Providers grapple with CMS 'rule'

People still misunderstand, avoid thinking about long-term care, poll shows

The Centers for Medicare & Medicaid Services has a lot of long-term care providers shaking their heads. They're not sure they heard one of CMS's latest proposed rules right.

It's easy to see where the confusion comes from. It's almost as if providers walked into the CMS “grocery store” and the CMS manager there said, “I'm either going to give you $1.50 for sweeping my floors or you can pay ME $11.30 and you'll still sweep the floors.” A bit of a drastic difference there.

CMS, the rule-maker, appears not to be able to make up its mind on what to pay operators in fiscal 2012. Usually, authorities propose a relatively low reimbursement rate and the affected group lobbies for better terms.

This time, the agency issued a rule — sort of. It said it might follow more traditional processes and give providers a 1.5% pay hike come July 1. On the other hand, it also proposed a possible 11.3% pay cut, based on data that show providers have earned a lot more than anticipated under the payment system that was implemented last October. The implication is that many providers have been gaming the system with upcoding.

Of course, the final negotiated number is going to land somewhere between the +1.5% and -11.5%. But what's so odd is that usually in a negotiation, one side doesn't supply both numbers to haggle over.

CMS has essentially issued a challenge to providers: Give us your best shot and tell us why we shouldn't drastically lower your reimbursement rates. Then, we'll figure out if it's going to be a big, bad cut or just a bad cut. They'll also be studying reimbursement-filing figures for the second quarter of this year carefully.

The clock is ticking.