OHCA/CGS Meeting November 13, 2012 CGS Administrators, LLC November

Today’s Topics  Discuss submitted questions  Other tips  Q&A CGS Administrators, LLC November

Discussion Topics 1.Proposed settlement for cost-based SLP services o Need provider-specific details in order to research further CGS Administrators, LLC November

Discussion Topics year-end review rate letters: – Proposed at 0.71% and 0.36%; tentative settlements reflect 0.50% and 0.57% Initially: 14-day lag for pass-through payments Based on information we received about how NGS calculated lag-time, we changed the lag to 17 days We can still adjust days if lag-time calculation was inconsistent between prior years CGS Administrators, LLC November

Discussion Topics 3.CGS requested “Exhibit 1 Coinsurance Bad Debt” schedules for 2010 and 2011; these were already submitted with the ECRS files 4.Requests to resubmit ECRS files- please explain Most prior files were transferred to CGS from the prior contractor In some cases, we could not locate these documents in the transferred files CGS Administrators, LLC November

Discussion Topics 5.Policies for pass-through payments and issuance of lump- sum adjustments For SNFs: – Pass-through payments determined based on allowable bad debts calculated during tentative review of cost report: CGS calculates interim adjustment – Adjusted rate continues for 6-7 months into the new year; results in large variances in amounts due reported on the as-filed cost reports – Lump sum determination supports a more even flow of funds w/ bi- weekly payments – CGS uses a $5,000 materiality factor for issuance of lump sum payment adjustments CGS Administrators, LLC November

Discussion Topics 5.Policies for pass-through payments and issuance of lump- sum adjustments For hospitals: – At least 2 rate reviews are completed during the year 1 based on calculations made during tentative review of filed cost report If possible, 1 based on findings from desk review and audit (if performed) and settled w/ Notice of Program Reimbursement Interim payment adjustments are determined during the rate review CGS Administrators, LLC November

Discussion Topics: #6 TopicTimeframe for Completion Cost report acceptanceWithin 30 days of receipt Tentative settlementsWithin 60 days of acceptance NPRs (non-audit units)Within 1 year of acceptance NPRs (audit units)Within 60 days of exit conference Audit adjustmentDuring pre-exit conference and/or completion of desk review CGS Administrators, LLC November

Discussion Topics 7.No-pay bills Providers are required to submit a bill, even though no benefits may be payable by Medicare This allows CMS to keep track of the benefit period Must submit no-payment bills for beneficiaries that have previously received Medicare-covered care and subsequently dropped to a non-covered level of care but continue to reside in a Medicare-certified area of the facility CGS Administrators, LLC November

Discussion Topics 7.No-pay bills TOB 210 Include from-to dates Submit all days/charges as non-covered (non-covered days and charges beginning with the date after active care ended) Condition code 21 Patient status: use appropriate code CGS Administrators, LLC November

Discussion Topics: #8-9 Key contacts – PCC: most questions – CSR line is Request escalation as necessary Voic box for escalated issues: – Sheri Thompson: , – Ken McCullough: , – Jennifer Brown: , – Overpayments and A/R adjustments: – Michelle Tennant (primary): , – Noelle Weybright (secondary): , CGS Administrators, LLC November

Discussion Topics 10.CGS may not have received current mailing addresses for facilities during J15 implementation – how to rectify? CGS sends reminder letter for cost report to address listed in the National STAR (System for Tracking Audit & Reimbursement) CGS can update if we are notified CGS Administrators, LLC November

Discussion Topics 11.Proposed lawsuit settlement re: chronic conditions in home health care, SNF stays, and outpatient therapy Lawsuit brought at federal level CMS will provide direction to contractors if/when changes in guidelines are made CGS will communicate directly with associations and via listserv CGS Administrators, LLC November

Discussion Topics Other reminders: Requests for documentation based on medical review activities: Please respond w/in 30 days Include all appropriate records Be aware of signature requirements (PIM, chapter 3, section ) CGS Administrators, LLC November

Discussion Topics Other reminders: Therapy caps Reference CMS MLN Matters article MM8036 and MM7785MM8036MM7785 CGS web article: “Therapy Cap Exception”Therapy Cap Exception Q&As from CGS Ask-the-Contractor Teleconference Q&As CGS Administrators, LLC November

Questions? Revised October 23, 2012 © 2012 CGS Administrators, LLC.