September 30th, 2016
Medicaid released information that provides an update to the New Jersey Supplemental Prenatal Care Program (NJSPCP). This program provides prenatal medical care to pregnant women who would have qualified for the NJ FamilyCare Program, if they didn’t have immigration status. (See Attachment).
- The September 19, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
- PET scan claims are denying for missing/invalid diagnosis code. PET scan HCPCs 78816 and 78815 refer to cancer. These claims must have a cancer diagnosis code. Covered cancer diagnosis codes are found at:
New York Medicaid
New York Medicaid issued new 2017 ICD-10 codes for services provided from October 1, 2016 through September 30, 2017. The list is located at www.eMedNY.org.
Self Pay: Did you Know?
Certain insurance companies (NJ Cure) are known for sending payments which have the comment “if cashed, claim is considered “paid in full” and you will not bill the insured. Did you know that even if you DO cash the check, you have 90 days to RETURN the monies to the insurance company and pursue them for full payment?
State Issue: Property Tax
- NJHA sent out a blast e-mail to legislators in mid-August to call for swift passage of A-3635/S-2329, the moratorium and study commission bill, and A-3888/S-2212, known as the “standing” bill, which would prohibit third party tax appeals.
- There are 35 property tax related litigations against not for profit hospitals in New Jersey outstanding in relation to the property tax issue.
- FY 2017 IPPS Final Rule
- The final rule was released at the beginning of August, the below provisions will go into effect October 1, 2016.
- Imputed Wage Index Floor – CMS finalized an extension of the imputed “rural” wage index floor policy for one year. The final imputed wage index floor for New Jersey in FY 2017 is 1.1358, an increase from the proposed FY 2017 value of 1.1257. According to the data currently published in CMS’s wage tables and NJHA’s modeling, the one-year extension of the imputed floor provision will benefit 18 New Jersey hospitals by $40.5 million in combined Medicare inpatient and outpatient payments in FY 2017.
- Medicare Disproportionate Share Hospital (DSH) Reductions – CMS continues the Medicare Disproportionate Share Hospital (DSH) payment policy as mandated by the ACA.
- For FY 2017, using Congressional Budget Office (CBO) estimates of the uninsured population from March 2015, CMS will retain 55.36% of the 75% uncompensated care pool, down from the 63.69% retained in FY 2016.
- NJHA estimates a statewide reduction of $8.4 million in Medicare DSH payments in FY 2017 as compared to final FY 2016 Medicare DSH payments.
- In addition, CMS did not finalize its proposal to begin the transition to Worksheet S-10 data for the Medicare DSH calculation in FY 2018.
- Numerous commenters, including NJHA, expressed concerns regarding the quality of the data and urged the agency to delay the transition. The rule articulates that CMS expects to use Worksheet S-10 data in the calculation of Factor 3 in the future, no later than FY 2021.
- In the interim, the agency will explore other ways of determining uncompensated care as used in Factor 3 of the DSH formula until the Worksheet S-10 data is ready for use.
- Hospital Readmissions Reduction Program (HRRP)
- CMS will add readmissions following coronary artery bypass graft (CABG) surgery to the HRRP for FY 2017. This is in addition to the four conditions that are already part of the program – pneumonia, heart failure and heart attack, chronic obstructive pulmonary disease (COPD) and total hip/total knee arthroplasties (THA/TKA).