My Blog Has Moved

My blog has moved to a new location and will now be supported by the WordPress engine. The new address is http://peteharmon.hfssoft.net/. This blog will remain through March 22, 2010 and will then be deleted.

SNF (2540-96) Transmittal 17

CMS recently issued a new Transmittal 17 for the SNF, 2540-96. T.17 is effective for FY Begin 10/1/2009 and after (i.e. must use T.17, our version 17). W/S S-2 line 20 was revised to REQUIRE an answer, F for a Full report; L for a Low Medicare Utilization report; and N for a No Medicare Utilization report. W/S S-5, lines 10 and 11 are now N/A, effective for FYE 5/31/2009 and after, due to HIPPA data sensitivity. W/S S-4 part III, columns 5 and 6 (SCIC visits), is N/A effective for services on or after 1/1/2006. Similarly, W/S H-6, lines 8.05, 8.06, 8.09, and 8.10, are N/A for SCIC payments. W/S I-4 was revised for the H1N1 vaccine changes. Effective for services on or after 9/1/2009, new columns 2.01 and 2.02 were added for H1N1 Only, and Influenza and H1N1 combined, respectively. W/S E part III, line 10.04 is a NEW line added for Dual Eligible Bad debt Recoveries.

RHC/FQHC Draft Transmittal 8

CMS issued a Draft Transmittal 8, for the RHC/FQHC (222-92 forms). This is effective for FYE on or after 10/1/2009 (i.e. must be used for these FYE). T.8 changes W/S B part I, line 1 instructions to emphasize that physician data (FTEs and Visits), for services furnished to facility patients by staff physicians working under a contractual agreement with an RHC on a regular ongoing basis in the RHC/FQHC facility, are placed on line 1, and are subject to productivity standards in accordance with 42 CFR 491.8. T.8 also modified W/S C part II, line 15 calculation to phase out the Outpatient Mental Health Treatment Limit of 62.5%, over 5 years. The Limit remains 62.5% for services through 12/31/2009. For services 1/1/2010 to 12/31/2011, the Limit is 68.75%. For services 1/1/2012 to 12/31/2012, the Limit is 75%. For services 1/1/2013 to 12/31/2013, the Limit is 81.25%. For services on or after 1/1/2014, the Limit is zero, or 100% reimbursement is computed. T.8 also modified W/S B-1 for the H1N1 vaccine costs. Effective for services on or after 9/1/2009, columns 2.01 and 2.02 were added to calculate the costs of H1N1. Medical Supply cost, Total Injections, and Medicare Injections must be identified (split), between Pneumococcal, Seasonal Influenza, H1N1 Only, and H1N1 and Influenza combined. Once T.8 Draft is finalized, we will have to process a CMS Test Case and get a new approval for our software.

HHA Transmittal 14

CMS issued a new Transmittal 14 for the HHA (1728-94 Forms). It is effective for FYE on or after 10/1/2009 (i.e. must use T.14 for these FYE). T.14 implements the RHC/FQHC phase out of the Outpatient Mental Health Limit of 62.5%, over 5 years. W/S RF-3, line 14 calculation will remain 62.5% for services through 12/31/2009. For services 1/1/2010 to 12/31/2011, the Limit is 68.75%. For services 1/1/2012 to 12/31/2012, the Limit is 75%. For services 1/1/2013 to 12/31/2013, the Limit is 81.25%. For services on or after 1/1/2014, the Limit is zero, or 100% reimbursement is computed. T.14 also implements the H1N1 vaccine changes, effective for services on or after 9/1/2009. W/S RF-4 has added columns 2.01 and 2.02 to capture data and calculate the costs of H1N1 and Influenza vaccines. Medical Supply cost, Total Injections, and Medicare Injections must be split (identified) between Pneumococcal, Seasonal Influenza, H1N1 Only, and Influenza and H1N1 combined. T.14 codified the change to eliminate W/S S-3 part IV, columns 5 and 6, for SCIC. These columns are no longer used effective for services on or after 1/1/2008. T.14 also added the FI/MAC "name" to S-2 line 29.02, column 3. We have a table in our W/S S-2 HELP, with all the names. We are awaiting the CMS Test Case and beginning of the approval process for T.14.

