logo
Archive

Cms Grouper Tool 2020

author
Paul Gonzalez
• Tuesday, 19 October, 2021
• 21 min read

Included in the v02.1.21 HH PPS Grouper software update are the FY 2021 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes, effective beginning January 1, 2021 The PDG, or Home Health PPS Grouper Software (Hogs), relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds.

pdgm impact health tool patient driven groupings oasis under fazzi cms agency revenue simplified accuracy coding documentation important even encouraged
(Source: www.fazzi.com)

Contents

In conjunction with the implementation of the PDG, there will be a change in the unit of home health payment from a 60-day episode to a 30-day period. Archived versions of the Home Health Prospective Payment System (HH PPS) Grouper are available for download.

The HH PPS Grouper software will only work for OASIS submissions with an assessment completion date from through December 31, 2019. Included in the v02.1.21 HH PPS Grouper software update are the FY 2021 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes, effective beginning January 1, 2021.

Implementation of New International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes, Effective April 1, 2020 : Both U07.1, COVID-19 and U07.0, Vaping-related disorder are assigned to the Medication Management, Teaching and Assessment-Respiratory (MMTA-Respiratory) clinical group for purposes of case-mix adjustment under the HH PPS.

The PDG relies more heavily on clinical characteristics, and other patient information to place home health periods of care into meaningful payment categories. One case-mix variable is the assignment of the principal diagnosis to one of 12 clinical groups to explain the primary reason for home health services.

This version 5.00 Final, effective October 1, 2020, replaces the v5.00 Beta posted previously. This second beta release addresses the issue encountered by Vent era in regard to error code 9.

manage dashboard multiple tools single commander cms
(Source: www.wpkube.com)

A Beta test release of CMG version 5.00 is now available to assist providers and vendors in the transition of the program from DLL to Java JAR. The prior CMG and DLL Versions were both 4.01, allowing processing of IRFA assessments with discharge date on or after 4/1/ 2020.

It uses the Quality Indicator items, incorporates an unweighted motor score calculation, contains revised case-mix groups, and updates the ICD-10-CM codes used by the CMG grouper. NOTE: During the beta testing, there were errors in the DLL for low motor score values documented in Appendix E. These errors were corrected for the final release.

This new version incorporates revisions to the list of comorbidities used by the CMG grouper. This new version incorporates revisions to the list of comorbidities used by the CMG grouper.

This new version incorporates a correction to the handling of comorbidities by the CMG grouper. The test data files posted with the original CMG 2.81 package are flawed.

Comorbidity Tier assignment is made on the basis of the presence of specific single ICD-10-CM diagnosis codes and on the basis of specific ICD-10-CM code combinations. The only changes with the final version of CMG 2.70 (from the previous draft version) is to remove the word “Draft” from the file names and documentation headers of “Technical documentation.pdf” and Program documentation.pdf”.

intellicad cms iges step software mechanical cadprofi import export 3d techyv 2d
(Source: www.intellicad.org)

The major change with draft version of CMG 2.70, from the current version CMG 2.60, is to accommodate the expansion of the comorbidities (Item 24 on the IRFA) from a maximum of 10 ICD-9 codes to a maximum of 25 ICD-9 codes. CMG V2.70 Corrected XML Test Data (ZIP) : In the XML test data included with the CMG 2.70 package, an incorrect format has been used for Item 24 comorbidities that are skipped.

The data specifications require a skipped comorbidity to be coded as a single caret but the test data has been coded as a caret with trailing blanks . These errors have been corrected in a new XML test data file (CM1F15V9 xml.zip) now available for download.

The update adds a third item explaining XML test data problems and the corrections made. Section 1886(d) of the Act specifies that the Secretary shall establish a classification system (referred to as Dogs) for inpatient discharges and adjust payments under the IPS based on appropriate weighting factors assigned to each DRG.

Therefore, under the IPS, we pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary's stay is assigned. Congress recognized that it would be necessary to recalculate the DRG relative weights periodically to account for changes in resource consumption.

Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually. Currently, cases are classified into Medicare Severity Diagnosis Related Groups (Madras) for payment under the IPS based on the following information reported by the hospital: the principal diagnosis, up to 24 additional diagnoses, and up to 25 procedures performed during the stay.

dashboard cms covid metrics rolls monitor safety help tool another
(Source: www.wsoctv.com)

In a few Madras, classification is also based on the age, sex, and discharge status of the patient. Effective October 1, 2015, the diagnosis and procedure information is reported by the hospital using codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).

For additional information on the MS-DRG system, including yearly reviews and changes to the Madras, please view prior Inpatient Prospective Payment System (IPS) proposed and final rules located in the left navigational area of this page. CMS is hosting a listening session that will describe the Medicare-Severity Diagnosis-Related Group (MDR) Complication and Comorbidity (CC)/Major Complication and Comorbidity (MCC) Comprehensive Analysis discussed in the FY 2020 Inpatient Prospective Payment System (IPS) proposed and final rules.

This listening session will include review of the methodology to measure the impact on resource use and will provide an opportunity for CMS to receive public input on this analysis and to address any clarifying questions in order to assist the public in formulating written comments on the current severity level designations for consideration for FY 2021 rule making. For additional information regarding the Version 38 Test GROUPER please see the file titled CMS -1735-P Table 6P.1a below.

The 21st Century Cures Act requires that by January 1, 2018, the Secretary develop an informational “Hopes version” of at least 10 surgical Madras. Under the Hopes version of the Madras developed for this requirement, to the extent feasible, the MS-DRG assignment for a given service furnished to an outpatient (billed using a Hopes code) is as similar as possible to the MS-DRG assignment for that service if furnished to an inpatient (billed using an ICD-10-PCS code).

The HCPCS-MS-DRG definitions manual and software developed under the requirements of section 15001 of the 21st Century Cures Act (Public Law 114–255). Our new PDG grouper allows you to project Health Insurance Prospective Payment System (Hips) codes for expected revenue.

could analysis affect reimbursement proposed changes cms takeaway key medical groups
(Source: www.premierinc.com)

Now you can easily project a Hips code based on the data at the beginning of the billing period, allowing for faster RAP submissions. Developed in partnership with Simplest and modeled after the interactive CMS grouper, our PDG grouper uses claims data and clinical information to determine a Hips code.

This document corrects technical and typographical errors in the final rule that appeared in the September 18, 2020, issue of the Federal Register titled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2021 Rates; Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible Hospitals and Critical Access Hospitals”. Start Further Info Donald Thompson and Michele Hudson, (410) 786-4487.

End Further Intend PreambleS tart Supplemental Information In FR Doc. The corrections in this correcting document are applicable to discharges occurring on or after October 1, 2020, as if they had been included in the document that appeared in the September 18, 2020, Federal Register.

On the following pages: 58435 through 58436, 58448, 58451, 58453, 58459, 58464, 58471, 58479, 58487, 58495, 58506, 58509, 58520, 58529, 58531 through 58532, 58537, 58540 through 58541, 58553 through 58556, 58559 through 58560, 58580 through 58583, 58585 through 58588, 58596, 58599, 58603 through 58604, 58606 through 58607, 58610, 58719, 58734, 58736 through 58737, 58739, 58741, 58842, 58876, 58893, and 58898 through 58900, we are correcting inadvertent typographical errors in the internal section references. On page 58596, we are correcting an inadvertent typographical error in the date of the Med PAR data used for developing the Medicare Severity Diagnosis-Related Group (MS-DRG) relative weights.

On pages 58716 and 58717, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the Carotid Neon System technology. On pages 58721 and 58723, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the Cefiderocol technology.

map cms
(Source: globalitfactory.com)

On page 58768, due to a conforming change to the Rural Floor Budget Neutrality adjustment (listed in the table titled “Summary of FY 2021 Budget Neutrality Factors” on page 59034) as discussed in section II. B. Of this correcting document and the conforming changes to the Out-Migration Adjustment discussed in section II.

On page 59006, in the discussion of Medicare bad debt policy, we are correcting inadvertent errors in the regulatory citations and descriptions. On pages 59031 and 59037, we are correcting inadvertent typographical errors in the internal section references.

