With the New Year upon us, all of us at HW&Co. would like to wish you a happy, healthy and prosperous New Year. As always, the New Year brings many changes to the Long-Term Care Industry. We are pleased to provide you with updates on some of these changes.

In this issue:

    1. 2017 Part B Fee Schedules
    2. Therapy Caps Exception Process Extended
    3. Multiple Procedure Payment Reduction Remains in Effect
    4. January 1, 2017 Ohio SNF Medicaid Rates
    5. Make Sure Your PS&R System Login is Active!
    6. 2017 Medicare Part A Coinsurance & Medicare Part B Deductible

2017 Part B Fee Schedules

In conjunction with The Medicare Access and CHIP Reauthorization Act of 2015, which replaced the Sustainable Growth Rate (SGR) formula with new systems for establishing payment updates to the Medicare Part B physician fee schedules, the 2017 physician fee schedules will receive a .5% update.   However, in conjunction with the final rule for 2017, various adjustments to some of the underlying factors that are used to calculate the payments will be made effective January 1, 2017.  As a result, the changes to the payments for each code will vary, in some case widely, from the reported .5% update.

The Therapy fee schedules provided below are effective from January 1, 2017 through December 31, 2017.  It is important to forward the fee schedules to your business office personnel to use for January bills. The schedules are available in PDF format in the links below.  Our Revenue Cycle Consultants are available to assist with any billing questions you may have. In addition, if you use PointClickCare, the Part B fee schedules are automatically updated in your system.

2017 Ohio Therapy Medicare Part B Fee Schedule

The fee schedules also include a change to the physical and occupational therapy evaluation and re-evaluation codes.  Codes 97001 through 97004 have been deleted and replaced by codes 97161 through 97168 (see page 3 of 5 of the fee schedule linked above).  The new codes include three evaluation codes and a re-evaluation code for each discipline.  The evaluation codes are broken out by the complexity of the evaluation.  At this time, there is no difference in payment for the different levels of complexity.  The new codes are subject to the Multiple Procedure Payment Reduction (MPPR; see article below).

Many of the fee schedules change or are updated on a quarterly basis. Please review the appropriate schedule based on the Centers for Medicare & Medicaid Services (CMS) updates. Check the CMS website on a regular basis for updates to these schedules. Please note that these schedules are not all-inclusive. We have attempted to limit this information to the most commonly used Healthcare Common Procedure Coding System (HCPCS) codes for long-term care facilities.

Fee schedules for lab, radiology, PEN and DMEPOS services are also available.  These fee schedules may be helpful in negotiating contracts with your ancillary service providers.  Please contact your HW Healthcare Advisor if you would like a copy of one of these fee schedules for 2017 services.
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Therapy Caps Exception Process Continues through December 31, 2017

The therapy caps exception process remains in effect through December 31, 2017. The caps for physical and speech therapy (combined) and occupational therapy will be $1,980 for 2017.  The manual review process for beneficiaries that reach $3,700 of therapy services was also extended through December 31, 2017.
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Multiple Procedure Payment Reduction Remains in Effect

The Multiple Procedure Payment Reduction (MPPR) remains in effect for 2017. The MPPR cuts the practice component of the fee schedule payment for certain HCPCS codes by 50% when more than one kind of therapy is provided to a resident in a single day.

For 2017, the MPPR covers therapy services billed under 51 different HCPCS codes. The last column of the therapy fee schedules provided above shows the payment that would be made under the MPPR for the affected therapy codes.
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January 1, 2017 Ohio SNF Medicaid Rates

Medicaid rates for most Ohio nursing facilities were recalculated on January 1, 2017 using the average of the June 30, 2016 and September 30, 2016 Medicaid case mix scores.  The updated rates will impact payments from both traditional Medicaid and MyCare Ohio Medicaid.  It is important that you review these calculations closely as any errors must be corrected within 30 days of the receipt of your rate letter.  Though ODM is putting additional pressure on the MyCare plans to accurately update the rates, be sure to review your MyCare payments carefully, as the MyCare plans have had significant issues in the past.  Please contact us if you would like any assistance in reviewing your January 1, 2017 Medicaid rate.
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Make Sure your PS&R System Login is Active!

In 2015, CMS’s IACS system, which housed the PS&R system, migrated to the Enterprise Identity Management System (EIDM).  IACS users with existing logins should have been migrated automatically.  However, passwords expire every 60 days and must be changed.  In addition, to avoid being locked out, the PS&R system must be accessed at least once every six months.  We recommend you address any password or log in issues now to avoid delays in accessing your PS&R reports for the Medicare cost reports due in May.

Please contact your HW Healthcare Advisor if you have any questions on accessing the PS&R system.
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2017 Medicare Part A Coinsurance & Medicare Part B Deductible

Effective January 1, 2017, the Medicare Part A coinsurance rate for SNFs will increase to $164.50 per day from $161.00 for days 21 through 100. The Part B deductible will increase to $183.00 from $166.00.
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