Net SNF funding will stay the same for FY 2006 according to the Proposed Rule for Medicare PPS Payment for SNFs published in the Federal Register on May 19.

The Proposed Rule adds a new RUG category, "Rehab plus Extensive" with nine new RUGs. The new category reflects the higher costs of beneficiaries who require both rehabilitiation and certain high-intensity medical services.

The new 53-group RUG-III system is scheduled to go into effect January 1, 2006 (the current 44-group system will be used from October 1 thru December 31, 2005.)

CMS is proposing a 3 percent across-the-board increase to the case-mix weights to help pay for residents who use a higher level of ancillary services than is built into the system. Also proposed is a "market basket" increase of about 3 percent. The temporary add-on for residents with AIDS will remain in effect during FY 2006.

The increases will compensate for the removal of the temporary add-ons for some RUG-III groups. Together the changes will result in FY 2006 Medicare SNF payments that are about equal to FY 2005.

The Proposed Rule also includes an invitation to submit comments on:

• Pay for Performance programs for the SNF setting
• Clarification of employment status (direct/indirect) for Nurse Practitioners and CNSs regarding signing SNF stay certifications
• Concurrent therapy
• Whether time spent in observation status at a hospital should count toward the qualifying 3-day stay
• Including only treatments furnished since admission in MDS P1a, such as IV medications, suctioning, and tracheostomy care
• Other options, for example eliminating projection of anticipated therapy during the 5-day PPS assessment, and decreasing or eliminating grace days for the 5-day and/or all PPS MDS assessments

Click here to read the Proposed Rule in the 5-19-05 Federal Register

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Providers can now apply online for their National Provider Identifier (NPI). The NPI is a unique 10-digit number that will be assigned to each provider, including SNFs, hospitals, and physicians. A HIPAA requirement, it must be used on standard forms such as claims, beginning May 23, 2007.

Apply on paper:  beginning July 1, 2005, applications may be submitted on paper. The forms are available at the NPI application Website or by calling 800-465-3203

The Internet application asks for the organization name, Employer Identification Number, name of authorized official for the organization, their phone number and address, taxonomy (provider type), state license information, and a contact person including name, phone number and e-mail.

Instructions on time frames for using the NPI will be released in 2006. Providers are to include their NPI if available, in MDS Section W - Supplemental Items that goes into effect October 1, 2005.

The NPI Final Rule was published in the Federal Register of January 23, 2004. Highlights:

• Covered providers are required to obtain an NPI for itself and its subparts. "Covered" providers transmit health information in electronic form in connection with standard transactions, such as claims
• NPIs are designed to last indefinitely; providers are required to notify the NPS of changes in required data within 30 days of the change
• Only one physical location address will be associated with each NPI

Unique Identifiers are the fourth part of HIPAA that includes Privacy, Security, and Transaction and Code Set Standards. In addition to providers, identifiers also are required for health plans (the rule has not yet been released) and employers (already determined to be the Employer Identification Number).

Click here for the NPPES Website where you can apply for your NPI.

To read CMS' May 6, 2005 letter to providers, click here.

Medlearn Matters SE0528 also contains information on the NPI, click here.

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The draft RAI manual revisions released in May 2005 replace the updates released this March and will be effective June 15, 2005.  The biggest change is the addition of instructions for completing the new MDS Section W - Supplemental Items (see the next article for more on Section W). The comment period on Section W extends to June 17, 2005 with a final verison of Section W scheduled to be posted August 22, 2005 for an effective date of October 1, 2005.

A partial list of other areas addressed in the latest update:

• Chapter 1 - change in ownership when the new owner does not assume the assets and liabilities of the previous owner, resident transfers due to disasters, electronic signatures
• G4A - process and coding sections for assessing ROM limitations
• K5 - definitions of parenteral/intravenous, mechanically altered diet, and therapeutic diet
• M1 - intent, definition, process, clarification, and example sections regarding ulcers
• M2 - examples of types of ulcers
• M3 and 4 - intent and definitions
• M5 - definitions section
• P1d - intent
• P3 - definition of ROM
• R2a,b - clarify signature and date
• T1d - Clarify physician orders

Click here for the update -- scroll down to "June Update 2005"

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Corrections to the draft data specifications released earlier for MDS Section W were posted May 10, 2005 at the MDS 2.0 What's New Website: click here and scroll to Data Specification Version 1.30.

Completion of MDS Section W is mandatory for assessments with Assessment Reference, Discharge, and Re-entry dates of October 1, 2005 and later. There will be no warnings or errors if Section W is completed when it is not necessary.

Section W2 must be completed for all residents on all assessment types (OBRA and/or PPS) with ARDs and discharge tracking forms with discharge dates between October 1 and June 30.  The five items:

W1. National Provider ID – if available

W2a. Influenza vaccine received or not for this year’s Influenza season (October 1 thru March 31)

W2b. Reason influenza vaccine not received

W3a. Pneumococcal vaccine (PPV) status up to date?

W3b. Reason PPV not received

Click here to view the complete proposed text for Section W as shown in the draft RAI manual.

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Only electronic Medicare claims will be accepted, effective July 5, 2005. Since February 2004, CMS has had a contingency plan in place that called for non-HIPAA-compliant electronic and paper claims to receive a 13-day delay in payment.

CMS issued a Change Request April 29, 2005 stating the policy that "with few exceptions, claims must be submitted to Medicare electronically." CR 3815 includes enforcement information for fiscal intermediaries. Click here to open it.

Medlearn Matters 3815 also addresses this issue. Click here to read it.

Keane Care Clients please note: our Accounts Receivable/Billing software is HIPAA-compliant for all Medicare intermediaries and for Medicaid in all states. If you are not yet submitting claims electronically, please contact your nearest Client Services office.

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The knowledge gained and friendships made at the 2005 Keane Client Conference didn't "stay in Vegas." This year more attendees bring back even more valuable information and contacts than last year. 

Attendees of the May event in Las Vegas benefitted from 23 sessions led by Keane employees and clients that ranged from overviews of software updated released in the previous year, to specific topics, such as how to switch to electronic payment, best practices for payroll, how to computerize your facility's incident report, and setting up your system for maximum performance.

Keane Care Clients please note:  PowerPoint presentations from the sessions will soon be available from VistaKEANE Insider, the clients-only section of the Keane Care Website.  Click here to visit the Insider (password required).  It's free and easy to sign up for your password, click here.

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