Do not wait. Update your patients' records and use Medicare Beneficiary identifiers (MBIs) now, before you are busy with other patient insurance changes in January.

CMS encourages people with Medicare to carry their cards with them since they removed the Social Security Number-based number; if your patients do not bring their Medicare cards with them:

Give them the "Get Your New Medicare Card" flyer in English (or Spanish)....

After months of discussions with the Cabinet for Health and Family Services (CHFS) via the KHA Medicaid Technical Advisory Committee (TAC) meetings, monthly Medicaid managed care organization (MCO) issue list meetings, individual meetings with CHFS and presentations to the Medicaid Advisory Committee (MAC), the Cabinet has made a final decision regarding sepsis.

On Wednesday, Department for Medicaid Services (DMS) Medical Director Judy Ann Theriot released a memo detailing coding and reimbursement guidelines for sepsis. CHFS will follow the CMS DRG and ICD-10 definitions of sepsis. MCOs are directed to "...base utilization management for sepsis on sepsis-2 criteria until such time that CMS adopts sepsis-3 criteria."

View the memo for more details.

On September 8, KHA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the Medicare hospital outpatient prospective payment system (OPPS) proposed rule for calendar year (CY) 2018. The Association has significant concerns with this proposal's reductions in payment for 340B hospitals as well as changes to remove total knee replacement from the inpatient only list, which is unsafe and will negatively impact hospitals participating in the CMS Comprehensive Care for Joint Replacement (CJR) and the Bundled Payment for Care Improvements (BPCI) programs.

A copy of KHA's comments are available on the Policy page (members only) of www.kyha.com.

If you have any questions, please contact Nancy Galvagni at KHA (ngalvagni@kyha.com).

Yesterday, Kentucky Medicaid Commissioner Steve Miller announced a one-month delay to the implementation of a new Medicaid policy to no longer pay for early elective deliveries (EEDs) unless certain documentation is provided. This will also apply to Medicaid managed care organizations (MCOs). KHA requested the delay to provide additional time for hospitals to obtain more details about the policy and the required documentation, and to implement process changes in their facilities.

Notice of the policy change was initially provided through a June 23, 2017, letter to hospitals, which had a start date of September 1, 2017. Under the addendum, denials will start for claims with dates of service beginning on or after November 1, 2017. Also, hospitals will get a reminder notice of the November 1 effective date on claims paid with dates of service through October 31, 2017, that do not meet the new requirements.

KHA is working with the Department for Medicaid Services to provide a webinar...

The Kentucky Department for Medicaid Services (KY DMS) is clarifying coverage for early elective deliveries (EED) including non-medically necessary inductions and cesarean deliveries. Claims submitted for labor inductions or cesarean sections on or before 39 weeks gestation that are not properly documented as medically necessary will be denied by Kentucky Medicaid including Kentucky Medicaid Managed Care Organizations (MCOs).

KY DMS's goals are to: 1) guide providers and hospitals to sound practice recommendations made by AGOG; 2) reduce morbidity in neonates from birth trauma and fetal immaturity; 3) reduce non-medically necessary deliveries less than 39 weeks gestation and; 4) encourage greater collaborations between hospitals and their physicians in developing quality improvement initiatives aimed at improving birth outcomes in Kentucky.

Medicaid delivery claims submitted, with dates of service on or after 9/1/2017, from enrolled hospitals and practitioners for elective inductions...

KHA is hosting a two-part educational webinar program on CMS Quality Based Payment Reform Programs for acute hospitals with content provided by KHA data analytics partner, DataGen. In order to participate in the webinars, you must register in advance using the links below.

Tuesday April 12 3:00 - 4:00 p.m. (ET) DataGen Review of Medicare’s Value-Based Purchasing Program for Kentucky Hospitals https://datagen.webex.com/datagen/onstage/g.php?MTID=ec1dae3260357942e49e688b7b7ed22cb Tuesday April 26 3:00 - 4:00 p.m. (ET) DataGen Review of Medicare’s Readmission Reduction & HAC Programs for Kentucky Hospitals https://datagen.webex.com/datagen/onstage/g.php?MTID=ea3de65d771dfe6dce2ae3e4329f020f0...

On April 30, KHA submitted comments to the Kentucky Office of Legal Services regarding 907 KAR 10:830 on the proposed diagnosis-related group (DRG) reimbursement methodology for the Medicaid fee-for-service population. The Association's comments addressed a long-standing concern and request by the Medicaid Hospital Technical Advisory Committee (TAC) for providing a transition period to new rates and retaining the existing rate appeal process. KHA also requested changes to maintain budget neutrality in updating rates and clarification on several other aspects of the proposed new methodology.

A copy of the comments is available on the Policy page of the Members Only section of www.kyha.com.

If you have any questions, please contact Nancy Galvagni at KHA (502-426-6220 or 800-945-4542 or via email at ngalvagni@kyha.com).