Hospital Transmittal 21

Transmittal 21 is effective for FYE on or after 10/1/2009 (i.e. must use T.21 for FYE 10/1/2009 and after), except for the H1N1 Vaccine changes which are effective for services on or after 9/1/2009. T.21 added three new ancillary cost centers, Cardiac Rehab, Hyperbaric Oxygen Therapy, and Lithotripsy. These will be available from our "pick list" of cost centers. W/S S-2, line 30.03 for CAH ambulance reimbursed at "cost", is N/A for FY Begin 10/1/2009 and after. If the CAH has ambulance services exempt from the Fee Schedule (PS&R Report 85C), then these charges are input on W/S D part V, line 65, column 5, just like any other ancillary charge. W/S S-3 part I, line 26, columns 5.01, 5.02, 6.01, and 6.02, for Observation Bed Days, are N/A for FY Begin 10/1/2009 and after. No more "admitted" and not admitted split. Total observation bed days will now be subtracted in the calculation of E part A, line 3 (bed days available). W/S E part A and L part I, line 4.01 or 5.01, are revised to INCLUDE in Total days, the Labor and Delivery Days from the NEW line 29 of S-3 part I. This is effective for FY Begin 10/1/2009 and after. W/S S-2 line 21.01, column 2 was added for Pickle providers ("Y" indicates Pickle for operating DSH). If Pickle, then the allowable DSH percentage is automatically 35%, on E part A line 4.03. W/S E-3 part I, lines 1.02, 1.04, 1.41, and 1.42 must be subscripted for column 1.01, if the FY overlaps 10/1/2009, as the LIP "factor" changed from 0.6229 to 0.4613. You only need to split payments on line 1.02 as we calculate the rest. W/S M-3 line 14 calculation is phasing out the "limit", over 5 years. For services through 12/31/2009 the 62.5% limitation remains. For services 1/1/2010 to 12/31/2011, the limit is 68.75%. For services 1/1/2012 to 12/31/2012 the limit is 75%. For services 1/1/2013 to 12/31/2013 the limit is 81.25%. For services on or after 1/1/2014, the limit is zero, or 100% reimbursement. W/S M-4 added columns 2.01 and 2.02 for the H1N1 vaccine. Medical Supply cost, Total injections, and Medicare injections must be split between Pneumococcal, Influenza, H1N1 Only, and Influenza and H1N1 combined.

Final Transmittal 20

I need to correct my earlier post about T.20. I previously indicated the new line 55.30 for Implantable Devices, is effective for FY Begin 5/1/2009 and after, but could be used now. This is incorrect. CMS clarified that line 55.30 may be used for FY Begin 5/1/2009 and after, but NOT before. This line will be required in the new 2552-10, as line 69 in the Draft.

Final Hospital Transmittal 20

HFS received CMS approval for T.20 on 9/17/2009. This will be our Version 20.0.118.0. One major change from the Draft, is that Capital IME is still reimbursed through 9/30/2010. The T.20 instructional changes for W/S L part I, were rescinded. Transmittal 20 is effective for FY Begin 5/1/2009 and after, but has varying effective dates for some of the changes. TOPS was extended through 12/31/2009, so the "extension" is effective 1/1/2009 and after, and now includes Small, SCH; as well as Small Rural Hospitals. W/S S-8 lines 9 and 10 are now N/A due to HIPPA info, and is effective for 5/1/2009 FY Begin and after. New line 55.30 on W/S A, for Implantable Devices, is effective for 5/1/2009 FY Begin and after, but may be used by providers now, if they choose. The new ESRD changes for lines 5.xx on E part A, column 1.01, are effective for Services on or after 1/1/2009. The E part A line 7 instructional changes to allow the use of 2006 data, is effective for 1/1/2009 FY Begin and after. The E-3 part VI, line 6 and 7 instruction chnages have no effective date, so they are retroactive back to 9/30/1996 FYE and after.

MAC J-7 Protest

No sooner was J-7 (Arkansas, Louisiana, Mississippi) awarded to Trailblazer Health - July 10, 2009, than it was protested (by Pinnacle, I think) - July 21, 2009. Thus, CMS issued a "stop order" for Trailblazer to cease any work on J-7 until the protest is resolved. As they say on the evening news, "more to come"!