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CMS Rule Cuts SNF Reimbursement Rates by 11.1%

by Published On: Apr 28, 2011Updated On: Aug 02, 2011

On July 29, the Centers for Medicare and Medicaid Services (CMS) published the final rule for skilled nursing facility Medicare reimbursement in fiscal 2012.

The new rates went into effect on Oct. 1, 2011.

The final rule: 

  • Closes loopholes in therapy reimbursement. 
  • Imposes a cut in Medicare reimbursement rates that will average 11.1% for all skilled nursing facilities (SNF)

For any one organization, the size of the reimbursement cut may be larger or smaller than 11.1% based on case-mix and on geographic location.

We have developed the following preliminary informational tools on the final rule:

We are planning a webinar on the final rule for LeadingAge members in the near future, and we will follow up with details as soon as arrangements are complete.

Provider Resources

  • CMS posted the FY 2012 SNF Personal Computer (PC) Pricer, which is a free tool provided by CMS to assist SNFs and other interested parties in determining the Medicare payment for an inpatient SNF claim. Download the User's Manual for detailed instructions on how to use of the PC Pricer software, including field definitions, claims entry instructions and sample screens and reports.

LeadingAge Educational Call

On Sept 13, 2011, Aegis Therapies presented an audio conference, co-sponsored by LeadingAge on MDS 3.0 reporting changes that will be effective Oct.1, and how to plan for them.  

Aegis staff also provided practical insight on how to adapt and monitor your therapy services to meet the new definitions for group therapy and the COT OMRA, ideas for training around the EOT-OMRA and the EOT-R, and the opportunity to ask questions and get a unique perspective of future plans directly from a reputable therapy company. The PowerPoint presentation is available. 

The audio recording is also available.

CMS National Provider Call

CMS hosted a national provider call on the rule on Aug. 23. Subject-matter experts discussed new MDS 3.0 policies:

Brief History of SNF Proposed Cut

On April 28, 2011, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on a prospective payment system and consolidated billing for for skilled nursing facilities

LeadingAge submitted comments about the proposed rule, offering suggestions on how to deal with group therapy payment refinement, rate refinements, non-therapy ancillaries and disclosure of ownership information that aligns with requirements on IRS Form 990. 

These comments are the beginning of an advocacy effort to avoid drastic cuts to Medicare payment for nursing facilities. 

On July 5, 2011, LeadingAge held a Tele-Townhall for members to learn about proposed payment cuts to nursing homes and the implications for members. LeadingAge submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the FY 2012 proposed rule for SNFs for setting the 2012 Medicare payment rates (starting in Oct. 1, 2011) and major changes to the MDS reporting. We made several recommendations on how to align payment with quality and promote transparency in reporting of ownership.

For those who were not able to participate in the tele-townhall, you can listen to a recording

SNF proposed rule resources

 



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