2 Episode results for "Basler Jimmy"
IPPS 2021 Final Rule Summary [PODCAST]
"Welcome. To the hospital finance podcast, you're go to source for information and insights that can help you stay ahead of the challenges impacting healthcare finance, and now the host of the hospital finance podcast Michael Pass. Naughty. 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, twenty one. And you previously mentioned that Covid nineteen had an impact on factor two of the uncompensated care calculation. Were there any other areas of the final rule that stood out? As being impacted by covid nineteen. Will Mike, it is probable that it impacted the new technology add on payments as it pertains to qualify infectious disease products that qualified under an alternative pathway. It seems some antimicrobial drugs will receive conditional approval for pavement even if the product has not yet beget, then granted if the marketing authorisation. Thanks Jimmy that was a great summer summary of some of the key highlights. To read other highlights in the rest of our report, you can go to bessler DOT COM forward slash I. Twenty twenty one tax, the entire report Jimmy thanks for coming back to the PODCAST and talking to us about this year's. Final rule. This concludes today's episode of the hospital, Finance podcast for show notes and additional resources to help you protect and enhance revenue at your hospital visit. bessler. Dot Com forward slash podcasts. The hospital finance podcast is a production of bessler smart about revenue to nations about results.
2021 OPPS final rule summary [PODCAST]
"Welcome to the hospital finance. Podcast your go to source for information and insights. They can help you stay ahead of the challenges impacting healthcare finance and now the host of the hospital finance podcast. Michael pass naughty. Hi this mike. Not and welcome back to the award. Winning hospital finance podcast. The final rule for twenty twenty one has published and to review some highlights of that new rule. I'm joined by jimmy mendez. Who's a senior manager on our reimbursement team here at basler. Jimmy welcome back to the show. Thank you mike. It's good to be here. So jimmy we're going to go through just a few of the items that appeared in this role Let's start off. What can we expect. Regarding the ups payment rate and the asc payment rate increase will be two point. Four percent for the pbs pain. Rate based on this update. Cms estimates the total payments to keep ps providers for calendar year. Twenty twenty one will be approximately eighty four billion dollars which represents an increase of seven and a half billion from the previous year the statutory two percent reduction in payments for hospitals that failed to meet the hospital. Outpatient quality reporting requirements will continue now. Cms adopted policy to date the afc payments system using the hospital market basket. Update the afc payment rate. Update will also be two point. Four percent of the result for hospitals that meet applicable quality reporting requirements. Cms feels this will help to promote citing neutrality between hospitals and cheese and encourage the migration of services from the hospital setting to the lower cost asc setting total payments to afc's are projected to be five point four billion which is an increase of twenty million last year and jimmy every year. Seems like three forty be program is a hot button issue. Are there any changes regarding that program. This year well. My casinos section three forty of the public health service act allows participating hospitals and other providers to purchase certain covered outpatient drugs for manufacturers at discount prices in the previous years. Cms was paying the average sales price or asp minus twenty two and a half percent. The initially proposed to change that to asap minus twenty eight point seven percent but in the end they decided to keep it at esp minus twenty two and a half percent ems believes that maintaining the current payment policy is appropriate in order to maintain consistent and reliable payment during this public health. Emergency we are in the three forty be payment policy continues to exempt rural sole community hospitals children's hospitals and pbs exempt cancer hospitals. Who will continue to be paid at a p plus six percents hospitals have challenged. Cms in court. In efforts to reduce the payment reduction but have been unsuccessful. Okay and let's talk a little bit about the inpatient only list. Can you describe that forest and explain what the plans are for that. Sure the inpatient only lives is a series of seventeen hundred procedures for which medicare will only pay when performed in the hostile impatient setting however cms raised concerns that this list has restricted patient. Choice when it comes to surgery and recently proposed to phase out the list altogether the faith period will take three years and will commence on january first twenty twenty one beginning around three hundred primarily musculoskeletal related services. Okay and were there any notable changes regarding coverage of asc procedures. Well there used to be a theme of facilitating the shifting the procedures from an inpatient setting to an afc setting. This includes the addition of two hundred sixty seven surgical procedures to the covered procedures. Lists starting in on january. First twenty twenty one list of these can be found in table sixty on page eight hundred and fifty two of the twenty twenty one. Opiates final rule. Thanks jimmy and we've really just scratched the surface here. There are obviously a number of other aspects to the. Ps final rule and jimmy has just delivered a webinar With a lot more detail on it about the ups final rule you can find a recording of that webinar. At bessler dot com. Just head up to the insights button in the upper right hand corner. Click on the reimbursement button on the next page and you will see the webinar that jimmy delivered on this topic. Jimmy thanks so much for coming back to the podcast today. This concludes today's episode of the hospital. Finance podcast for show notes and additional resources to help you protect and enhance revenue at your hospital. Visit bessler dot com forward slash podcasts. The hospital finance podcast is a production of bessler smart about revenue to nations about results.