Friday, March 1, 2019 9:00 AM 12:30 PM Location: The Department of - PowerPoint PPT Presentation

Friday, March 1, 2019 9:00 AM – 12:30 PM Location: The Department of Health Care Policy & Financing, 303 East 17 t h Avenue, Denver, CO 80203. 7 t h Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# Topic Suggestions, due by close of business one week prior to the meeting. S end suggestions to Elizabeth Quaife at elizabeth.quaife@ state.co.us 1

Welcome & Introductions • Thank you for participating today! • We are counting on your participation to make these meetings successful [Poll] 2

• WE WILL BE RECORDING THIS WEBINAR. • ALL LINES ARE MUTED. PRESS *6 IF YOU WISH TO UNMUTE. PARTICIPANTS CAN ALSO UTILIZE THE WEBINAR CHAT WINDOW • If background noise and/ or inappropriate language occurs all lines will be hard muted. • Please speak clearly when asking a question and give your name and hospital 3

Overview of the Day • Hospital Engagement Meeting 9:00-12:30 • Coffee Break TBA 4

5 Colorado Department of Health Care Policy and Financing

Dates and Times for Future Hospital Stakeholder Engagement Meetings in 2019 Dates of Meetings Meeting Time January 11, 2019 12:30 p.m. – 4:00 p.m. March 1, 2019 9:00 a.m. – 12:30 p.m. May 3, 2019 9:00 a.m. – 12:30 p.m. July 12, 2019 12:30 p.m. – 4:00 p.m. S eptember 13, 2019 12:30 p.m. – 4:00 p.m. November 1, 2019 9:00 a.m. – 12:30 p.m. The agenda for upcoming meetings will Please note the offset be available on our external website on dates and times to work a Monday the week of the meeting. around holidays AND https:/ / www.colorado.gov/ pacific/ hcp Medical Services Board f/ hospital-engagement-meetings 6

Topics Provided For Engagement Meetings We great ly appreciat e feedback and t opics provided prior t o t he Engagement Meet ings as request ed. To encompass t hese more effect ively, st art ing on May 3 rd , slide(s) will be dedicat ed at t he beginning of each appropriat e sect ion of t he meet ing t o include t he quest ion from t he S t akeholder and Department ’ s response when possible. Example: A quest ion regarding EAPG/ Out pat ient will be at t he beginning of t he EAPG/ Out pat ient designat ed sect ion of t he meet ing. Followed by t he response or st at us. An individual response back t o t he Provider will st ill occur but t his will allow all Providers t o see t he t opics and responses submit t ed. 7

Topics Provided For Engagement Meetings Topics for the Engagement Meetings can be sent to Elizabeth Quaife anytime from the day after the recent Hospital S takeholder Engagement Meeting up to the Friday before the next Hospital S takeholder Engagement Meeting. All topics and whom they originated from are tracked. 8

Upcoming Topics/Discussions May 3, 2019 Hospital S takeholder Engagement Meeting • UB-04: IP and OP Billing Manual Update 9

Webpage Updates Webpages were required to be reviewed and updated by January 31, 2019. The following changes have been made: Inpatient Hospital Rates Page • Long Term Acute Care Hospitals, Rehabilitation Hospitals, Spine/Brain Injury Treatment Hospitals and Psychiatric Hospitals APR-DRG rates were removed and moved to Inpatient Hospital Per Diem Reimbursement page Outpatient Hospital Rates Page • Old EAPG survey link was removed • Added September 7, 2018 and November 2, 2018 Provider Summaries • Awaiting new link to the 3M Definitions Manual. Link is currently disabled Inpatient Hospital Per Diem Reimbursement Page • APR-DRG Rate page updated to include new hospital: Vibra Rehabilitation Hospital • Per Diem Rate Page updated to include new hospital and correct terminology 10

Webpage Updates (cont.) Hospital Stakeholder Engagement Meeting Page • Old meeting information can only be posted for two years (current calendar year and previous year) • To request meeting documents for calendar year 2017, please send an email to Elizabeth Quaife • Meeting Summaries uploaded • Hospital Stakeholder Engagement Meeting Summary, November 2, 2018 • Per Diem Hospital Engagement Meeting Summary, November 2, 2018 • During the quality check, it was found the Hospital Stakeholder Engagement Meeting PowerPoint for January 12, 2018 was incorrect. Correct PowerPoint has been uploaded • The 2019 Meeting schedule dates and times has been uploaded 11

