HOSPITAL MEETING Friday, September 1, 2017 8:00 AM 12:00 PM - - PowerPoint PPT Presentation

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HOSPITAL MEETING Friday, September 1, 2017 8:00 AM 12:00 PM - - PowerPoint PPT Presentation

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HOSPITAL MEETING Friday, September 1, 2017 8:00 AM 12:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 11 th Floor Rooms A&B. For more information contact: Elizabeth Quaife at

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HOSPITAL MEETING

Friday, September 1, 2017 8:00 AM – 12:00 PM

Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 11th Floor Rooms A&B. For more information contact: Elizabeth Quaife at 303.866.2083 or elizabeth.quaife@state.co.us & Diana Lambe at 303.866.5526 or diana.lambe@state.co.us.

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Overview of Meeting

  • General Hospital Meeting

8:00-10:00

  • Break

10 min.

  • General Hospital Meeting cont’d

10:10-12:00

  • Lunch

12:00-1:00

  • CC/CCEC Stakeholder Meeting

1:00-2:00

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Colorado Department of Health Care Policy and Financing

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HOSPITAL ENGAGEMENT MEETING TOPICS 9/1/2017 8am-12pm

  • General Hospital Meeting
  • Feedback on Future Meetings
  • Specialty Hospital Rates Methodology Update
  • Cost Settlement Updates
  • Innovative Medications Update
  • Rate Related System Issues Update
  • Suspended Claims
  • a. HCPCs Annual Update
  • b. Drug Related Revenue Code
  • ICD-10 10/1/2017 update on new Diagnosis Codes
  • Mass Adjustment & Testing Adjustments Update
  • EAPG Rule Change
  • EAPG Software Updates
  • Transportation
  • EAPG UD & 25 Modifiers
  • EAPG Mass Adjustment Update

• CCEC/CC Stakeholder Meeting 1pm - 2pm

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GROUND RULES FOR WEBINAR

  • WE WILL BE RECORDING THIS WEBINAR
  • PLEASE MUTE YOUR LINE UNLESS SPEAKING
  • Please speak clearly when asking a question and give your name and

hospital

  • We are going to try to avoid muting the phone lines to encourage

conversation, so please don’t:

  • Put us on hold
  • Drive in your car w/window open while listening
  • Sit in a noisy location
  • Be cautious of side conversations and language (we can

hear you and it is being recording)

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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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Staffing Updates

  • Marguerite Richardson has retired: Cost Settlements have been taken
  • ver by Andrew Larson
  • Andrew Larson: CC/CCEC Analyst questions/concerns contact at

Andrew.Larson@state.co.us

  • Elizabeth Quaife: Specialty Hospital Analyst. Please send all NEW

inquiries for Specialty Hospitals to Elizabeth.Quaife@state.co.us.

  • Raine Henry is currently on leave. For questions in regards to Hospital,

Lab and Telemedicine Policy please contact Ana Lucaci at Ana.Lucaci@state.co.us

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  • 3/3/2017
  • 5/5/2017
  • 7/7/2017
  • 9/1/2017
  • 11/3/2017

Dates for Future Hospital Engagement Meetings in 2017

The agenda for upcoming meetings will be available on our external website in advance of each meeting. https://www.colorado.gov/hcpf/inpatient- hospital-payment Registration links for each session during the day will also be available prior to the meeting. Just click on the links to register for each session and you will receive the link to connect to the webinar. Meetings will now begin at 9am starting with 11/3/2017 meeting

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Future Hospital Engagement Meetings in 2018

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  • Meetings will now begin at 9am
  • Minutes/Summary Helpful for July’s Meeting
  • Suggestions

Engagement Meeting Dates for 2018

01/12/2018 07/13/2018 03/02/2018 09/07/2018 05/04/2018 11/02/2018

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Specialty Hospital Budget Neutral

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Peer Groups Severity of Illness Individual Hospital Stepdown by Days of Service Blanket (all hospitals combined)

  • Attempts at variety of combinations of above components
  • Over 30 different calculations
  • Calculations discarded when too costly for Hospitals or over Budget
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Specialty Hospital Budget Neutral

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Challenges In Calculating Per Diem

  • Calculating differences in the weights from FY 16 to FY 17
  • Which elements to use in Per Diem calculation
  • Each approach required new calculations
  • Making sure utilized information was accurate (removing duplicate claims

and transfer logic applied to LTACs and Rehabilitations)

Per diem Components

  • Manually calculated FY 16 using FY 17 rates
  • Tested against cases for FY 17
  • Grouped into Peer Groups
  • Stepdown in Service Days