We are correcting an error in the version 38 ICD-10 MS-DRG assignment for some cases in the historical claims' data in the FY 2019 Med PAR files used in the rate setting for the FY 2021 IPS/Latch PPS final rule, which resulted in inadvertent errors in the MS-DRG relative weights (and associated average length-of-stay (LOS)). Additionally, the version 38 MS-DRG assignment and relative weights are used when determining total payments for purposes of all the budget neutrality factors and the final outlier threshold.

As a result, the corrections to the MS-DRG assignment under the ICD-10 MS-DRG GROUPER version 38 for some cases in the historical claims' data in the FY 2019 Med PAR files and the recalculation of the relative weights directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold. Of this correcting document, we made updates to the calculation of Factor 3 of the uncompensated care payment methodology to reflect updated information on hospital mergers received in response to the final rule.

Factor 3 determines the total amount of the uncompensated care payment a hospital is eligible to receive for a fiscal year. Per discharge uncompensated care payments are included when determining total payments for purposes of all the budget neutrality factors and the final outlier threshold.

payment health rate medicaid cy case mix adjustment therapy surveyors national purchasing value based
(Source: www.federalregister.gov)

As a result, the revisions made to the calculation of Factor 3 to address additional merger information directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold. We made an inadvertent error in the Medicare Geographic Classification Review Board (MG CRB) reclassification status of one hospital in the FY 2021 IPS/Latch PPS final rule.

Specifically, CCN 050481 is incorrectly listed in Table 2 as reclassified to its geographic “home” of BSA 31084. This correction necessitated the recalculation of the FY 2021 wage index for BSA 37100 and affected the final FY 2021 wage index with reclassification.

The final FY 2021 IPS wage index with reclassification is used when determining total payments for purposes of all budget neutrality factors (except for the MS-DRG reclassification and recalibration budget neutrality factor and the wage index budget neutrality adjustment factor) and the final outlier threshold. Due to the correction of the combination of errors listed previously (corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, revisions to Factor 3 of the uncompensated care payment methodology, and the correction to the MG CRB reclassification status of one hospital), we recalculated all IPS budget neutrality adjustment factors, the fixed-loss cost threshold, the final wage indexes (and geographic adjustment factors (Gas)), the national operating standardized amounts and capital Federal rate.

On page 59034, the table titled “Summary of FY 2021 Budget Neutrality Factors”. On page 59040, the calculation of the outlier fixed-loss cost threshold, total operating Federal payments, total operating outlier payments, the outlier adjustment to the capital Federal rate and the related discussion of the percentage estimates of operating and capital outlier payments.

On page 59039, we are correcting a typographical error in the total cases from October 1, 2018, through September 31, 2019, used to calculate the average covered charge per case, which is then used to calculate the charge inflation factor. On pages 59047 through 59048, in our discussion of the determination of the Federal hospital inpatient capital-related prospective payment rate update, due to the recalculation of the Gas as well as corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, we have made conforming corrections to the capital Federal rate, the incremental budget neutrality adjustment factor for changes in the Gas, and the outlier threshold (as discussed previously).

(Source: www.phcppros.com)

As a result of these changes, we also made conforming corrections in the table showing the comparison of factors and adjustments for the FY 2020 capital Federal rate and FY 2021 capital Federal rate. As we noted in the final rule, the capital Federal rate is calculated using unbounded budget neutrality and outlier Start Printed Page 78750adjustment factors.

However, after rounding these factors to 4 decimal places as displayed in the final rule, the rounded factors were unchanged from the final rule. On page 59057, we are making conforming changes to the fixed-loss amount for FY 2021 site neutral payment rate discharges, and the high-cost outlier (HBO) threshold (based on the corrections to the IPS fixed-loss amount discussed previously).

On pages 59060 and 59061, we are making conforming corrections to the national adjusted operating standardized amounts and capital standard Federal payment rate (which also include the rates payable to hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a result of the conforming corrections to certain budget neutrality factors and the outlier threshold previously described. On pages 59062, 59070, 59074 through 59076, and 59085 we are correcting inadvertent typographical errors in the internal section references.

