Jimmy Mendez, Medicare, Twenty Twenty discussed on The Hospital Finance Podcast
I this is my best day and welcome back to the award-winning hospital finance podcast. As we do every year bessler releases a summary of the final rule and to give us some highlights of this year's rule. I'm joined by Jimmy Mendez, who is a senior manager on our reimbursement services team here at Basler Jimmy Welcome back to the show. Here. Jimmy the release of the PS final rule for twenty twenty one was delayed several weeks due to covert nineteen this year. What were some of the most anticipated pieces of information? Well as usual, some of the key areas are the mass market basket rate, increase the uncompensated care figures, and of course, a wage index related information. Now you bad. So let's walk through those what happened to the market basket rate. The market basket rate increase will be two point four percent for fiscal year two, thousand, twenty, one. This will be the updated providers that submit quality data and our meaningful E. H. R. Users. This figure is reduced by point six percent it quality data is not submitted and reduced an additional one point eight percent if the provider is not a meaningful E. H. R. User. Jimmy what did the figures for? CARE look like. The bow to be distributed in uncompensated care for F.. Y. Twenty twenty one is eight, point, two nine. This is just slightly down from the eight point, three, five, billion distributed in F-, wide, twenty twenty. However, the proposed at twenty twenty, one amount had been seven, point, eight, one, seven, billion. Factor. To the calculation is the uninsured estimate provided by CMS, his office of the actuary that estimate was sixty seven point eighty, six percent in the proposed final, but it was adjusted to seventy seventy, two, point eighty, six percent in the final rule, the updated figured takes into consideration the effects of covid nineteen, and of course, this contributed to the amount in the final rule being eight, point, two, nine billion and that being higher than what was proposed initially. For factor three B uncompensated care calculation cms will use line thirty from the two thousand seventeen cost report as two thousand seventeen is the most recently available single year with audited S. ten data. For future years, CMS will. To use the most recent available single year audited as and that. Were there any interesting developments for wage index? Well. There was some movement in the designations of numerous counties. There are thirty four counties designated as urban that will now be rural forty seven counties that were previously rural that will now be urban and nineteen counties will move to another CBS say or to a new or modified CBS eight. But one was keep in mind that there is a five percent cap on any decrease in a hospitals wage index from the hospitals final wage index in fiscal year twenty twenty. In addition approximately two, hundred, eighty, five hospitals will benefit from the rural floor rule being applied. These are urban area hospitals of the State whose wage index is below the area wage into applicable to hospitals located in rural areas of that state. Wage, index will be set at the rural area level. So, when you think about the whole roll Jimmy, what are some areas of concern? Well an important one relates to Medicare. Bad debts. Forty to see a far or one three, eighty nine discloses the requirements for Medicare bad debt as does the provider Reimbursement manual or PRM chapter three the Pr Am is more detail and is what hospitals are accustomed to comply with based on its application by the respective. Max The purpose of the final rule appears to code by the PRN chapter three requirements, most of which will apply retroactively. There are a couple of requirements that I wished to essentially. One pertains to the process of determining that a non dual eligible beneficiary is indigent and thus exempt from the reasonable collection effort requirements. The rule stipulates the provider must not use a beneficiaries declaration of their inability to pay their medical bills or deductibles incur insurance as sole proof indigenes for medical kits. The provider must take into account the analysis, the both of beneficiary facets, only those convertible to cash, and then necessary for the beneficiaries daily living and income. and must determine that no source of the beneficiary would be legally responsible for the beneficiaries medical bill such as the legal. Guardian or State Medicaid Program. Another pertains to how bad debts reported on the financial statements for cost reporting periods beginning on or after October first twenty twenty Medicare, at the that's. Not Be written off to contractual allowance account, but must be charged to an uncollectible receivables account the results in a reduction in revenue. Were there. Any other issues that caught tension? Well. Mike There are twelve new MSTAR jeez including MS DART eighteen kyw merrick Antigen Receptor T. cell immunotherapy. which has the biggest the RG weight of thirty seven point thirty, three surpassing the DR weight of Ms. A zero one heart transplant. Two of the new embassy are Jeez. Five Twenty One and five, twenty, two relate to hip replacement and are subject to the post acute transfer policy. Other items of note, include the back that stem cell acquisition costs will be reimbursed on a reasonable cost basis effective precaut- reporting periods beginning on or after ten, one, hundred, twenty. Hospitals are not required to be Medicare certified transplant centers like solid organ transplant centers are required to be the determination of Medicare share of the stem cell acquisition costs will be somewhat different than that. Employ solid organs that the mechanics of how it will work or not entirely clear yet. Also a new requirement relates to market based Ms. The RG data collection and change in methodology for calculating the relative rates. Hospitals will be required to report on their Medicare caution for the median pair specific negotiated. At the hospital has the dossier with all of its Medicare advantage organization pairs by DAS BY MS. For cost reporting periods ending on or after January. First Twenty,.