Tag Archive for: Medicare

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Indiana Medicaid Releases Proposed Rule for Overhaul of Medicaid Integrity Requirements

By: Christa Roberts, PT, MPT, RAC-CT and Eleisha Wilkes RN, RAC-CT

The details of proposed rule LSA #18-251 were published on October 4, 2018 by the Indiana Family and Social Services Administration, and introduces plans to revamp the Medicaid program integrity requirements. LSA #18-251 is extensive and impacts the bulk of business facets for Indiana Medicaid providers, including claims filing time limits, medical record retention, provider enrollment, sanctions, audits, and provider appeals.

LSA #18-251 consolidates existing rules, clarifies requirements and adds new program integrity requirements affecting Medicaid providers. Some of the more significant changes are as follows:

  • Currently, providers have up to one year from the date of service to submit an original claim; however, under the proposed rule, providers would have to submit claims for payment within 180 days of the date of service or the claim would be denied (effective January 1, 2019).
  • Providers will be subject to a medical record retention for financial records period of 3 years following submission to Indiana Medicaid (there is currently no record retention policy).
  • The proposed rule consolidates and adds new provider enrollment requirements.
  • Medicaid payment suspension procedures authorized by Federal law are outlined.
  • A new section is added regarding provider exclusions and readmissions (specifically, the rule lists various offenses that could result in an exclusion and sets a duration of up to 3 years for such exclusion).
  • A new section describes prepayment review processes and procedures (previously only available in agency manuals).
  • The proposed rule revises existing Medicaid overpayment provisions to align with changes in Indiana law (adds a 3-year look back period for audits initiated after July 2, 2019, though may be extended to 7 years under certain circumstances).
  • Administrative appeals procedures are consolidated and changed to align with Indiana law.

LSA #18-251 is open for public comment until the public hearing, which is preliminarily scheduled for October 26, 2018. A copy of the proposed rule can be reviewed at: www.in.gov/legislative/iac/20181003-IR-405180251PRA.xml.pdf

 

 

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Functional Performance and Care Plan Quality Measure: MDS Section GG

In October 2016, all skilled nursing facilities will be submitting a new admission and discharge MDS for all Medicare fee-for-service beneficiaries. The purpose of the new admission and discharge assessments is to gather information for the quality reporting program (QRP). Specifically, there is a new MDS Section GG that required for only your Med A patients at admission and discharge. No other payers are included in this quality measure. Read more

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SNF PEPPER Now Available: Implement an effective response in preparation for government audits

The Q4FY15 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2015 is now available for download through the PEPPER Resources Portal. To obtain your SNF’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer of your organization should:

  1. Review the Secure PEPPER Access Guide.
  2. Review the instructions and obtain the information required to authenticate access. Note: A new validation code will be required. A patient control number or medical record number from a claim for a traditional Medicare FFS beneficiary with a “from” or “through” date in September 1-30, 2015 will be required.
  3. Visit the PEPPER Resources Portal.
  4. Complete all the fields.
  5. Download your PEPPER.

The SNF PEPPER will be available to download for approximately two years.

Revised in this release: The “Therapy RUGs” target area has been discontinued.

 

About SNF PEPPER

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. PEPPER is distributed by TMF® Health Quality Institute under contract with the Centers for Medicare & Medicaid Services.

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