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CCH® Reimbursement Integrated Library
The Reimbursement Integrated Library delivers the key performance indicators for maximizing reimbursement. The Library includes three invaluable titles:

• Dennis Barry's Reimbursement Advisor - This monthly newsletter provides all the facts about reimbursement strategies to minimize the adverse effects of DRGs, RBRVs, APCs and capitation to optimize hospital reimbursement.
• Receivables Report - This monthly newsletter includes actual profit-improvement examples from facilities nationwide, secrets for successfully challenging denials, tips for using automation to increase cash flow, and strategies your colleagues are using now to prepare for health care reform.
• Hospital Accounts Receivable Analysis - This quarterly journal is a synopsis of statistical data related to hospital receivables.

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July 2008, Volume 23, No. 11

Health care providers face ongoing clarifications and revisions to policy, procedures and regulations relating to Medicare reimbursement. As often is the case, the Centers for Medicare and Medicaid Services (CMS) issues clarifications that can be inconsistent, guidance that that runs counter to prior CMS concerns, and revisions to procedures that may not achieve intended results. In the July 2008 issue, authors examine a new and conflicting CMS position on old debts, CMS’ departure from its prior concerns regarding freestanding emergency departments, and the interim steps leading toward changes in Provider Reimbursement Review Board (PRRB) appeal procedures.

• Coverage of Medicare “straddle” patients: When a hospital becomes Medicare certified in the course of a patient’s stay. Among the concerns of health care providers contemplating initial Medicare certification is coverage for Medicare patients whose hospital stays “straddle” the pre- and post-Medicare certification date. This issue also may arise in the change of ownership context when an acquiring entity does not accept the acquired entity’s provider agreement. Medicare policy under the hospital inpatient prospective payment system is clear, however, that the full diagnosis related group (DRG) payment will be made if at least one day of a patient’s stay is covered by Medicare.

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Fourth Quarter 2007, Volume 22, Number 1

• Major Indicators. At the end of 2007, US hospitals reported seeing mixed results among their key indicators. In the HARA Report on Fourth Quarter 2007, we break it down for you.

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Since the Medicare Improvements for Patients and Providers Act (MIPPA) (PubLNo 110-275) was enacted July 15, 2008, CMS has issued a series of updates noting how the new law affects different parts of the program. The updates relate to the physician fee schedule, the DMEPOS competitive bidding program, brachytherapy payments, the extension of therapy caps, the reinstatmtn of certain billing allowances for independent laboratories, waiving retroactively beneficiary cost-sharing amounts attributable to increased payment rates, and payments for ground ambulance services. CCH Chicago Bureau, July 25, 2008.

The House on July 24, 2008 approved legislation (H.Res. 1368) that delays consideration of President Bush’s so-called Medicare “trigger” bill for the rest of the 110th Congress. The trigger legislation, submitted in February, was required by the Medicare Modernization Act of 2003 (MMA) (P.L. 108-173). That law included a provision that requires presidential and congressional action if general taxpayer revenues provide more than 45 percent of Medicare funding for two consecutive years. CCH Washington Bureau, July 24, 2008.

The Medicare Recovery Audit Contractor (RAC) program demonstration identified more than $1.03 billion in improper Medicare payments during its three-year demonstration, which ended in 2008, according to the final report on the demonstration issued by CMS. Ninety-six percent of the improper payments were overpayments.

Under the program, the Medicare Trust Funds have received more than $693.6 million as of March 27, 2008. A break down of the overpayments by provider type shows that 85 percent of overpayments were collected from inpatient hospital providers, 6 percent were from inpatient rehabilitation facilities, and 4 percent were from outpatient hospitals.

The three year-demonstration project ran from 2005 to March 2008. The project ran in three states: California, Florida, and New York. Under the Tax Relief and Health Care Act of 2006 (TRHCA) (PubLNo 109-432), the RAC program will be rolled out to all 50 states by 2010. CMS is in the process of approving new RAC contractors for the states that will become part of the program in 2008.

RAC Demonstration Report, July 11, 2008, ¶52,306.

Panelists at a recent Senate Finance Committee hearing agreed that health information technology can not only help reduce health care costs and improve quality, but also can improve the way the government pays for Medicare services. “Many observers believe that widespread use of [information technology] would improve health-care quality and efficiency,” said Senate Finance Committee Chairman Max Baucus (D-Mont.) at a July 17, 2008, hearing to explore health care reform options. “Unfortunately, health care has been slow to adopt IT,” he said.

Ranking Member Charles Grassley (R-Iowa) noted the systems are expensive to install. “While it's clear that electronic patient records will improve efficient health care, the economics have not proven attractive to doctors,” he said. “We need to think about how to make adoption of electronic records more attractive to those who will use them,” he said. CCH Washington Bureau, July 23, 2008.

Senate Finance Committee chairman Max Baucus (D-Mont.) and Senate Finance Committee Healthcare Subcommittee chairman John D. Rockefeller, IV (D-WV) have decided not to pursue a Senate resolution denouncing a Bush administration directive regarding enrollment in the State Children's Health Insurance Program (SCHIP) (see related story in Report No. 1519).

On August 17, 2007, The administration issued a directive (see ¶51,977) that would require states to enroll 95 percent of children in families with incomes up to 200 percent of poverty in SCHIP before expanding coverage to children in higher-income families. The senators on July 17, 2008, authored a joint resolution (S.J.Res. 44) that sought to nullify the directive through the Congressional Review Act. The Government Accountability Office issued a report on April 17 stating that the directive is in fact a rule for purposes of the Act and, therefore, violates the statutory requirements for Congressional notice and review. CCH Washington Bureau, July 23, 2008

CMS will begin offering physicians bonus payments for adopting electronic prescribing in 2009, HHS Secretary Michael Leavitt and CMS Acting Administrator Kerry Weems announced on July 21, 2008. Beginning January 1, 2009, Medicare will provide a 2 percent incentive payment to prescribing doctors who use the technology in 2009 and 2010; the incentive will be phased down to 1 percent in 2011 and 2012 and to a one-half percent incentive payment in 2013.

Beginning in 2012, eligible professionals who are not successful electronic prescribers will receive a one-half percent reduction in payment, Weems said. The agency will exempt some prescribers if it finds they face significant hardship or write only a few prescriptions. Weems said that the CMS will discuss this exception during rulemaking this fall. CCH Washington Bureau, July 22, 2008.

Medicare General Information, Eligibility and Entitlement Manual, Pub. 100-01, Transmittal No. 52, July 11, 2008, ¶157,428. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1550, July 18, 2008, ¶157,429. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1551, July 18, 2008, ¶157,430. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1552, July 18, 2008, ¶157,431. Premium content

Medicare Claims Processing Manual , Pub. 100-04, Transmittal No. 1553, July 18, 2008, ¶157,432. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1554, July 18, 2008, ¶157,433. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1555, July 18, 2008, ¶157,434. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1557, July 18, 2008, ¶157,435. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1558, July 18, 2008, ¶157,436. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1560, July 18, 2008, ¶157,437. Premium content

Medicare Financial Management Manual , Pub. 100-06, Transmittal No. 140, July 17, 2008, 2007, ¶157,438. Premium content

One-Time Notification Manual, Pub. 100-20, Transmittal No. 359, July 18, 2008, ¶157,439. Premium content

One-Time Notification Manual, Pub. 100-20, Transmittal No. 360, July 18, 2008, ¶157,440. Premium content

Medicare Prescription Drug Benefit Manual, Pub. 100-18, Transmittal No. 2, July 18, 2008, ¶157,441. Premium content