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.  2019 Part B Fee Schedules

2.  Therapy Caps Update

3.  Multiple Procedure Payment Reduction Remains in Effect

4.  Make Sure your PS&R System Login is Active!

5.  2019 Medicare Part A Coinsurance & Medicare Part B Deductible

6.  January 1, 2019 Ohio SNF Medicaid Rates

7.  Medicaid Benchmarking Reports Now Available


2019 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 2019 physician fee schedules will receive a .1% update.   However, in conjunction with the final rule for the 2019, various adjustments to some of the underlying factors that are used to calculate the payments will be made effective January 1, 2019. As a result, the changes to the payments for each code will vary, in some case widely, from the reported .1% update.

The Therapy fee schedules provided below are effective from January 1, 2019 through December 31, 2019. It is important to forward the fee schedules to your business office personnel to use for January bills. 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.

2019 Ohio Therapy Medicare Part B Fee Schedule

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 2019 services.

Therapy Caps Update

The therapy caps for Part B therapy services were eliminated in the Bipartisan Budget Act of 2018. However, the KX modifier must still be used when services over the limits are provided as a provider attestation of medical necessity.   The limits for 2019 are $2,040 for physical and speech therapy (combined) and occupational therapy.   The budget act also lowered the threshold for targeted medical reviews of therapy claims from $3,700 to $3,000.

Multiple Procedure Payment Reduction Remains in Effect

The Multiple Procedure Payment Reduction (MPPR) remains in effect for 2019. 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 2019, 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.

Make Sure your PS&R System Login is Active!

Just a quick reminder that passwords for the CMS PS&R system 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.

2019 Medicare Part A Coinsurance & Medicare Part B Deductible

Effective January 1, 2019, the Medicare Part A coinsurance rate for SNFs will increase to $170.50 per day from $167.50 for days 21 through 100. The Part B deductible will be $185.00 for 2019, up $2 from 2018.


January 1, 2019 Ohio SNF Medicaid Rates

Medicaid rates for most Ohio nursing facilities were recalculated on January 1, 2019 using the average of the June 30, 2018 and September 30, 2018 Medicaid case mix scores. The updated rates will impact payments from both traditional Medicaid and MyCare Ohio Medicaid. The statewide average rate as of January 1, 2019 is $196.32, an increase of $.37 over the July 1, 2018 average rate of $195.95.

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, 2019 Medicaid rate or a detailed rate history analysis.

Medicaid Benchmarking Reports Now Available

The 2017 Medicaid Nursing Facility (NF) Cost Report database from ODM and the ICF-IID cost report database from DODD allow us to analyze annual cost, census, and staffing trends. We can compare your facility’s expenses, census and staffing against selected competitors, as well as county, peer group and statewide averages. These reports provide valuable information to assist you in optimizing the operations of your facility. Please contact us if you are interested in a benchmarking report.

Steve Anderson CPA