The tables that are available on the internet have been updated to reflect the revisions discussed in this correcting document. Of this correcting document, CCN 050481 is incorrectly listed as reclassified to its home geographic area of BSA 31084.

In this table, we are correcting the columns titled “Wage Index Payment BSA” and “MG CRB Re class” to accurately reflect its reclassification to BSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for BSA 37100.

pdgm mix case groups clinical weights analysis
(Source: aegistherapies.com)

Also, the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and Los, corrections to Factor 3 of the uncompensated care payment methodology, and recalculation of all the budget neutrality adjustments (as discussed in section II. B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes.

Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes listed in Table 2. Therefore, we are making corresponding changes to some out-migration adjustments listed in Table 2.

Also, as discussed in section II. A of this correcting document, we made a conforming change to the 25th percentile wage index value across all hospitals. Accordingly, we are making corresponding changes to the values for hospitals in the columns titled “FY 2021 Wage Index Prior to Quartile and Transition”, “FY 2021 Wage Index With Quartile”, “FY 2021 Wage Index With Quartile and Cap” and “Out-Migration Adjustment”.

We also updated footnote number 6 to reflect the conforming change to the 25th percentile wage index value across all hospitals. Of this correcting document, CCN 050481 is incorrectly listed in Table 2 as reclassified to its home geographic area of BSA 31084 instead of reclassified to BSA 37100.

This correction necessitated the recalculation of the FY 2021 wage index for BSA 37100. Also, corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and Los, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all the budget neutrality adjustments (as discussed in section II. B.

(Source: www-qa.mouritech.com)

Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes and Gas of all CBS As listed in Table 3.

This correction necessitated the recalculation of the FY 2021 wage index for BSA 37100. Also, corrections to the version 38 MS-DRG assignment for some cases Start Printed Page 78751in the historical claims data and the resulting recalculation of the relative weights and Los, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all the budget neutrality adjustments (as discussed in section II. B.

Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. As a result, as discussed previously, we are making corresponding changes to the FY 2021 wage indexes.

Therefore, we are making corresponding changes to some out-migration adjustments listed in Table 4A. Specifically, we are correcting the values in the column titled “FY 2021 Out Migration Adjustment”.

As stated in the FY 2021 IPS/Latch PPS final rule (85 FR 58834 and 58835), we allowed the public an additional period after the issuance of the final rule to review and submit comments on the accuracy of the list of mergers that we identified in the final rule. Based on the comments received during this additional period, we are updating this table to reflect the merger information received in response to the final rule and to revise the Factor 3 calculations for purposes of determining uncompensated care payments for the FY 2021 IPS/Latch PPS final rule.

webinar demand
(Source: selmanholman.thinkific.com)

We are revising Factor 3 for all hospitals to reflect the updated merger information received in response to the final rule. We are also revising the amount of the total uncompensated care payment calculated for each DSH-eligible hospital.

The total uncompensated care payment that a hospital receives is used to calculate the amount of the interim uncompensated care payments the hospital receives per discharge; accordingly, we have also revised these amounts for all DSH-eligible hospitals. These corrections will be reflected in Table 18 and the Medicare Ash Supplemental Data File.

Per discharge uncompensated care payments are included when determining total payments for purposes of all the budget neutrality factors and the final outlier threshold. As a result, these corrections to uncompensated care payments impacted the calculation of all the budget neutrality factors as well as the outlier fixed-loss cost threshold.

Of this correcting document, we have made corresponding revisions to the discussion of the “Effects of the Changes to Medicare Ash and Uncompensated Care Payments for FY 2021” for purposes of the Regulatory Impact Analysis in Appendix A of the FY 2021 IPS/Latch PPS final rule to reflect the corrections discussed previously and to correct minor typographical errors. 553 (b) of the Administrative Procedure Act (APA), the agency is required to publish a notice of the proposed rule making in the Federal Register before the provisions of a rule take effect.

