery of duplicate payments. This pertains to situations where both the Department of Veteran Affairs and Medicare have made payment for the same services. The request updates the current Medicare Secondary Payer duplicate payment process [3].
CMS Updating IPF PPS
CMS has announced its medical billing and coding updates to the IPF PPS. It is adjusting rates by 2.8% in line with the 2021-based IPF market basket increase of 3.3%, with a reduction of 0.5% point productivity. CMS is also adjusting the outlier threshold, keeping estimated outlier payments at 2.0% of total payments [4].
New Revisions to Medicare Part B Pneumococcal Vaccination Coverage
CMS has revised Medicare Part B coverage of pneumococcal vaccinations to move into alignment with the Advisory Committee on Immunization Practices (ACIP) recommendation for coverage. This change was effective June 27, 2024 and goes into effect November 25, 2024 [5].
Final Rule for the IPPS and LTCH PPS
CMS released final rule updates for Medicare fee-for-service hospital billing policies and payment rates for inpatient hospitals and long-term care hospitals. The publication meets legal requirements for updating policies for these hospitals annually [6].
HHS Reports That Medicare Improperly Paid Hospitals
The OIG released a report that Medicare payments to hospitals with specific MS-DRG hospital coding for mechanical ventilation might be improperly paid. The OIG estimates that $79.4 million has been improperly paid to hospitals over the audit period [7].
Medicare Claims Processing Manual Chapter 1 Updates Released
Under transmittal 12789, CMS released new payer codes for Chapter 1 of the Medicare Claims Processing Manual. The updates include condition codes, modifiers, and value codes and are effective September 16, 2024 [8].
Home Health Billing Grouper Quarterly Update
CMS has released a change request for the January 2025 update to the home health grouper software. The home health billing update notification applies to chapter 10, section 80 and goes into effect January 1, 2025 [9].
General Update to Provider Enrollment Instructions
CMS has released clarification around a set of Medicare provider enrollment policies. These policies cover topics including various certified provider types and model letters. The change goes into effect September 16, 2024 [10].
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References
[1] J. Emerson, “21 health systems dropping Medicare Advantage plans | 2024,” Becker’s Healthcare, 30 August 2024. Available: https://www.beckershospitalreview.com/finance/15-health-systems-dropping-medicare-advantage-plans-2024.html.
[2] CMS, “Ensuring Continuity of Coverage for Individuals Receiving Home and Community-Based Services (HCBS),” 19 August 2024. Available: https://www.medicaid.gov/federal-policy-guidance/downloads/cib08192024.pdf.
[3] CMS, “CMS Transmittal 12800 Change Request 13694,” 19 August 2024. Available: https://www.cms.gov/files/document/r12800msp.pdf.
[4] CMS, “Fiscal Year 2025 Medicare Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) and Quality Reporting (IPFQR) Updates Final Rule (CMS-1806-F),” 30 July 2024. Available: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-medicare-inpatient-psychiatric-facilities-prospective-payment-system-ipf-pps-and-0.
[5] CMS, “CMS Transmittal 12801 Change Request 13750,” 21 August 2024. Available: https://www.cms.gov/files/document/r12801bp.pdf.
[6] CMS, “FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule –- CMS-1808-F,” 1 August 2024. Available: https://www.cms.gov/newsroom/fact-sheets/fy-2025-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0.
[7] OIG, “Medicare Improperly Paid Hospitals An Estimated $79 Million For Enrollees Who Had Received Mechanical Ventilation,” August 2024. [Online]. Available: https://oig.hhs.gov/documents/audit/9957/A-09-22-03002.pdf.
[8] CMS, “CMS Transmittal 12789 Change Request 13736,” 15 August 2024. [Online]. Available: https://www.cms.gov/files/document/r12789cp.pdf.
[9] CMS, “CMS Transmittal 12793 Change Request 13730,” 15 August 2024. [Online]. Available: https://www.cms.gov/files/document/r12793cp.pdf.
[10] CMS, “CMS Transmitta 12796 Change Request 13725,” 15 August 2024. [Online]. Available: https://www.cms.gov/files/document/r12796pi.pdf.
