Transcript MEDICARE WAGE INDEX - HFMA Western Michigan

MHA Update
Western Michigan HFMA
March 20, 2013
Vickie R. Kunz
Senior Director
Health Finance
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Payer Issues
• Hospitals are reminded that a role of the
MHA is to assist you in resolving payer
issues.
• We can’t resolve what we don’t know to
be an issue so please keep us
informed.
• Contact Marilyn Litka-Klein or Vickie
Kunz at the MHA regarding various
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payer issues.
MHA Contact Info
• Marilyn Litka-Klein, Vice President,
Health Finance
– Phone: (517) 703-8603
– Email: [email protected]
• Vickie Kunz, Senior Director, Health
Finance
– Phone: (517) 703-8608
– Email: [email protected]
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Recent “Fiscal Cliff “ Bill
• American Taxpayer Relief Act of 2012
included several significant Medicare
payment cuts for hospitals in
conjunction with averting the 27 percent
cut to Medicare physician payments and
delaying the 2% sequester from Jan.1
until March 1, 2013.
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Medicare Cuts
• IPPS coding adjustment reductions totaling at
least 9.7% over a 4-year period, FY 2014 -17.
• Projected to reduce IPPS payments to Michigan
hospitals by $106 million in FY 2014 and $437
million over the 4-year period.
• Takes effect Oct. 1, 2013.
• Hospital specific analysis distributed Jan. 10.
– CEOs/CFOs/Directors of Reimbursement
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2% Sequester
• CMS e-News issued March 8.
• Medicare fee-for-service claims with dates of service
or dates of discharge on or after April 1 will be
subject to a 2% reduction in Medicare payment.
– $72 million cut for April 1 – Sept. 30, 2013.
– 10-Year Impact: $1.4 billion.
• The payment adjustment will be applied to all claims
after determining coinsurance, any applicable
Medicare secondary payment adjustments.
• Impacts IPPS, OPPS, Rehab, Psych, HHA, LTCH,
GME, and CAH payments.
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Low Volume Adjustment
• Extended the LVA through FY 2013.
• Hospitals must submit request to their
MAC/FI by March 22, in order for LV
payment adjustment to be retro to
Oct. 1, 2012.
• See MHA email notification to impacted
hospitals March 5.
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Medicare Dependent Hospital
• Extended the Medicare Dependent
Hospital program until Oct. 1, 2013.
– Expected to increase FY 2013 Medicare
FFS payments to Michigan hospitals by
$1.2 million.
– Retro to Oct. 1, 2012.
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Group Appeals
• Rural Floor Budget Neutrality
• Various DSH/SSI Issues
• Pension Costs – Wage Index
Calculations
• MHA recently coordinated sessions with
DataGen and Baker Healthcare
Consulting to provide additional info.
• Contact Vickie to obtain more info.
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FY 2014 Wage Index
• April 10 – Deadline for FIs/MACs to
transmit final revised wage index data to
CMS for inclusion in final wage index.
• April 17 – Deadline for hospitals to
appeal FI/MAC determinations and
request CMS intervention in cases of
disagreement.
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Outpatient Therapy Services
• 2013 collection of claims-based data on
patient functional status over an
episode of PT, OT and SLP services.
• All therapists will be required to report
new G-codes and modifiers on the claim
form:
– initial evaluation, every 10 visits and at
discharge.
– CMS will adopt testing period thru June 30.11
RAC Update
• See March 4 MHA Monday Report article and
registration info for March 26 AHA RacTrac webinar.
– Contact RacTrac Help Desk at (888)722-8712 if needed.
• Webinar will provide an update on the CMS guidance
regarding claims determinations by Administrative
Law Judges.
• AHA is pursuing clarification from CMS regarding the
ALJs making timely and efficient determinations for
payment rather than sending cases back to the
Qualified Independent Contractors (QICs).
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Revised Billing Policy – Denied Claims
• CMS released two rules proposing to revise
its position on rebilling for Medicare inpatient
claims denied by Medicare contractors,
including RACs.
• “Administrator’s Ruling” makes an immediate
change for medically necessary services
where the RAC has determined the services
were reasonable and necessary but the site
of care should have been outpatient rather
than inpatient.
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Cont., Rebilling for Denied Claims
• Hospitals limited to 1-year timeframe for
rebilling.
• Since RAC audits can review claims
during the previous three years,
hospitals would be prevented from
rebilling claims for two of the three
years.
• AHA will continue its litigation.
• See March 18 MHA Monday Report. 14
Revised Readmission Adjustment Factors
• Beginning in FY 2013, Medicare FFS inpatient
payments are adjusted based on hospital
performance on Medicare readmissions for heart
attack, heart failure and pneumonia.
• CMS issued initial factors as part of FY 2013 IPPS
final rule with revised factors released in October.
• More revised factors released in March.
• Factors revised for approximately 40 Michigan
hospitals.