Status Update for SCRs Department SCR prioritization is re-evaluated every two weeks. The Department considers factors such as:  financial risk,  impact on providers,  relative magnitude, etc. The Department is committed to moving forward with these important changes, and will continue to provide updates as they are available. SCR Prioritization Priority #2 , on hold until Inpatient PAR is Medicare Crossover Claims implemented Priority #7 , on hold until Inpatient PAR is IPP-LARCs implemented Per Diem Hospital Rates (LTACs/Rehabs) Priority #24 Observations over 24 hours/24-48 hours Not Yet Prioritized JW Modifier Not Yet Prioritized 12

Part B Only and Part A Exhaust Workaround The Department is working on a method to reprocess Part B Only and Part A Exhaust claims. Please send Part B Only and Part A Exhaust Inpatient ICNs by March 8, 2018 to Raine.Henry@state.co.us We will be prioritizing claims with DOS and Paid Dates prior to April 1, 2017. 13

Community Clinic and Community Clinic and Emergency Center (CC/CCEC) Reminder CC/ CCECs previously enrolled as a hospital provider type and/ or billing through their main hospital ID need to enroll as and bill under the CC/ CCEC provider type for dates of service beginning December 1, 2018, going forward. Details on enrolling as in the CC/ CCEC provider type can be found on the Information by Provider Type page under Community Clinic. 14

Inpatient Hospital Review Program (IHRP) • Information regarding IHRP authorization requirements can be found on eQHealth’ s website: http:/ / www.coloradopar.com/ Inpatient.aspx • Additional information regarding S B 18-266 Controlling Medicaid Costs Initiatives can be found here: https:/ / www.colorado.gov/ pacific/ hcpf/ controlling-medicaid-costs- initiatives • Please see https:/ / www.colorado.gov/ hcpf/ provider-news for regular provider updates and to sign up for the IHRP Newsletter email list • For questions and/ or comments please email: HospitalReview@ hcpf.state.co.us 15

FY2019-20 Hospital Base Rates  S till working on base rate development for this year and working toward having a first look available by sometime in April.  Diana will be unavailable during the month of March to finish building FY2019-20 hospital base rates. For emergency requests – please contact Kevin Martin. 16

30-day Review Period  After rates are built, the S tate provides a 30-day review period during which hospitals can request their rate calculations for review and ask specific questions about how their rate was created.  We wholeheartedly encourage hospitals to ask for their calculations since despite our quality checks, we do manage to find data entry issues. The data we receive from the hospital intermediaries is in print format and cannot be uploaded to a spreadsheet and therefore requires a lot of data entry.  Every year as part of the rate building process, documents are prepared to send calculations to any hospital that requests them. 17

30-day Review Period  We continue to find that some hospitals are unaware when the 30- day review period starts and ends.  Current Communication consists of: 1. Provider Bulletin 2. Emails to list of individuals entered on Hospital Engagement Meeting email list 3. Notice given during Hospital Engagement Meetings 4. Rates Loaded to Inpatient Hospital Payment webpage 5. Ideas on other ways to get the word out?  How can we improve that communication? 18

Separating Baby from Mother’s Claim DRG APR-DRG DESCRI PTI ON To make t he change, 589 Neonate bwt < 500g or GA < 24 weeks 634 Neonate, birthwt > 2499g w resp dist synd/ oth maj resp cond t he Depart ment has 630 Neonate birthwt > 2499g w major cardiovascular procedure been working on a plan 588 Neonate bwt < 1500g w major procedure 593 Neonate birthwt 750-999g w/ o major procedure t o present t o hospit als 612 Neonate bwt 1500-1999g w resp dist synd/ oth maj resp cond 602 Neonate bwt 1000-1249g w resp dist synd/ oth maj resp or majanom which will consist of t he 591 Neonate birthwt 500-749g w/ o major procedure following universe of 640 Neonate birthwt > 2499g, normal newborn or neonate w other problem 625 Neonate bwt 2000-2499g w other significant condition Delivery & Neonat al 614 Neonate bwt 1500-1999g w or w/ o other significant condition 639 Neonate birthwt > 2499g w other significant condition DRGs: 607 Neonate bwt 1250-1499g w resp dist synd/ oth maj resp or majanom 631 Neonate birthwt > 2499g w other major procedure DRG APR-DRG DESCRI PTI ON 633 Neonate birthwt > 2499g w major anomaly 540 Cesarean delivery 609 Neonate bwt 1500-2499g w major procedure 560 Vaginal delivery 622 Neonate bwt 2000-2499g w resp dist synd/ oth maj resp cond Vaginal delivery w complicating 611 Neonate birthwt 1500-1999g w major anomaly 541 procedures exc sterilization &/ or 583 Neonate w ECMO D&C 608 Neonate bwt 1250-1499g w or w/ o other significant condition Vaginal delivery w sterilization 542 621 Neonate bwt 2000-2499g w major anomaly &/ or D&C 626 Neonate bwt 2000-2499g, normal newborn or neonate w other problem 19