➢ Blanket Calculation – Utilized all Hospital service days ➢ Peer Group Calculation – Each peer group received their own calculated service days

  • Medicare Crossover tested in FY 17
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Specialty Hospital Budget Neutral

**Implementation Goal July 1, 2018**

Proposed Step Down Per Diem Rate Using Blanket Calculated Service Days and 5% Stepdown: Q1 $ Q2 $ Q3 $ Q4 - starts $ LTAC 0-21 $2,084.02 22-42 $1,979.82 43-77 $1,880.83 78 $1,786.79 REHAB 0-21 $1,082.20 22-42 $1,028.09 43-77 $976.69 78 $927.85 CRAIG 0-21 $3,070.13 22-42 $2,916.62 43-77 $2,770.79 78 $2,632.25 Proposed Step Down Per Diem Rate Using Peer Group Service Days and 5% Stepdown: Q1 $ Q2 $ Q3 $ Q4 - starts $ LTAC 0-14 $1,989.29 15-35 $1,889.83 36-63 $1,795.33 64 $1,705.57 REHAB 0-14 $1,032.70 15-21 $981.07 22-35 $932.01 36 $885.41 CRAIG 0-28 $2,930.58 29-63 $2,784.05 64-84 $2,644.85 85 $2,512.61

Preliminary Proposed Per Diem Rates (two options) Per Diem Equation

  • Total Peer Group Reimbursement/ Total Group Days
  • Total Peer Group Reimbursement/ Total Peer Group Days

Action Item: Interested in Feedback. Missing components? Favor one option over the other?

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Specialty Hospital Long Term Solutions

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Reviewing possible combinations of: Any budget changes that are not budget neutral must go through the Budget Process

  • Main details decided by Nov 2018
  • Implementation Goal: July 1, 2020
  • Per Diem
  • Stepdown System
  • Severity of Illness
  • Peer Group
  • Quality

Component

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Specialty Hospital Future Meetings/Updates

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  • Set up Monthly Meetings for Specialty Hospitals
  • On a Friday, starting October 6th, 1pm-3pm
  • Obtain Feedback/ Ideas
  • Understand patient’s journey
  • Prior to admission to Specialty
  • During stay at Specialty
  • After discharge from Specialty
  • Volunteers for Onsite Visits

Would like to meet with most LTACs and Rehabs at least

  • nce prior to end of the year.

Specialty Hospital Engagement Meetings 10/06/2017 (1pm-3pm) 11/3/2017 (1pm-2pm) 12/01/2017 (1pm-3pm)

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Cost Settlement Updates

  • Backlog of Settlements from Marguerite’s Retirement

and System implementation have been resolved

  • If you have received a letter from Meyers and Stauffer,

but NOT from the Department, please contact Andrew Larson

  • Process being internally re-developed

➢ Will supply updates as they come up

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Innovative Medication Updates

  • We have been researching various options but this is a very resource

intensive process

  • Received requested information from a few hospitals
  • We welcome and are open to any additional feedback from hospitals
  • Still researching/reviewing all information
  • We are in the process of applying for a grant to investigate the

acquisition cost of drugs

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MASS ADJUSTMENT TESTING UPDATE

227 Claims – Scheduled Process Date 9/8/2017

Numbers are subject to change due to adjustments made by Providers or Department staff

Count of ICN_NBR Column Labels Row Labels ICD10_oldsystem ICD10_wrongversion LVP_3hosp Transfer_Claims Grand Total HealthOne 50 3 1 54 HealthOne North Suburban Medical Center 8 8 HealthOne Presbyterian/St. Luke's Medical Center 7 1 8 HealthOne Rose Medical Center 6 2 8 HealthOne Sky Ridge Medical Center 4 4 HealthOne Spalding Rehabilitation Hospital 1 1 2 HealthOne Swedish Medical Center 9 9 HealthOne The Medical Center of Aurora 15 15 HealthSouth 5 1 15 21 HealthSouth Littleton Rehabilitation 3 6 9 HealthSouth Rehabilitation Hospital of Colorado Springs 2 1 9 12 SCL Health 50 50 Exempla Good Samaritan 4 4 Exempla Lutheran Medical Center 14 14 Exempla Saint Joseph Hospital, Inc. 23 23 Platte Valley Medical Center 3 3

  • St. Mary's Hospital and Medical Center, Inc.