Similarly, section 1871(b)(1) of the Act requires the Secretary to provide for notice of the proposed rule making in the Federal Register and provide a period of not less than 60 days for public comment. Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the notice and comment and delay in effective date APA requirements; in cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well.

hub advantage
(Source: www.advantagecsp.com)

Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an agency to dispense with normal rule making requirements for good cause if the agency makes a finding that the notice and comment process are impracticable, unnecessary, or contrary to the public interest. In addition, both section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay in effective date where such delay is contrary to the public interest and an agency includes a statement of support.

We believe that this correcting document does not constitute a rule that would be subject to the notice and comment or delayed effective date requirements. This document corrects technical and typographical errors in the preamble, addendum, payment rates, tables, and appendices included or referenced in the FY 2021 IPS/Latch PPS final rule, but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule.

As a result, this correcting document is intended to ensure that the information in the FY 2021 IPS/Latch PPS final rule accurately reflects the policies adopted in that document. In addition, even if this were a rule to which the notice and comment procedures and delayed effective date requirements applied, we find that there is good cause to waive such requirements.

Undertaking further notice and comment procedures to incorporate the corrections in this document into the final rule or delaying the effective date would be contrary to the public interest because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPS/Latch PPS final rule accurately reflects our policies. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply implementing correctly the methodologies and policies that we previously proposed, requested comment on, and subsequently finalized.

This correcting document is intended solely to ensure that the FY 2021 IPS/Latch PPS final rule accurately reflects these payment methodologies and policies. Therefore, we believe we have good cause to waive Start Printed Page 78752the notice and comment and effective date requirements.

health billing services pdgm grouper table synergy consulting revenue cycle
(Source: www.synergycsi.com)

Moreover, even if these corrections were considered to be retroactive rule making, they would be authorized under section 1871(e)(1)(A)(ii) of the Act, which permits the Secretary to issue a rule for the Medicare program with retroactive effect if the failure to do so would be contrary to the public interest. As we have explained previously, we believe it would be contrary to the public interest not to implement the corrections in this correcting document because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPS/Latch PPS final rule accurately reflects our policies.

On page 58448, lower half of the page, second column, first partial paragraph, lines 19 and 20, the reference, “section II. E.2.b.” is corrected to read “section II. D.2.b.”. On page 58495, middle of the page, third column, first full paragraph, line 5, the reference, “section II. E.1.b.” is corrected to read “section II. D.1.b.”.

On page 58529, bottom half of the page, first column, last paragraph, lines 11 and 12, the reference, “section II. E.12.a.” is corrected to read “section II. D.12.a.”. On page 58532, top of the page, second column, first partial paragraph, line 5, the reference, “section II. E.4.” is corrected to read “section II. D.4.”.

On page 58559, bottom half of the page, third column, first full paragraph, line 21, the reference, “section II. E.12.c.” is corrected to read “section II. D.12.c.”. On page 58580, third column, last paragraph, line 3, the reference, “section II. E.13.

(1) First column, first paragraph, line 3, the reference, “section II. E.13. (2) Third column, last paragraph, line 3, the reference, “section II. E.13.

grouper ms code packages supercoder cpt coding icd codes
(Source: www.supercoder.com)

Bottom of the page, third column, last paragraph, line 3, the reference, “section II. E.13. (1) First column, first paragraph, line 3, the reference, “section II. E.13.

(2) Third column, first full paragraph, line 3, the reference, “section II. E.13. Bottom of the page, second column, first full paragraph, lines 2 and 3, the reference, “in section II. E.13.

(1) First column, last paragraph, line 3, the reference, “in section II. E.13. (2) Third column, last paragraph, line 3, the reference, “section II. E.13.

Top of the page, second column, partial paragraph, line 7, the reference, “section II. E.8.a. First partial paragraph, line 13, the reference, “section II. G.1.a.

Last partial paragraph, line 21, the reference, “section II. G.1.a. On page 58716, first column, second full paragraph, lines 14 through 19, the phrase, “with 03HK0MZ (Insertion of stimulator lead into right internal carotid artery, open approach) or 03HL0MZ (Insertion of stimulator lead into left internal carotid artery, open approach)” is corrected to read “with 03HK3MZ (Insertion of stimulator lead into right internal carotid artery, percutaneous approach) or 03HL3MZ (Insertion of stimulator lead into left internal carotid artery, percutaneous approach).”.

