August 22, 2022

Top Questions from the FY 2023 IPPS Final Rule Summary Webinar

Looking for more information about the FY 2023 IPPS Final Rule? BESLER’s Reimbursement Manager Christina Brown answers your questions from the recent webinar.

To watch Christina’s FY 2023 IPPS Final Rule Summary Webinar, click HERE.

Does the CMS Star Rating impact wage index or rates in any way?

No.
Will the new rule for DGME FTEs apply to any cost report not yet NPR’d?

Yes. If your cost report is still under review, you may have to contact your MAC to see if they will make the adjustment in the calculation.
Can you clarify more about HAC conditions, please? Does this apply to HACs that impact the DRG when not POA? Or is this something else?

The HAC Reduction Program is a separate and distinct program from the Hospital-Acquired Conditions Present on Admission Indicator (HAC POA) provision established by the Deficit Reduction Act (DRA) of 2005. The following website has more information on the DRA HAC POA provision: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html
Nursing Allied Health Payment: Other than updates to National Numbers, it appears CMS has changed the methodology to calculate. Both hospital and national numbers are 2 years back times current year pool amount, correct?

There was no change in the calculation methodology for Nursing Allied Health Payments. Per the Final Rule, “…we accessed the HCRIS data from the first quarterly HCRIS update of 2022. However, to calculate the ‘pool’ and the direct GME MA percent reduction, we ‘project’ Part A direct GME payments and MA direct GME payments for the current calendar years, which in this final rule, are CYs 2020 and 2021 as the best available cost report data.”
Can we go back to VPB 2% reduction and add back to explain how it will be calculated?

Per the Final Rule, “each hospital will receive the payment reduction for the Hospital VBP Program as required by statute, but every hospital will receive a value-based incentive payment amount that matches the payment reduction amount.” This will result in a 0 net impact.
However, in the rules I think CMS did say that they would apply it for prior and penultimate as it applies to the current year cost reports since it is a 3-year average, correct ?
This is correct. CMS states in the final Regulation that it will go back to MCRs on or after 10/01/2001 to correct the three-year rolling average. If you have the calculation issue present in FFY 2001, CMS will go back to 1999 to make sure the three-year average is correct for FY 2001. The revised instructions for Worksheet E-4 lines 12 and 13 to state: “Effective for cost reporting periods beginning on or after October 1, 2001, if the prior/penultimate year total weighted FTE count from line 8, column 3 is less than or equal to line 5 from the prior/penultimate year, then enter the amounts from line 8, columns 1 and 2, in columns 1 and 2 of this line. If subject to the cap in the prior year or penultimate year respectively, if the prior/penultimate year total weighted FTE count from line 8, column 3 is greater than the amount on line 5 from the prior/penultimate year, then enter in column 1 the result of ((primary care & OB/GYN weighted FTEs/total weighted FTEs) x FTE cap)). Enter in column 2 the result of ((other weighted FTEs/ total weighted FTEs) x FTE cap)) plus the amount on line 10, column 2.
What if the FTE count exceeds the CAP because of an affiliation agreement?

The finalized revised instructions for WS E-4 Line 9 address the weighted and unweighted FTE counts on line 8 and line 5 (post Affiliation Agreement counts). Since the Affiliated hospital has reduced their overall FTE Cap for DGME it would be an appropriate interpretation to include these FTEs in the FTE counts on lines 5, 6 and 8.
For the low volume rule, does that only apply to Medicare discharges or all discharges?

Total discharges for all inpatients.
We are currently working on a 2018 reopening that was initiated by Novitas. If they go through with the reopening, will they also have to apply the new GME cap rules per the 2023 IPPS rule?
We would recommend contacting Novitas and make them aware of the calculation error and ask them if they can add it to the re-opening. Persuant to 42 CFR 405.1885(‘c)(2), CMS will not grant a reopening for resettlement of a MCR that has been NPR’d. A hospital can always request a reopening. If the hospital is reopening a MCR for other purposes and the reopening request is granted, it would reasonable to request the MAC make an adjustment to your DGME settlement amount although the MAC may consider the request outside of the scope of the reopening.
Clarifying — so even though there are numbers in the impact file, there will be no penalties?

