MDS Alert

Get ready for updated code files for SNF consolidated billing. The annual updated list of HCPCS codes excluded from SNF consolidated billing will be posted at www.cms.hhs.gov/snfconsolidatedbilling. The updated code list goes into effect on Jan. 1, 2007. 

Say goodbye to the Part B rehab therapy cap exceptions as of Jan. 1 unless Congress intervenes ... again. A cap of $1,780 for occupational therapy and $1,780 for physical therapy and speech language and pathology services combined will be in place Jan. 1, 2007 for all settings except the outpatient hospital. Not only that, but the therapy caps exceptions process will no longer be in place as of that date. 

If Congress passes legislation providing exceptions, CMS will act as soon as possible, although the agency won't know if the exceptions would be retroactive until officials see what Congress passes, said Ellen Gay, health information specialist for CMS, during the Nov. 29, 2006 SNF LTC/SNF Open Door Forum.

Got questions about the advance beneficiary notice under development? You can review a pdf of the SNF ABN town hall meeting held in September and a follow-up Q&A document with the most frequently asked questions at the meeting. To access the files, go to
www.cms.hhs.gov/BN/04_FFSSNFABNandSNFDenialLetters.asp#TopOfPage. 

The MDS and care planning are once again in the OIG work plan's cross-hair. The 2007 plan says the OIG will examine "the type, frequency, and severity of nursing home deficiencies" related to MDS assessments and care planning. The agency notes that "in previous studies, [it] identified increases in deficiencies related to comprehensive assessments, care planning" and providing services "in accordance with the care plan."

The OIG also plans to look at how nursing homes have implemented Part D -- and whether dual eligible residents are receiving the drugs they need. And the agency will determine whether SNF submit "no pay" bills as required. You can read the entire work plan at http://oig.hhs.gov/publications/workplan.html.