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Medicare Advantage Plans
• As of Jan 2013, 30 plans in Michigan, with 515,000 or approximately
30% of Michigan’s 1.7 million Medicare beneficiaries enrolled.
– MA enrollment up by 60,000 since Oct. 2012.
– Up to 20 plans in some counties.
• Review MA payment rate for all plans.
• CAH entitled to Medicare cost reimbursement.
• Each MA plan may determine own utilization model and is not
required to maintain electronic transactions.
• Many MA have instituted “RAC-like” utilization programs.
• Matrix of MA plans by county available at MHA website – updated
quarterly, with MHA Monday Report article.
– See Jan. 28 MHA Monday Report for latest info
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Medicaid Issues
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Reimbursement Reform Initiative
• March 6 MSA correspondence to hospitals
formally announcing that they will begin a
formal project to review and redesign the
Medicaid payment system.
• March 7 - invitations sent to technical
workgroup.
– Target is to hold first meeting by March 29, with
future meetings twice per month.
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Cont., Medicaid Reform
• MSA guiding principles:
– More predictability
– Less volatility
– Efficiency
– Cost Effectiveness
– Simplicity
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Examine Reimbursement for These Areas
• Statewide DRG Rate with Appropriate
Adjustments
• Outlier Reimbursement
• Inpatient Capital
• Outpatient Prospective Payment
System
• Pool Payments
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MSA Timeline
• March – May
• April – June
• May – June
• June
Technical workgroup
MSA staff modeling.
Technical workgroup
recommendations to
steering committee.
MSA staff completes
software/systems
request changes and
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draft SPAs.
Cont., MSA Timeline
• July – Dec.
• Aug. – Dec.
• Jan. 1, 2014
MSA promulgates
policy and completes
final calculations.
CMS approvals
MSA begins phased
implementation.
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Medicaid Expansion
• ACA allows states to voluntarily expand
Medicaid to uninsured adults.
• Gov. Snyder proposes to expand
Medicaid to cover individuals up to
138% of federal poverty level effective
Jan. 1, 2014.
• State legislature must appropriate the
federal funds when omnibus budget
appropriation is passed later this spring.23
Cont., Medicaid Expansion
• Expected to cover about 450,000 low-income
adults who are currently uninsured but fail to
meet current eligibility requirements.
• Who would qualify?
– Individuals that are at least 19 years old.
– Those that are single, working with annual
earnings up to $15,856 or in a family of
four with earnings up to $32,499.
• Based on 138% of 2013 FPL
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MHA Expansion Resources
• MHA supports expansion and urges
member hospitals to use resources to
educate legislators, members of the
community, etc.
– Saves Money, Saves Lives
• Many tools available at:
www.expandmedicaid.com.
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Health Insurance Exchange
• Letter recently submitted to state Senate
urging lawmakers to support appropriating
the $30 million federal grant funding available
to establish a federal-state health insurance
exchange.
• Letter submitted on behalf of the business
community and collectively represents more
than 100,000 employers across Michigan.
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FY 2010 DSH Audits
• Hospitals should sign and submit an
FTP form to Myers and Stauffer if they
haven’t already done so.
• Hospital surveys expected to be
available March 29, with hospitals to
have until April 30, to complete and
submit to Myers and Stauffer.
• Preliminary report due to MSA Sept. 30.
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• Final report due to CMS Dec. 31.
Continued, DSH Audits
• FY 2009 DSH audit results indicate that
27 hospitals would have had payment
recoveries totaling $111 million.
• DSH payment recoveries begin with FY
2011 DSH audit, expected to occur a
year from now.
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FY 2014 Hospital Tax Base
• Hospitals are encouraged to review
their FY 2012 filed cost reports and
submit an amended report if needed.
– FYEs Oct. 1, 2011 – Sept. 30, 2012
• Are bad debts reported as a reduction
to net patient revenues or an operating
expense?
• See MHA Advisory Bulletin # 1340
included in March 11 Weekly Mailing. 29
Health Care Advocacy Day
• 8 a.m. to 1 p.m. on April 17 in Lansing.
• MHA
• Michigan Association of Healthcare
Advocates
• Michigan Healthcare Volunteer
Resource Professionals
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BCBSM Mutualization
• As reported in the March 11 MHA Monday Report,
the state Senate unanimously approved SBs 61 and
62 which would allow BCBSM to become a nonprofit
mutual disability insurer.
• These bills bring regulatory reform and set up a
health and wellness fund to which BCBSM will
contribute $1.6 billion over 18 years.
• Legislation is necessary to help BCBSM transition as
the ACA is implemented.
• Gov. Snyder is expected to sign these bills into law.
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BCBSM Fee Screens
• Certain outpatient services currently paid as a
percentage of charges will be converted to
fee-based payments effective Oct. 1, in
accordance with the BCBSM PHA.
