HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 9:00 AM 12:00 PM - - PowerPoint PPT Presentation

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HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 9:00 AM 12:00 PM - - PowerPoint PPT Presentation

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HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 9:00 AM 12:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode:

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HOSPITAL ENGAGEMENT MEETING

Friday, May 4, 2018 9:00 AM – 12:00 PM

Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 7th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us

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Overview of Meetings

  • General Hospital Meeting

9:00-10:00

  • Break

10 min.

  • General Hospital Meeting cont’d

10:10-12:00

  • Lunch Break

12:00-1:00

  • EAPG Engagement Meeting

1:00-3:00

  • Specialty Hospital Meeting

3:00-4:00

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Colorado Department of Health Care Policy and Financing

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HOSPITAL ENGAGEMENT MEETING TOPICS 5/4/2018 9am-12pm

· General Hospital Meeting

  • Specialty Hospital Update
  • Items Pending Additional Research/Action
  • Medicare Crossover: 12X & Part A Exhausted prior to stay
  • Interim Billing Rules
  • TC/26 Modifiers
  • Baby on Mom's Claim Update
  • FY 2018-19 Hospital Base Rates Update
  • Mass Adjustment Updates (INPATIENT ONLY)
  • Inpatient Future Plans/Goals
  • Type of Bill 85X
  • Outpatient Future Plans/Goals
  • Staffing Updates
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GROUND RULES FOR WEBINAR

  • WE WILL BE RECORDING THIS WEBINAR
  • ALL LINES ARE MUTED. PLEASE UTILIZE WEBINAR CHAT

WINDOW

  • Please speak clearly when asking a question and give your

name and hospital

  • If you wish to utilize the conference line for speaking, please

submit the request through webinar chat window. We will temporarily mute the microphones and activate the conference line. This may take a few moments.

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Welcome & Introductions

  • Thank you for participating today!
  • We are counting on your participation to

make these meetings successful

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  • 1/12/2018
  • 3/2/2018
  • 5/4/2018
  • 7/13/2018
  • 9/7/2018
  • 11/2/2018

Dates for Future Hospital Engagement Meetings in 2018

The agenda for upcoming meetings will be available on our external website in advance of each meeting. https://www.colorado.gov/pacifi c/hcpf/hospital-engagement- meetings Meetings will now begin at 9am starting with 11/3/2017 meeting

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Audio

The Department has been experimenting and researching other options for audio. Unfortunately, we have not found a way to include quality sound in the room while including the conference line. Additional request for equipment has been made but the conference line will continue to stay muted and

  • n stand by while we utilize microphones in the

room. If you would like to speak through the phone line, please submit the request in the chat box and we will take a moment to change over. We appreciate your patience and participation.

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Agenda Items

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If you wish to request a topic for our next meeting. Please submit the request by the week prior to the meeting to ensure enough time is allowed to gather correct personnel and information on the topic. If a topic is submitted the week of the meeting, we cannot guarantee enough research will be completed to present at the meeting. However it will be carried over to the following meeting and any actionable items will be followed up with the Provider as soon as possible. Send all requests to Elizabeth Quaife at elizabeth.quaife@state.co.us The Meeting Agenda is posted on Monday the week of the meeting to

  • ur Hospital Engagement Meeting Website.
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Proposed Meeting Changes

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Starting July 13th we would like to align EAPG Meetings to the Hospital Engagement Meeting. This means EAPG meetings will be held from 11am-12:30pm every month. EAPGs will still continue on a monthly basis. Dates will remain unchanged. Provider Input: Is this agreeable or would we like to continue separate meetings?

Proposed Schedule on Meeting Days

Meeting Portion Time Hospital Engagement Meeting 9:00am-10:40am Break 10:40am EAPG Engagement Meeting 11:00am-12:30pm

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Specialty Hospital Meetings

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Finalizing Budget Neutral Per Diem

Specialty Hospital Engagement Meetings 3/2/2018 1pm-2pm 4/6/2018 1pm-2pm 5/4/2018 3pm-4pm 6/1/2018 3pm-4pm

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Specialty Hospital Per Diem

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CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 $2,188.44 35 $2,079.02 56 $1,975.07 >56 $1,876.31 REHAB 7 $962.63 14 $914.50 21 $868.77 >21 $825.33 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13 CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 21 $2,172.96 35 $2,064.31 56 $1,961.09 >56 $1,863.04 REHAB 14 $944.23 21 $897.02 28 $852.17 >28 $809.56 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13

Final Draft Options: Have already started obtaining preliminary approvals through the Department

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Pending Additional Research and/or Actions

The following items have been discussed at previous meetings and are pending while additional research and/or processes are being completed. An update is planned for July 13th meeting.

