I am Just a Bill
Timothy Powell, CPA, CHCP
November 5, 2024
Today is election day. I wanted to talk about the process by which laws are passed and regulations created in healthcare. Recently, the fall of
While much attention has been focused on the release of the IPPS Final Rule, other final rules might have gone unnoticed.
The Centers for Medicare & Medicaid Services (CMS) were very busy the first week of August, with the release of final rules for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs), and inpatient psychiatric facilities (IPFs). The highlights are listed below.
Skilled Nursing Facilities
This final rule will be effective Oct. 1, 2021. The Patient-Driven Payment Model (PDPM) was adopted Oct. 1, 2019. This year there have been updates to the ICD-10-CM mappings. A change has also been made to consolidated billing, with blood clotting factors now excluded. The HCPCS codes that report these substances are J7170, J7185-J7190, J7192-J7195, J7198-J7203, J7205, and J7207-J7211. The social determinants of health (SDoH) have also been added to the assessment. The Quality Reporting Program will adopt two new measures for the 2023 fiscal year (FY). These measures are SNF Healthcare-Associated Infections Requiring Hospitalization and COVID-19 Vaccination Coverage.
Hospices
This 226-page final rule will also be effective Oct. 1, 2021. This final rule has finalized changes to Hospice Conditions of Participation, the Hospice Quality Reporting Program, and the Home Health Quality Reporting Program. There is a 2-percent increase in payments. The FY 2022 patient cap amount is increased to $31,297.61. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey Star ratings will be added to Care Compare.
Inpatient Rehabilitation Facilities
The FY22 final rule becomes effective October 1, 2021. An overall increase in FY22 payments of 1.5% is estimated. This final rule also includes a modification to the number of quarters used for public reporting of IRF quality measures due to the public health emergency. SDOH have been added to the patient assessment data elements.
Inpatient Psychiatric Facilities
The payments will increase by 2.1 percent compared to the FY 2021 rates. The COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure will be added for FY 2023. CMS is also seeking feedback on quality measures and the data validation pilot program.
Conclusion
This is just a high-level summary. The URLs for the fact sheets and the final rules have been listed below under Resources. The Inpatient Prospective Payment System (IPPS) Final Rule was also released on August 2, 2021, so there will be lots of reading material available.
Resources
SNFs:
Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-skilled-nursing-facility-snf-prospective-payment-system-pps-final-rule-cms-1746
Final Rule: https://public-inspection.federalregister.gov/2021-16309.pdf
Hospices:
Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-hospice-payment-rate-update-final-rule-cms-1754-f
Final Rule: https://public-inspection.federalregister.gov/2021-16311.pdf
Inpatient Rehabilitation Facilities:
Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-inpatient-rehabilitation-facility-irf-prospective-payment-system-pps-final-rule
Final Rule: https://public-inspection.federalregister.gov/2021-16310.pdf
Inpatient Psychiatric Facilities:
Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-inpatient-psychiatric-facility-ipf-prospective-payment-system-pps-final-rule-cms
Final Rule: https://public-inspection.federalregister.gov/2021-16336.pdf
Today is election day. I wanted to talk about the process by which laws are passed and regulations created in healthcare. Recently, the fall of
If you’ll recall, a couple of weeks ago, I reported on the Centers for Medicare & Medicaid Services (CMS) Proposed Rule for the social determinants
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