With the New Year upon us, HW&Co. would like to wish you a happy, healthy and prosperous New Year. The New Year always 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:
- 2024 Part B Fee Schedules
- Therapy Caps Update
- Multiple Procedure Payment Reduction Remains in Effect
- Make Sure your PS&R System Login is Active!
- 2024 Medicare Part A Coinsurance & Medicare Part B Deductible
- PRF Reporting Period 6 Now Open
- January 1, 2024 Ohio SNF Medicaid Rates
- Medicaid Benchmarking Reports Available
MEDICARE UPDATES
2024 Part B Fee Schedules
Update: On March 9, 2024, President Biden signed the Consolidated Appropriations Act, 2024, which included a 2.93 percent update to the CY 2024 Physician Fee Schedule (PFS) Conversion Factor (CF) for dates of service March 9 through December 31, 2024. The increase was not retroactive so there are now two different fee schedules for 2024. Please be sure to use the correct link below based upon the date of service.
The Medicare Part B Physician Fee Schedule Final rule was released by the Centers for Medicare & Medicaid Services (CMS) on November 2, 2023. The final rule called for cuts of 3.37% to overall fee schedule payments. The final conversion factor, the main underlying component of the fee schedule payment calculation, is $32.74, a reduction from $33.89 in 2023. Various lobbying organizations, including the American Medical Association, have requested Congress pass legislation to eliminate the reductions, though all efforts have failed to date (see update). As with every year, the payment rates for individual HCPCS codes may vary from the stated percentage change due to changes in the other underlying components of the payment calculation.
The Therapy fee schedules provided below are effective from January 1, 2024 through December 31, 2024. 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.
2024 Ohio Therapy Medicare Part B Fee Schedule for dates of service January 1, 2024 to March 8, 2024
Many of the fee schedules change or are updated every quarter. Please review the appropriate schedule based on the Centers for Medicare & Medicaid Services (CMS) updates. Check the CMS website regularly 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 2024 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 2024 are $2,330 for physical and speech therapy (combined) and occupational therapy. The 2018 budget act also lowered the threshold for targeted medical reviews of therapy claims from $3,700 to $3,000, which will be in effect through calendar year 2028.
Multiple Procedure Payment Reduction Remains in Effect
The Multiple Procedure Payment Reduction (MPPR) remains in effect for 2024. 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 2024, the MPPR covers therapy services billed under 51 different HCPCS. 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.
2024 Medicare Part A Coinsurance & Medicare Part B Deductible
Effective January 1, 2024, the Medicare Part A coinsurance rate for SNFs will increase to $204.00 per day from $200.00 for days 21 through 100. The Part B deductible will be $240.00 for 2024, up $14 from 2023.
PRF REPORTING PERIOD 6 NOW OPEN
Reporting Period 6 for Federal Provider Relief Funding is now open. All providers who received more than $10,000 of Provider Relief Funds (PRF) between July 1, 2022 and December 31, 2022 must report to the Health Resources Services Administration (HRSA) no later than March 31, 2024.
This reporting period will likely apply to very few long-term care providers, as most providers received their Phase 4 and ARPA Rural funds prior to June 30, 2022. However, some providers were initially denied but received funds after June 30, 2022 pursuant to HRSA’s reconsideration process. For these providers, the period of availability for eligible expenses covers January 1, 2020 through December 31, 2023, while the period of availability for lost revenues covers January 1, 2020 through June 30, 2023.
The reporting portal is available on the HRSA website, which also includes information and FAQs on allowable expenses and other reporting matters.
Please contact us if you need any assistance with your Provider Relief Fund reporting.
MEDICAID UPDATES
January 1, 2024 Ohio NF Medicaid Rates
The Ohio Department of Medicaid (ODM) has posted updated rate letters to providers’ PNM portals in for new rates effective January 1, 2024. The rate update was significantly different to prior mid-year updates as, for the first time, ODM updated providers’ quality incentive scores for quality measures from July 1, 2022 through June 30, 2023. In addition, the January 1, 2024 rates were the first rates impacted by providers’ decisions on freezing case mix scores due to Ohio’s change to a PDPM-based case mix system. The statewide average rate increased by $4.06 to $275.50.
We recommend you review your rate closely to ensure it has been calculated correctly. Should you believe ODM has made an error, you must file a request for rate reconsideration within 30 days of the date of the rate letter. Please contact us if you would like an analysis of your rate.
Medicaid Benchmarking Reports Available
The 2022 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.
HW HEALTHCARE ADVISORS
Our team consists not only of CPAs, but also highly trained and experienced billing/revenue cycle consultants, certified medical office managers and LNHAs. We are dedicated to working with the regulatory, operational and reimbursement challenges that providers face in an ever-changing healthcare environment.
We can assist you in streamlining your processes, optimizing your operations and identifying potential opportunities and risks. Please contact any of our HW Healthcare Advisors to discuss how we can help you and your facility stay on the path to success.
Disclaimer: Information in this article is subject to change and is based upon current information as of the issue date.