  • Medicare Part A exhaust during stay
  • IPP-LARCs
  • Observations over 24 hours

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Transportation (ambulance)

Reminder please send inquiries or questions in regards to policy to the NEMT mailbox. Email Address: NEMT@hcpf.state.co.us

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12X & Part A Exhaust Prior to Stay

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Interim Billing Rules

Type of Bill 112

  • Reimbursed charges from Health First Colorado

should be at a minimum of $100,000.00 (not billable charges)

  • Patient Status: 30, still a patient
  • Health First Colorado is primary payee. Medicare

Crossovers and other 3rd party payers do not qualify for interim billing

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**Rule language has been update for new Billing Manual Version

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Interim Billing Rules (cont.)

Type of Bill 113

  • Additional $100,000 in reimbursed dollars from

Health First Colorado (Total $200,000 minimum)

  • Patient Status: 30, still a patient
  • Health First Colorado is primary payee. Medicare

Crossovers and other 3rd party payers do not qualify for interim billing

  • Type of Bill 112 must be voided prior to Type of Bill

113 being submitted

  • Claim start date must be the admit date or

reimbursement/APR-DRG may be impacted

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Interim Billing Rules (cont.)

Type of Bill 114

  • Final Interim Bill after patient has been discharged
  • All previous interim bills must be voided prior to

submitting final bill

  • Health First Colorado is primary payee. Medicare

Crossovers and other 3rd party payers do not qualify for interim billing

  • Claim must be billed for entire stay, from Admin

date to Discharge date for accurate grouping and reimbursement

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TC/26 Modifiers

  • TC and 26 modifiers must be appended to

procedure codes that allow the modifiers if only

  • ne component of the service was performed.
  • Submitting a code that allows TC or 26 without a

modifier signifies that the global service was performed by the submitting provider.

  • Only the global service or the TC/26 modifier

combination will be paid, other combinations will be denied as duplicate services.

  • Procedure codes that allow TC and 26 can be found
  • n the Department’s Fee Schedule.

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TC/26 Modifiers

  • Claims missing the TC modifier must be rebilled in
  • rder for the professional claim with the 26

modifier to process correctly.

  • The Department will work with providers to

address claims that hit timely filing after being rebilled for this reason.

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Baby on Mom’s Claim - Update

  • The Department is identifying the institutional

claims denying for age and/or gender edits and a transmittal has been sent to begin reprocessing these claims. A reprocess date has not yet been set for these claims.

  • The Department is reprocessing professional claims

containing the UK modifier that denied for age and/or gender edits. The first wave of these claims processed in the 4/20/18 cycle.

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Baby on Mom’s Claim - Reminder

As previously discussed, if the baby stays after the mother is discharged, the baby will start their own claim based on the reason that they are staying past the mother's discharge. Using a newborn/live birth diagnosis code (Z38, Z38X or Z38XX) as primary diagnosis on the baby’s independent claim may cause the claim to be ungroupable and result in appropriate denial. If this happens, the hospital should focus admitting and primary diagnoses around the reason why the child is staying in the hospital and resubmit the claim. UB 04: IP and OP Billing Manual page 6 Additionally, for professional baby on mom claims the UK modifier needs to be present for the Department to identify the claim as a mom/baby claim.

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Baby on Mom’s Claim Moving Forward

Multiple groups within the Department are currently working on separating the baby from the mother’s

  • claim. Currently working on:
  • System updates
  • Timeline for system implementation
  • Recalibration of weights
  • Rule & Policy changes

The anticipated timeline and process will be communicated with Providers in future meetings.

