MHA Today | May 9, 2016

May 9, 2016
MHA Today: News for Healthcare Leaders

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet. Connect with us on LinkedIn.

In This Issue
Medicaid Updates Restorative Dental Services Provisions
MHA Comments On Medicare Part B Drug Payment Rule
CMS Updates RAC ADR Limits
CMS Posts Preview Reports
CDC Reports On State Health Care Utilization

What You Need To Know This Week

  • Celebrate Missouri hospitals during National Hospital Week!
  • Just five more days in this year’s legislative session – stay tuned for possible alerts.

state and federal health policy developments

Medicaid Updates Restorative Dental Services Provisions

Staff Contact: Steve Renne

Effective for service dates on or after Sunday, May 15, the reimbursement for restorative dental services will be based on the number of unique surfaces per tooth, per date of service.

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MHA Comments On Medicare Part B Drug Payment Rule

Staff Contact: Daniel Landon

MHA has submitted comments regarding the Centers for Medicare & Medicaid Services’ proposed rule to create a new system for paying for drugs under the Medicare Part B Program. MHA previously released an issue brief on the topic, and provided members with hospital-specific cost implications through HIDI Analytic Advantage®. District-specific data on the hospital cost implications was distributed to Missouri congressional staff.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Updates RAC ADR Limits

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services announced a change to the additional documentation request limits for Medicare institutional providers under the Recovery Audit Contractor Program. The new ADR limits are two-pronged. The first will include a limit of .5 percent of the provider’s total number of paid claims from the previous 12 months, then divided by eight to serve as a 45-day cycle limit. After three 45-day cycles have been completed, the facility denial rate will be calculated. The ADR limit would then be set based on the denial rate table as follows.

Denial Rate (Range) Adjusted ADR Limit (Percent of Total Paid Claims)
91-100% 5.0%
71-90% 4.0%
51-70% 3.0%
36-50% 1.5%
21-35% 1.0%
10-20% 0.5%
4-9% 0.25%
0-3% No reviews for three (45-day) review cycles

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Quality and Population Health

CMS Posts Preview Reports

Staff Contact: Dana Dahl

The July 2016 Hospital Compare outpatient preview reports now are available for participating hospitals through Saturday, June 4. Hospital-specific reports for the fiscal year 2017 Inpatient Quality Reporting Program claims-based measures also are available for preview through June 4. Both reports are posted on the QualityNet Secure Portal.

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CDC Reports On State Health Care Utilization

Staff Contacts: Daniel Landon or Leslie Porth

The Centers for Disease Control and Prevention has published an analysis of state variation in having a “usual place of care” or having seen a “general doctor” in the previous 12 months. The study year is 2014.

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Consider This ...

Yesterday was Mother’s Day and the first day of National Hospital Week. In 2015, 73,972 babies were born in Missouri hospitals.

Source: Hospital Industry Data Institute