(Source: www.businessinsider.in)

On page 58717, first column, first partial paragraph, line 5, the phrase, “with 03HK0MZ or 03HL0MZ” is corrected to read “with 03HK3MZ or 03HL3MZ.” On page 58721, third column, second full paragraph, line 17, the phrase, “XW03366 or XW04366” is corrected to read “XW033A6 (Introduction of cefiderocol anti-infective into peripheral vein, percutaneous approach, new technology group 6) or XW043A6 (Introduction of cefiderocol anti-infective into central vein, percutaneous approach, new technology group 6).”.

On page 58723, second column, first partial paragraph, line 14, the phrase, “procedure codes XW03366 or XW04366” is corrected to read “procedure codes XW033A6 or XW043A6.” On page 58736, second column, first full paragraph, line 27, the reference, “II. G.9.b.” is corrected to read “II. F.9.b.”.

On page 58741, third column, second partial paragraph, line 17, the reference, “section II. G.9.a.” is corrected to read “section II. F.9.a.”. Start Printed Page 78754 On page 58768, third column, first partial paragraph, line 3, the figure “0.8465” is corrected to read “0.8469”.

Line 4, the regulation citation, “(c)(3)(i)” is corrected to read “(c)(1)(ii)”. c. Lines 17 and 18, the phrase “charged to an uncollectible receivables account” is corrected to read, “recorded as an implicit price concession”.

Start Printed Page 78755(e) Line 33, the figure “$29,051” is corrected to read “$29,064”. (2) First full paragraph, line 11, the phrase “threshold for FY 2021 (which reflects our” is corrected to read “threshold for FY 2021 of $29,064 (which reflects our”.

(Source: www.selmanholman.com)

Start Printed Page 78756(1) Second full paragraph, line 43, the figure “0.9984” is corrected to read “0.9983”. (1) Third paragraph, line 4, the figure “0.9984” is corrected to read “0.9983”.

The chart titled “COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2020 CAPITAL FEDERAL RATE AND THE FY 2021 CAPITAL FEDERAL RATE” is corrected to read as follows: Lower half of the page, first column, second full paragraph, last line, the figure “$29,051” is corrected to read “$29,064”.

Start Printed Page 78762(1) Third full paragraph: (b) Line 11, the section reference “II. G.” is corrected to read “II. E.”.

(2) Fourth full paragraph, line 6, the figure “0.99798” is corrected to read “0.997975”. Third column, first full paragraph, line 26, the figure “1.000426” is corrected to read “1.000447”.

First column, third full paragraph, line 6, the figure “0.986583” is corrected to read “0.986616”. Second column, second full paragraph, line 5, the figure “0.993433” is corrected to read “0.993446”.

coding essentials supercoder physician tools specialties medical cpt icd codes
(Source: www.supercoder.com)

On pages 59078 and 59079 in the section titled “Effects of the Changes to Uncompensated Care Payments for FY 2021”, the section's language (beginning with the phrase “Rural hospitals, in general, are projected to experience” and ending with the sentence “Hospitals with greater than 65 percent Medicare utilization are projected to receive an increase of 0.62 percent.”) Is corrected to read as follows: “Rural hospitals, in general, are projected to experience larger decreases in uncompensated care payments than their urban counterparts. Overall, rural hospitals are projected to receive a 7.19 percent decrease in uncompensated care payments, while urban hospitals are projected to receive a 0.29 percent decrease in uncompensated care payments.

However, hospitals in large urban areas are projected to receive a 0.75 percent increase in uncompensated care payments and hospitals in other urban areas a 1.94 percent decrease. By bed size, smaller rural hospitals are projected to receive the largest decreases in uncompensated care payments.

Rural hospitals with 0-99 beds are projected to receive a 9.46 percent payment decrease, and rural hospitals with 100-249 beds are projected to receive a 7.44 percent decrease. However, larger rural hospitals with 250+ beds are projected to receive a 7.64 percent payment increase.