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FY18-19 Hospital Base Rate Update

CMS has finally issued Table 14 but renamed it: CMS-1677-N Table 1 [ZIP, 54KB] With this table, we have the information we need to calculate the Low Volume Payment (LVP) Adjustment for Hospitals who qualify. Regarding qualification: Hospitals who have currently been approved for LVP through their fiscal intermediary (Novitas, WPS) are as follows:

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CMS-1677-N Table 1 --- LIST OF HOSPITALS WITH FEWER THAN 1,600 MEDICARE DISCHARGES BASED ON THE MARCH 2017 UPDATE OF THE FY 2016 MedPAR FILE AND POTENTIALLY ELIGIBLE HOSPITALS FOR THE FY 2018 LOW VOLUME HOSPITAL PAYMENT ADJUSTMENT (Eligibility for the low-volume hospital payment adjustment is also dependant upon meeting the mileage criteria specified at 42 CFR 412.101(b)(2)(iii)) CMS Certification Number (CCN) Hospital Name Medicare Discharges FY 2018 Low-Volume Payment Adjustment (Percentage Add-on)* LVP approved by Fiscal Intermediary

060004

BRIGHTON COMMUNITY HOSPITAL ASSOCIATION

1038 0.100357

YES

060006

MONTROSE MEMORIAL HOSPITAL

1264 0.060000

YES

060008

SAN LUIS VALLEY

647 0.170179

YES

060016

ST THOMAS MORE

874 0.129643

YES

060030

MCKEE MEDICAL CENTER

1495 0.018750 060036

ARKANSAS VALLEY

642 0.171071 060043

KEEFE

36 0.250000

Receives Peer Grp Rate

060044

COLORADO PLAINS

440 0.207143

YES

060049

YAMPA VALLEY

484 0.199286

YES

060054

COMMUNITY HOSPITAL GRAND JUNCTION

1113 0.086964 060071

DELTA COUNTY MEMORIAL HOSPITAL

891 0.126607

YES

060075

VALLEY VIEW HOSPITAL ASSOCIATION

1012 0.105000

YES

060076

STERLING

523 0.192321 060096

VAIL VALLEY

360 0.221429

YES

060103

AVISTA ADVENTIST HOSPITAL

759 0.150179 060117

ANIMAS SURGICAL HOSPITAL, LLC

289 0.234107 060118

ST ANTHONY SUMMIT

210 0.248214

YES

060124

ORTHO COLORADO HOSPITAL

1525 0.013393 060125

CASTLEROCK ADVENTIST

907 0.123750 060126 BANNER HEALTH-FT. COLLINS 173 0.250000

*This table lists IPPS hospitals with fewer than 1,600 Medicare discharges based on the March 2017 update of the FY 2016 MedPAR files and is not a listing of the hospitals that qualify for the low-volume adjustment for FY 2018; it does not reflect whether or not the hospital meets the mileage criterion (that is, the hospital must also be located more than 15 road miles from any other IPPS hospital).

Hospitals listed in italics participate in CMS Rural Community Hospital Demonstration

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FY18-19 Hospital Base Rate Update

Hospitals who are NOT participating in the CMS Rural Community Hospital Demonstration will not receive LVP in their Medicare Base Rate until: 1) they contact fiscal intermediary for approval, 2) fiscal intermediary reproduces their DRG Disclosure which shows LVP and 3) contact Diana.Lambe@state.co.us or 303.866.5526 so I can request new DRG Disclosure from fiscal intermediary.

Please contact Diana Lambe ASAP if you have any questions about your LVP Status

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FY18-19 Hospital Base Rate Update

FY2018-19 Medicaid Base Rate Notifications

  • We are following the same procedure we did last year and will post the

proposed rates for all hospitals to review for 30 days.

  • The Department will send an email out to all hospitals when the base rates are
  • loaded. Please enter your email on this site in order to receive notice when

the rates will be posted.

  • When posted, rates will be found here:

https://www.colorado.gov/hcpf/inpatient-hospital-payment

  • Goal is to have rates out on site June 1st, but this is best case scenario.

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Stop! Sign up now!

  • 1. To the right under Web Links. Select

‘Engagement Meeting Email Sign Up’

  • 2. Fill out the minimum required fields:
  • 3. Select option 11: Hospital

Engagement Meeting by clicking the square!

  • 4. Then hit the yellow ‘Sign Up’ button at

the bottom

Thank you!!!

