Does the
moratorium on the therapy caps begin Jan 1 or the day the President signs the
bill?
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]On Behalf Of Kathy
Archibald
Sent: Thursday, December 04, 2003
8:11 AM
To: [EMAIL PROTECTED]
Subject: Re: Medicare Update -
Moratorium on Therapy Caps
Rena - does
this mean that the caps are OFF for now, then?
-----
Original Message -----
To: [EMAIL PROTECTED]
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
