On September 24, 2013, the Centers for Medicare and Medicaid Services released the MDS 3.0 RAI Manual v1.11, with an effective date of October 1, 2013. This version of the MDS 3.0 RAI Manual incorporates clarifications to existing coding and transmission policy, integrates previously published Questions and Answers into the appropriate sections and addresses requested clarifications and scenarios concerning complex areas. To access the manual, click HERE.

On September 26, 2013, the Centers for Medicare and Medicaid Services (CMS) issued guidance on the fiscal year 2014 hospital inpatient prospective payment system final rule. In the FAQ document, CMS answers the following questions: Will CMS direct the Medicare review contractors to apply the 2-midnight presumption-that is, contractors should not select inpatient claims for review if the inpatient stay spanned two midnights from the time of admission? Will Medicare contractors base their review of the physician’s expectation of medically necessary care surpassing 2 midnights upon the information available to the admitting practitioner at the time of admission? What steps

Question Can an employer be fined for failing to provide employees with notice about the Affordable Care Act’s new Health Insurance Marketplace? Answer 

Five members of the Commission on Long Term Care issued an alternative report on September 23, 2013 outlining and discussing their recommendations to address the challenges facing our country’s long-term services and supports (LTSS) system. To transform today’s inadequate LTSS system into one that works, the Commission recommends the creation of a new system and, until it is established, improvements to existing public programs to better meet the needs of older adults and younger people with disabilities. The recommendations are as follows: 1. Create a Broader Financing Solution 2. Adopt a National Strategy to Improve and Strengthen the LTSS Workforce

The American Medical Association (AMA) has released the 2014 CPT Book. There are 5 new and 1 deleted CPT codes applicable to outpatient therapy services. Please see below for the changes that become effective January 1, 2014:

Noridian, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming as well as California, Hawaii, and Nevada, is providing clarification of coverage and documentation requirements for common rehabilitation delivery methods based on review findings. If Noridian is your Medicare Administrative Contractor, to read the clarification,

The Centers for Medicare and Medicaid (CMS) has issued an article that provides instructions for home health agency (HHA) use of the ABN as the replacement notice for the outgoing Home Health Advance Beneficiary Notice (HHABN), Form CMS-R-296, Option Box 1. In addition, this transmittal includes ABN issuance guidelines for therapy services and therapy specific examples. Examples for therapy includes when to issue an ABN when the patient is below the therapy, above the therapy cap, and when an ABN is not to be issued when the patient is above the therapy cap. Minor editorial changes were made to clarify

Skilled nursing facilities initiating compliance programs are encouraged to review Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports recently sent to each facility by the Centers for Medicare & Medicaid Services (CMS). These free provider-specific comparative data reports help identify billing practices which may be at risk for administrative review. CMS began mailing PEPPER to skilled nursing facilities in August 2013. PEPPER, or program for evaluating payment patterns electronic report, provides facility-specific data statistics for services provided to Medicare beneficiaries. PEPPERs compare a SNF’s claims data statistics with aggregate statistics from similar facilities in the state, Medicare administrative jurisdiction,