MHA Today | September 13, 2016

September 13, 2016

MHA Today: News for Healthcare Leaders
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In This Issue
Congressional Committee Leaders Query CMS On Fraud Preventions
FSD Releases Presumptive Eligibility Plan
CMS Resumes Short-Stay Patient Status Reviews


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Journey to Excellence: How High-Performing Health Care Leaders Achieve Organizational Success — ACHE Program
Thursday, Sept. 29
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Advocate
state and federal health policy developments


Congressional Committee Leaders Query CMS On Fraud Prevention

Staff Contact: Daniel Landon

The chairs of seven congressional committees overseeing health care policy have written a letter to the Centers for Medicare & Medicaid Services about the agency’s implementation of fraud prevention initiatives. It notes that “improper payments remain an enormous problem for the Medicare Program” and that “[we] are concerned that the FPS continues to rely primarily on outdated “pay and chase” activities rather than focusing on preventing potentially fraudulent dollars from going out in the first place.” The letter also poses several questions about Medicare’s Zone Program Integrity Contractors.

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FSD Releases Presumptive Eligibility Plan

Staff Contact: Steve Renne

The Family Support Division has released a transition plan for Medicaid providers interested in enrolling as a presumptive eligibility qualified entity. Between now and Wednesday, Nov. 30, the state is proposing to transition existing and new organizations to the updated presumptive eligibility regulations. The updated rules will bring Missouri into compliance with the provisions of the Affordable Care Act. Hospitals can perform Medicaid presumptive eligibility determinations for parents and children if they enter into a memorandum of agreement. Various resources are available on FSD’s website. MHA is hosting a webinar presented by FSD regarding the issue. Register online.

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Regulatory News
the latest actions of agencies monitoring health care


CMS Resumes Short-Stay Patient Status Reviews

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services temporarily paused short-stay inpatient status reviews by the beneficiary and family-centered care quality improvement organizations beginning May 4. CMS has announced that effective Sept. 12, BFCC QIOs will resume initial patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals and inpatient psychiatric facilities. CMS is lifting the pause because of the following.

  • BFCC QIOs successfully completed retraining on the two-midnight policy
  • BFCC QIOs completed a re-review of claims that previously were denied
  • CMS examined and validated the BFCC QIO peer review activities
  • BFCC QIOs performed provider outreach on claims impacted by the temporary suspension
  • BFCC QIOs initiated provider outreach and education regarding the two-midnight policy


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Consider This ...

Today is World Sepsis Day. Eighty percent of sepsis begins outside of the hospital for nearly 80 percent of patients. Four types of infections are most often associated with sepsis: lung, urinary tract, skin and gut.

Source: Centers for Disease Control and Prevention