If you are referring to the Hospital Readmission Program, there will still be penalties. The update relates to policy updates.
They will still be reported, but not applied for penalty.

For Value Based Purchasing, that is true.
Regarding VBP, I believe the rule stated that there would be a net zero impact. Table 16 of the rule is not necessary for FY 2023.

That is true.
The hospital readmission reduction will be 1.0 for FY 2023?

Table 15 is not available at this time to allow hospitals the opportunity to review and correct their calculations for FY2023. The table will be posted to the CMS Final Rule page when it is available.
Related to the GME Hospitals over their GME cap, can hospitals request their cost reports be reopened if within three year reopening from latest NPR?

You can always request a re-opening from your MAC. Pursuant to 42 CFR 405.1885(‘c)(2), CMS will not grant a reopening for resettlement of a MCR that has been NPR’d. If the hospital is reopening a MCR for other purposes and the reopening request is granted, it would reasonable to request the MAC make an adjustment to your DGME settlement amount although the MAC may consider the request outside of the scope of the reopening.
For FYE 6/30/22, can a hospital apply this rule to the prior and penultimate years on the cost report?

The revised instructions for Worksheet E-4 lines 12 and 13 state: “Effective for cost reporting periods beginning on or after October 1, 2001, if the prior/penultimate year total weighted FTE count from line 8, column 3 is less than or equal to line 5 from the prior/penultimate year, then enter the amounts from line 8, columns 1 and 2, in columns 1 and 2 of this line. If subject to the cap in the prior year or penultimate year respectively, if the prior/penultimate year total weighted FTE count from line 8, column 3 is greater than the amount on line 5 from the prior/penultimate year, then enter in column 1 the result of ((primary care & OB/GYN weighted FTEs/total weighted FTEs) x FTE cap)). Enter in column 2 the result of ((other weighted FTEs/ total weighted FTEs) x FTE cap)) plus the amount on line 10, column 2.
How far back did you say the new weighted rule goes back?

The revised instructions for Worksheet E-4 lines 12 and 13 state: “Effective for cost reporting periods beginning on or after October 1, 2001, if the prior/penultimate year total weighted FTE count from line 8, column 3 is less than or equal to line 5 from the prior/penultimate year, then enter the amounts from line 8, columns 1 and 2, in columns 1 and 2 of this line. If subject to the cap in the prior year or penultimate year respectively, if the prior/penultimate year total weighted FTE count from line 8, column 3 is greater than the amount on line 5 from the prior/penultimate year, then enter in column 1 the result of ((primary care & OB/GYN weighted FTEs/total weighted FTEs) x FTE cap)). Enter in column 2 the result of ((other weighted FTEs/ total weighted FTEs) x FTE cap)) plus the amount on line 10, column 2.
What’s the best way to determine why a county wage index decreased from the prior year?

It would be based on a detailed analysis of HCRIS data.
Sorry if I missed this, but can we reopen the cost report for a recalculated current year FTE count?

In the final Rule, CMS has stated that it will recalculate FTE Caps retroactive to MCRs on and after 10/01/2001. Any MCR that is not NPR’d will also receive an adjustment to the MCR’s settlement for the adjusted Cap. Pursuant to 42 CFR 405.1885(‘c)(2), CMS will not grant a reopening for resettlement of a MCR that has been NPR’d. A hospital can always request a reopening. If the hospital is reopening a MCR for other purposes and the reopening request is granted, it would reasonable to request the MAC make an adjustment to your DGME settlement amount although the MAC may consider the request outside of the scope of the reopening.
Is there an update on the pending House and Senate legislation that would restore the low volume back to 3,800?

None that we are aware of at this time.