6 6 UC-HEALTH 50 6 56 Memorial Hospital 18 2 20 Poudre Valley Hospital 10 10 University of Colorado Hospital 22 4 26 YAMPA 7 39 46 Yampa Valley Medical Center 7 39 46 Grand Total 162 10 39 16

227

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3M Grouper Software Updates

EAPG – Current Version 3.10.17.1

  • DXC to update EAPG from Version 3.10.17.1 in next month to Version

3.10.17.3. Will accommodate changes for versions 3.10.17.2 & 3.10.17.3

APR-DRG Current Version 33

  • ICD-10 10/1/2017 Update: The Department is planning for the APR-

DRG Version 33 Software to be updated to reflect the ICD-10 10/1/2017 Update on or shortly after 10/1/2017.

Software Updates

  • The Department is working with DXC to create a strategy for

communicating software updates to providers.

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Suspended Claims

Received access to Suspended Claims for analysis

  • Reviewing Data associated with claims

➢ Primary Suspension Claim causes

▪ HCPCs Annual Update ▪ Drug Related Revenue Codes

➢ Continue reviewing minor causes

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Edit/Audit Description Paid Amount ICN Count Drug Related Revenue Code or Procedure $1,810,962.08 5,477 HCPCS - Annual Update $6,153,009.59 14,564 $7,963,971.67 25,889

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EAPG Rule Change

  • 1.4% rate increase approved by CMS

➢ Requires update to Code of Colorado Regulations ➢ Will be presented to Medical Services Board (MSB) 10/13 ➢ Rule can be reviewed on Outpatient Hospital Payment page ➢ Feedback sent to HCPF_Hospitalregulatory@state.co.us.

  • Rate updates will be made pending MSB Approval

➢ Mass adjustment scheduling

  • Increased engagement with rule-making process

➢ Further rule changes will be announced similarly

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Hospital Transportation

  • EMT and Air Ambulance

Enrollment Type: Facility Provider Type: 13- Transportation Specialty Codes:

➢

083- Air- Emergent & Non-Emergent

➢

124- County Agency, Non Metro Area

➢

324- Emergency

  • Transportation Billing Manual, available on the Billing Manuals page

under the CMS-1500 drop-down list.

  • Contact NEMT@state.co.us for questions about transportation policy

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EAPG Modifiers

Modifier UD

  • Applies a 50% reduction rate when utilized for 340B drugs

in EAPGs

  • Assists with Department from collecting additional rebate

from Manufacturer when already applied during provider purchase of drug

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“If a drug is purchased by or on behalf of a Medicaid beneficiary, the amount billed may not exceed the entity's actual acquisition cost for the drug, as charged by the manufacturer at a price consistent with the Veterans Health Care Act of 1992, plus a reasonable dispensing fee established by the State Medicaid agency. “ from Federal Register Volume 59, Number 92 (Friday, May 13, 1994)

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EAPG Modifiers

Modifier 25

  • Default for Modifier 25 is off
  • Weights were set to accommodate Modifier 25 being off
  • To activate Modifier 25

➢ Assessment required of impact of having it off versus on ➢ Require recalibration of weights ➢ Requesting Feedback/documentation supporting Modifier 25 turn

  • n

Action Item: Requesting Providers to utilize Modifier 25 for billing. Additional payment will not be given, but allows a trackable component to view financial impact of 25 being off

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EAPG Webpage

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EAPGs Moving Forward

  • Received several requests for meetings in regards to EAPGs

➢ Biweekly meetings starting September 22nd, 2pm-4pm

Focusing resources on denials

➢ Line level denials – can lead to incorrect grouping logic ➢ Header level denials – causing entire claim to deny ➢ Tracking occurrences and accuracy of denials ➢ Initiating fixes when needed

  • Welcome feedback or examples of errors seen
  • Will continue to provide continuous updates

23 EAPG Meeting Dates: 2pm-4pm 9/22/2017 11/3/2017 10/6/2017 11/17/2017 10/20/2017 12/01/2017

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Questions, Comments, & Solutions

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Thank You!

Ana Lucaci Hospital Policy Specialist Ana.Lucaci@state.co.us Raine Henry Hospital Policy Specialist Raine.Henry@state.co.us Melanie Reece Family Planning Policy Specialist Melanie.Reece@state.co.us Andrew Larson CC/CCEC Rates Analyst Andrew.Larson@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 Hospital Rates Analyst Diana.Lambe@state.co.us Andrew Abalos Hospital Rates Analyst Andrew.Abalos@state.co.us Elizabeth Quaife Specialty Hospital Rates Analyst Elizabeth.Quaife@state.co.us