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Legacy Xerox Mass Adjustment Update

Approximately 4,500 denied claims will be run this week for mass

  • adjustment. Claims that had:
  • new 10/1/2016 ICD-10 diagnosis & surgical procedure codes which were not

recognized by grouper and caused the claim to deny

  • detail dates of 1/1/1900 (inserted during conversion)
  • It is likely that not all these claims will pay since some of them

correctly denied or were modified by the hospital and resubmitted later.

  • We do, however, expect some to pay and will be going over the results

to ensure all denials are for legitimate reasons (non-conversion related reasons).

  • Depending on how this goes, we will move on to paid claims which will

require testing to avoid unintended consequences.

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Inpatient Base Rate Reform (Inpatient Future Goals/Plans)

  • Base Rate Methodology:
  • Using the Medicare Base Rate as our starting point for Medicaid Base Rates

will continue to put us at risk of changes implemented at the Federal level.

  • The Department will present other base rate options at future meetings but

we welcome feedback on potential alternatives.

  • APR-DRG Weights:
  • The Department is considering switching to using 3M’s National Weights,

Average Length of Stay and Trim Points once Baby on Mom’s birth claims are

  • separated. This would allow us to remain more current with all 3M APR-DRG

version updates which happen yearly. The State is currently processing APR- DRG version 33.

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Type of Bill 85X

  • Medicare Crossover Claims for Critical Access

Hospitals

➢ interChange system supported TOB 85X claims as of

11/15/2017

➢ Denied claims were not reprocessed in larger effort to

correct pricing to Medicare coinsurance and deductible

➢ Several claims out of timely from post-interChange

implementation

➢ Transmittal created for resubmission of around 25,000

claims

➢ Aiming for completion date in May financial cycles

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EAPG Monthly Meetings

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2018 Meetings, Conference Room 7B, 1:00pm-3:00pm 05/04/2018 06/01/2018 07/13/2018* 08/03/2018 09/07/2018* 10/05/2018

*Merged back to Engagement Meetings? Time would be adjusted to 11:00am

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Agenda for EAPG Meeting

including but not limited to:

  • 3M visit scheduled for June 1st
  • Drug payments in EAPGs
  • 340B Discount, Rate Change

➢ Upcoming Rule Change – Details at

https://www.colorado.gov/pacific/hcpf/outpatient-hospital- payment

  • EAPG Grouper Version Updates

➢ Service Pack Differences

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Agenda for EAPG Meeting (cont.)

  • Mass Adjustment Updates

➢ Xerox MMIS EAPG claims (369,040 claims) ➢ Distinct Procedure Modifiers (XE, XS, XU, XP) (492 claims)

  • Legacy MMIS EAPG claim review
  • Questions and comments regarding EAPG payments,

billing, etc.

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Outpatient Future Plans/Goals

  • Resume discussions on EAPG Base Rate Reform

➢ How to determine base rates ➢ Appropriate add-ons to include ➢ Other considerations?

  • Continued analysis on drug services
  • Future modifications to EAPG methodology

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Staffing Updates

Andrew Larson resigned from the Department effective 3/16/2018

  • For assistance on Cost Settlements please contact

Andrew Abalos at andrew.abalos@state.co.us

  • For assistance on CC/CCEC Rates please contact

Elizabeth Quaife at elizabeth.quaife@state.co.us

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Questions, Comments, & Solutions

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The final poll is now an external survey to provide anonymity, please take a few moments to complete it. Thank you

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Thank You!

Elizabeth Quaife Specialty Hospital Rates Analyst Elizabeth.Quaife@state.co.us Ana Lucaci Hospital Policy Specialist Ana.Lucaci@state.co.us Raine Henry Hospital Policy Specialist Raine.Henry@state.co.us Jeremy Oat Operations Section Manager Jeremy.Oat@state.co.us Shane Mofford Payment Reform Section Manager Shane.Mofford@state.co.us Kevin Martin Fee for Service Rates Manager Kevin.Martin@state.co.us Diana Lambe Inpatient Hospital Rates Analyst Diana.Lambe@state.co.us Andrew Abalos Outpatient Hospital Rates Analyst Andrew.Abalos@state.co.us