• Change affects emergency, observation, treat
room, dialysis, general therapeutic, diabetes
education, cardiac rehab, pulmonary rehab,
clinic, urgent care, ambulance.
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Cont., BCBSM Fee Screens
• Fee screen payments available on
Web-DENIS by HCPCS.
• BSBSM intends to implement the
change in a budget-neutral manner for
first year of implementation.
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Days in A/R
• Based on 33 hospitals participating in
MHA Monthly Financial Survey (MFS)
• Jan – Dec 2012 versus 2011
•
•
•
•
Medicare – down from 31 to 30 days
Medicaid - down from 45 to 40 days
BCBSM – down from 35 to 31 days
Overall – down fro 46 to 45 days
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Michigan and National
Patient Margin (2002-2011)
0.0%
-0.2%
-0.3%
-0.5%
-1.0%
-1.1%
-1.5%
-1.4%
-1.5%
-1.6%
-1.8%
-2.0%
-2.0%
-2.1%
-2.3%
-2.3%
-2.5%
-1.6%
-1.7%
-2.6%
-3.0%
-2.6% -2.6%
-2.8%
-2.8%
-3.0%
-3.2%
-3.5%
2002
2003
2004
2005
2006
Michigan
2007
2008
National
2009
2010
2011
Michigan and National
Operating Margin (2002-2011)
6.0%
5.5%
5.5%
5.0%
4.4%
4.3%
4.0%
4.0%
3.7%
3.7%
3.6%
3.4%
3.3%
3.3%
3.3%
3.0%
2.8%
2.8%
3.0%
2.4%
2.0%
1.9%
1.6%
1.9%
1.7%
1.0%
0.0%
2002
2003
2004
2005
2006
Michigan
2007
2008
National
2009
2010
2011
Michigan and National
Total Margin (2002-2011)
8%
7.2%
7.2%
7.0%
6.9%
7%
6.0%
6%
4.8%
5%
4.9%
5.2%
5.2%
5.5%
5.3%
5.0%
4.9%
4.9%
4.4%
4%
3%
2.6%
2.4%
2%
1.8%
0.8%
1%
0%
-0.3%
-1%
2002
2003
2004
2005
2006
Michigan
2007
2008
National
2009
2010
2011
Michigan Cost per Equivalent Admission,
Relative to Great Lakes and National Averages (2002-2011)
0%
-1%
-1.5%
-1.7%
-2%
-2.3%
-3%
-2.5%
-2.9%
-3.0%
-3.1%
-3.4%
-4%
-3.7%
-4.1%
-4.3%
-5%
-4.3%
-4.8%
-4.6%
-5.0%
-5.5%
-6%
-6.3%
-6.3%
-5.6%
-6.1%
-7%
2002
2003
2004
2005
2006
GL
2007
2008
2009
2010
2011
US
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Michigan Gross Charge per Equivalent Admission,
Relative to Great Lakes and National Averages (2002-2011)
0%
-5%
-6.0%
-10%
-8.8%
-9.7%
-10.6%
-10.7%
-15%
-13.3%
-14.7%
-14.0%
-16.5%
-16.5%
-17.7%
-20%
-17.8%
-18.8%
-19.4%
-20.1%
-19.2%
-21.0%
-21.0%
-23.4%
-25%
-24.3%
-30%
2002
2003
2004
2005
2006
GL
2007
2008
2009
2010
2011
US
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Michigan Net Patient Revenue per Equivalent Admission,
Relative to Great Lakes and National Averages (2002-2011)
0%
-1%
-2%
-3%
-4%
-3.7%
-3.8%
-4.1%
-5%
-5.1%
-4.4%
-4.8%
-5.0%
-5.1%
-6%
-5.7%
-5.8%
-5.6%
-4.8%
-5.1%
-5.6%
-6.2%
-6.3%
-7%
-6.8%
-7.2%
-6.6%
-7.0%
-8%
2002
2003
2004
2005
2006
GL
2007
2008
2009
2010
2011
US
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MHA Resources
• Monday Report is available FREE to anyone and is distributed
via email each Monday morning.
– Go to website and select “Newsroom”, then Monday Report
• MHA Monday Report – electronic publication issued weekly
• Request password if you don’t have one.
– Email Donna Conklin at [email protected] to obtain MHA
member ID number
• Advisory Bulletins – Extensive communications available only to
MHA members, as needed. (Require password to obtain from
website).
• Hospital specific mailings as needed for various impact
analyses, etc.
• Periodic member forums
• See mha.org for other resources.
• Monthly Financial Survey provides free benchmarking of
financial and utilization statistics.
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???Questions???
Vickie Kunz , Senior Director, Health Finance
Michigan Health & Hospital Association
110 West Michigan Avenue, Suite 1200
Lansing, MI 48933
Phone: (517) 703-8608
Fax: (517) 703-8637
email: [email protected]
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