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Rena - does this mean that the caps are OFF for now, then?
----- Original Message -----
Sent: Wednesday, December 03, 2003 3:22
PM
Subject: Medicare Update
This is great news - courtesy of AHCA!
Rena
***********************************************************
MEDICARE
UPDATE
***********************************************************
TO:
AHCA Members
FROM: Alan DeFend, Vice
President, Public Affairs
SUBJECT: Medicare
Update
DATE: Wednesday December 3,
2003
____________________________________________________________________
We
are enormously pleased to advise of two additional and very
positive
Legislative/Administrative developments that will benefit
patients and
providers.
SNFs Won't be Penalized for OIG Audit
Claims Related to 3-Day Hospital Stay
As a result of superb work by
AHCA's Regulatory Department spearheaded by
Finance Policy Counsel Elise
Smith, CMS has announced that the government
will NOT be demanding
recoupment of more than $200 million in disputed
Medicare payments.
These claims, from '97 to '01, were identified in
several HHS Office of
the Inspector General (OIG) audits because of concerns
related to the way
the 3-day hospital stay was calculated to establish
eligibility for SNF
care. In Elise's May 6, 2003, letter to the OIG, AHCA
adamantly
opposed recoupment raising many technical and legal issues.
Officials at
CMS, led by Sheila Lambowitz, agreed to examine the issues we
raised, and
the Agency concluded that there was no pattern of
misrepresentation that
could be used to determine "fault" and, consequently,
instructed the
organizations that pay Medicare claims to cease efforts to
recover any
payments thought to be improper and to refund any funds
already
recovered.
We applaud the OIG and CMS on their decision
and this initiative and look
forward to working with them to achieve a
better policy. AHCA believes that
the 3-day stay is an
inappropriate requirement for SNF care but, so long as
it is in effect,
observation days preceding a hospital stay should be
counted toward the
requirement. Since CMS has concluded that the OIG's
findings "raise
significant policy issues related to the technical
eligibility criteria
for SNF care" we remain hopeful that progress will
continue to favorably
resolve the 3-day stay issue, which is one of AHCA's
highest Medicare
priorities.
You can read Elise's May 6 letter
at
<http://www.ahca.org/members/finance/medicare/general/letter_oig_3day_stay.p
df>
Therapy
Cap Moratorium to be effective When President Signs Medicare Bill
We
previously advised of the recently passed Medicare Bill's
provisions
regarding a two-year moratorium on caps on physical
therapy/speech language
pathology and on occupational therapy.
We've confirmed that the benefits
for patients of this provision will
take place as soon as the President
signs the bill and the legislation is
enacted. This is expected as early as
next Monday, thus allowing
for nearly an additional month of protection from
the caps. The
ultimate solution is the kind of permanent relief provided by
bipartisan
bills in the House and Senate that presently have nearly 300
co-sponsors
(H.R. 1125/S. 569). We support these bills, and you can
advocate
for their passage by contacting your Representative and Senators
by
calling the Capitol switchboard at 202-224-3121. To determine if
they
should be thanked for being supportive of this legislation or
encouraged to
sign on, go to <http://thomas.loc.gov>, enter the
bill number, and search
the bill status for the
cosponsors.
Rena R. Shephard,
MHA, RN, FACDONA, RAC-C
Healthcare Consultant
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