In contrast, the smallest urban hospitals (0-99 beds) are projected to receive an increase in uncompensated care payments of 2.61 percent, while urban hospitals with 100-249 beds are projected to receive a decrease of 1.05 percent, and larger urban hospitals with 250+ beds are projected to receive a 0.18 percent decrease in uncompensated care payments, which is less than the overall hospital average. By region, rural hospitals are expected to receive larger than average decreases in uncompensated care payments in all Regions, except for rural hospitals in the Pacific Region, which are projected to receive an increase in uncompensated care payments of 9.14 percent.

Urban hospitals are projected to receive a more varied range of payment changes. Urban hospitals in the New England, the Middle Atlantic, West South Central, and Mountain Regions, as well as urban hospitals in Puerto Rico, are projected to receive larger than average decreases in uncompensated care payments, while urban hospitals in the South Atlantic, East North Central, East South Central, West North Central, and Pacific Regions are projected to receive increases in uncompensated care payments.

(Source: forums.swedespeed.com)

By payment classification, hospitals in urban areas overall are expected to receive a 0.18 percent increase in uncompensated care payments, with hospitals in large urban areas expected to see an increase in uncompensated care payments of 1.15 percent, while hospitals in other urban areas are expected to receive a decrease of 1.60 percent. In contrast, hospitals in rural areas are projected to receive a decrease in uncompensated care payments of 3.18 percent.

Non teaching hospitals are projected to receive a payment decrease of 0.99 percent, teaching hospitals with fewer than 100 residents are projected to receive a payment decrease of 0.83 percent, and teaching hospitals with 100+ residents have a projected payment decrease of 0.41 percent. Proprietary and government hospitals are projected to receive larger than average decreases of 2.42 and 1.14 percent respectively, while voluntary hospitals are expected to receive a payment decrease of 0.03 percent.

Hospitals with less than 50 percent Medicare utilization are projected to receive decreases in uncompensated care payments consistent with the overall hospital average percent change, while hospitals with 50 to 65 percent Medicare utilization are projected to receive a larger than average decrease of 4.12 percent. It’s not so easy when conventions and other rules get in the way OR CMS did not place the wound in the grouper.

The Grouper allows users to enter one or more ICD-10-CM diagnosis codes and any applicable ICD-10-PCS procedure codes along with some other required inputs, click a button, and quickly get the resulting DRG and other important information (including the Relative Weight, Length of Stay, Procedure Type, Post Acute indication, etc. All payment dollar amounts are based on Medicare reimbursement only.

CPT is a registered trademark of the American Medical Association. CMS is aware of issues with the latest PDP DLL Package (V1.0002 FINAL).

(Source: economictimes.indiatimes.com)

We are targeting to release an updated version on Monday, October 7, 2019, which corrects the identified grouper discrepancies. Late submission payment penalties do not apply under the SNF PPS.

Other Articles You Might Be Interested In

01: Lures For Grouper
02: Lure For Grouper
03: Triathlon Age Grouper
04: Trolling For Grouper Crystal River
05: Trolling For Grouper In Tampa Bay
06: Trolling For Grouper In The Gulf
07: Trolling For Grouper In The Keys
08: Trolling For Red Grouper
09: Trolling Lures For Grouper
10: Order Grouper Online
Sources
1 www.kwseafood.com - https://www.kwseafood.com/seafood/fish/grouper-fillets/black-grouper
2 kwseafood.com - https://kwseafood.com/product-category/fish/grouper-fillets
3 www.keywestseafooddepot.com - https://www.keywestseafooddepot.com/Black-Grouper-Fillets_p_8.html
4 www.joepattis.com - http://www.joepattis.com/shop/select-quantity.cfm
5 www.seafoodharbor.com - https://www.seafoodharbor.com/fresh-grouper/
6 www.fdacs.gov - https://www.fdacs.gov/Consumer-Resources/Buy-Fresh-From-Florida/Seafood-Products/Grouper
7 www.mercato.com - https://www.mercato.com/item/grouper/159474
8 wildseafoodmarket.com - https://wildseafoodmarket.com/fish