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The 2003 Rehab Therapy caps for Medicare Part B payment are now in effect. The caps set a $1590 limit on Physical Therapy and Speech Therapy combined, and a $1590 cap on Occupational Therapy.
Litigation seeking to delay the caps was resolved September 30, 2003 without changing the September 1, 2003 implementation.
For VistaKEANE clients: instructions for handling the caps with Keane Care software are available in The Insider, the clients-only section of Keane Care's Website.
Therapy after the caps
Although residents in both Medicare-certified and non-certified beds are subject to the cap, those in certified beds may not receive Medicare Part B reimbursement for services after the $1590 limit due to consolidated billing rules.
Beneficiaries in non-certified beds may be reimbursed by Medicare for therapy provided in outpatient hospital settings. In the Open Door Forum on June 17, 2003, CMS officials stated that therapists from outpatient hospitals could travel to a SNF to provide services beyond the cap to beneficiaries in non-certified beds. The hospital would submit a bill to Medicare.
Further, a SNF could provide outpatient therapy services, if it is acting under arrangement with a hospital and the hospital bills for services. Points included in the memos:
- Beginning July 1, beneficiaries' Medicare Summary Notices (MSN) included a note about the caps. After September 1, MSNs show the amount accumulated for the caps, advise when the caps are met, and if payment is denied.
- When a beneficiary is close to reaching a cap, providers should bill the usual and customary charge, even though it might exceed $1590. Remittance advices will identify denied charges.
Click here for more detailed information on the caps, including HCPCS codes, in Program Memos AB-03-057 and AB-03-073.
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Keane Care's latest full-suite update to its clinical software system is now in general release. This update moves the clinical system to an open database architecture that will accommodate databases in addition to Microsoft® Jet Engine.
"The first additional database we will offer is Microsoft SQL Server. It will provide more capacity than Jet Engine, handle many more concurrent users and deliver better performance when handling large amounts of data," said Krystal Sampson, Software Development Manager for the clinical applications.
The SQL Server database is the solution for large facilities of 250 or more beds that use many or all of the VistaKEANE clinical applications.
The 4.3 update includes other significant enhancements, many of them suggested by our clients. An example of the suite-wide changes is "What's This?" Help, a new feature that delivers instant information specific to a field. Other enhancements were made to VistaKEANE clinical applications, including ADT, Care Plan, Rehab, and Resident Assessment.
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The December 2002 RAI Manual has been updated with a 71-page document. The first ten pages list the changes, the next 50+ pages are replacements for your printed Resident Assessment Instrument manual.
Most updates are to Chapter 3, the item-by-item guide to completing the MDS. Areas with changes include:
- MDS timing and coding - Chapter 2 and Section A3a
- ADL coding clarification - G1A
- Peripheral vascular disease, aphasia, respiratory infection, wound infection, ICD-9 codes - I1, I2
- Hallucinations, pain, headaches - J1, 2, 3
- Weight gain, Parenteral/IV- K3, 5
- Skin condition - M1, 2, 4, 5, 6
- Vitamin B12, subcutaneous pumps - O1, 3
- Coding, chemotherapy, dialysis, transfusions - P1a
- Coding minutes of therapy, group therapy, supervision - P1b
- ROM (passive), continuous passive motion devices - P3
- Definition of physician - P7, P8
- Signature of coordinator - R2a, b
- Estimate of minutes/days - T1d
Click here to view the complete RAI Manual with the August 2003 revisions.
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Two important resource documents regarding testing your electronic Medicare and Medicaid claims in the HIPAA format with Keane Care software are now posted in The Insider, the clients-only section of Keane Care's Website.
Testing Preparations for HIPAA standards
Now is the time to be testing electronic claims in the HIPAA format. Although CMS has announced a temporary delay in enforcing the October 16, 2003 deadline, providers are strongly encouraged to continue their testing process.
After October 16, all Medicare claims must be submitted electronically and will be accepted whether they are in the ANSI 837I format or not. For Medicaid claims there is no single standard format; states have announced a variety of contingency plans.
Providers must test with their Medicaid agency in addition to Medicare testing. Read this document for the steps you need to take to test your electronic claims in the HIPAA format with Keane Care billing software.
It's available at: /insider/products/vk-fin/ram/hipaa/hipaa.pdf
HIPAA Billing Status Report for RAM and DOS AR
This document gives you the testing status of each intermediary for Medicare billing and for each state for Medicaid billing. It also includes links to helpful Websites.
It's available at: /insider/products/vk-fin/ram/hipaa/HIPAA_Billing_Status_Report_Insider.htm
Join The Insider
If you are a Keane Care client and do not yet have your Insider password, click here to request one.
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Implementing the MDS 3.0 assessment will take longer than first announced, stated a CMS official in the CMS SNF Open Door Forum of September 30, 2003. CMS is currently revisiting the timeline in light of key concerns by stakeholders.
A new date has not been determined, but it will be later than the Spring 2005 date previously announced.
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The payment rates released in the Medicare PPS for SNFs Update of August 4, 2003 have been changed in a Correction published in the September 29, 2003 Federal Register. Wage indices for every area of the country have been corrected.
Click here to read the correction published in the Federal Register.
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Expect a new look and feel in Medicare manuals available online. Beginning October 1, 2003 they moved from being organized by provider to organized by function. CMS officials announced that this redesign streamlines the manuals, reducing redundancies and inconsistencies and will make it easier to update the manuals in the future.
Crosswalks have been added in the manuals to link you from old to new text and a search engine can help you find specific topics.
Click here to access the Medicare manuals.
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CMS is proposing to change the "75 percent rule" for Inpatient Rehabilitation Facilities (IRFs) to the "65 percent rule." The rule is used to separate IRFs from other types of hospitals. To be classified as an IRF, 75 percent of the inpatients must be treated for one or more of these conditions: stroke, spinal cord injuries, congenital deformity, amputations,
major multiple traumas, fracture of femur, brain injuries, polyarthritis, neurological disorders, and burns.
The Proposed Rule published in the September 9, 2003 Federal Register would change the percentage of patients to 65 percent. Other changes:
- Replacing polyarthritis with three groups of more precisely identified arthritis-related conditions
- Adding an assumption that if the facility's Medicare population complies with the rule, the total population complies
- Counting patients with a comorbidity that falls within the 12 conditions towards the 65 percent
- Changing the time period that determines compliance to the most recent, appropriate, and consecutive 12 months, rather than the most recent 12 months
Comments are accepted on the proposal until November 3, 2003. CMS suspended enforcement of the current rule in June 2002 because of concerns that it was being enforced inconsistently by fiscal intermediaries.
Click here to read the proposed rule.
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The Keane LTC Users' Group invites staff from all facilities using the VistaKEANE system to participate in their organization.
The mission of the Keane LTC Users' Group is to provide input to ensure all the products used by Keane Long-Term Care clients meet the ongoing requirements of the post-acute care community. The Users' Group is a self-governing body, independent of Keane.
Membership in the Users' Group is free and individuals determine their level of involvement.
Sign Up Now
Keane Care customers can visit the VistaKEANE Insider for more information and to sign up for the Keane LTC Users' Group.
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