CMS

CMS plan would completely overhaul Medicaid managed care

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Over the next few weeks, the Centers for Medicare & Medicaid Services is expected to unveil an ambitious and comprehensive policy-making effort that promises to completely transform and radically overhaul the Medicaid managed care marketplace.

Practical advice on reducing antipsychotics

Practical advice on reducing antipsychotics

Two CMS tags —F-Tag 329, which addresses unnecessarily using antipsychotic drugs, and F-Tag 309, which addresses taking steps to reduce antipsychotic drug use — are used by nursing home surveyors to identify specific federal nursing home regulations in order to evaluate whether a nursing home is meeting quality of care, quality of life, safety, among other standards.

Hospice care becoming costlier, less aggressive, study finds

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Brown researchers examined the change in last-year-of-life Medicare expenditures during the most recent expansion of the program that began in 2004 and continued through 2009.

Certain brand name meds drive up Part D prices, CMS finds

Certain brand name meds drive up Part D prices, CMS finds

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A popular acid reflux medication was the costliest drug paid for by Medicare Part D in 2013, while a blood pressure medication was the most frequently prescribed, according to a new report on prescription drug prices.

Doctors' participation jumps in quality and e-prescribing programs

Doctors' participation jumps in quality and e-prescribing programs

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Physician participation in the CMS Physician Quality Reporting System and Electronic Prescribing Program grew 47% from 2012 to 2013, according to a federal report released late last week.

Online forum will explain new home health rating system

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A special one-hour, web-based open door forum will be held May 7 to explain to providers the new set of star ratings for the Home Health Compare website, the Center for Medicare & Medicaid Services announced.

Self-reporting False Claims Act violation averts litigation

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Long-term care providers would do well to know the lesson from one Pennsylvania continuing care facility, which averted costly litigation when it discovered and later reported irregularities of more than $1 million in Medicare claims.

Defeat the plague of improper claims

Defeat the plague of improper claims

For recovery auditing professionals everywhere, performance-based payments are a financial best practice and the industry standard. The client wins when no upfront expenses occur and payments are made only when actual dollars are returned.

Watchdog: CMS should monitor Recovery Audit Data warehouse

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A new Government Accountability Office report recommends sweeping government reforms that would mitigate fragmentation and duplication of a number of Medicare and Medicaid programs.

Connecting the hospice compliance dots

Connecting the hospice compliance dots

If someone asked you if your hospice was compliant with the Centers for Medicare & Medicaid Office of Inspector General's Effective Compliance Program Guidance for Hospice, what would you tell them?

Where were YOU when CMS changed the Five-Star rating system?

Where were YOU when CMS changed the Five-Star rating system?

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Some things will always stay etched in our mind. Where were you on February 12, when CMS publicly announced immediate changes to the Five Star Quality Rating System for Nursing Homes?

RAC beats CMS on payment lawsuit appeal

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A federal appeals court last week ruled that the Centers for Medicare & Medicaid Services violated federal contracting regulations when it stretched out payment terms for recovery audit contractors.

SNF victory in federal appeals court expected to cause review of other deficiency cases

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A federal appeals court has upheld fines emanating from a pair of deficiencies found and affirmed at a California nursing home. But the provider and its legal counsel are thrilled because the court also ruled that 25 other alleged deficiencies should be reviewed for relevance.

AHCA pitches 'permanent' therapy payment system

AHCA pitches 'permanent' therapy payment system

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Nursing homes' biggest national ally and advocate is making the rounds on Capitol Hill this week in an effort to convince Congress to let die a lengthy experiment to withhold therapy claims while it roots out fraud.

Quality improving in nursing homes: CMS review

Quality improving in nursing homes: CMS review

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The 2015 National Impact Assessment of the Centers for Medicare & Medicaid Services Quality Measures Report shows "clear progress in improving the healthcare delivery system to achieve the three aims of better care, smarter spending, and healthier people."

OIG: Government should consider more drug substitution

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Drug substitutions saved the government $13 million last year, but more drug substitutions under Medicare Part B would have saved an additional $6 million, the Office of Inspector General for Health and Human Services concluded in a recent report to Congress.

Slavitt, Conway rise in rank at CMS

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A number of internal promotions and a few staff acquisitions from a Health and Human Services' insurance unit highlight a series of leadership changes at the Centers for Medicare & Medicaid Services, it was announced on Monday.

Officials: More additions and rebasings of nursing home ratings to come

Officials: More additions and rebasings of nursing home ratings to come

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Nearly one-third of the nation's skilled nursing facilities lost a rating star due purely to administrative changes Friday, when regulators also emphasized that more quality measures will be added next year — when another round of Five Star scores rebasing also could take place.

RAC groups battle provider plea for short-stay payment relief

RAC groups battle provider plea for short-stay payment relief

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Third-party firms that audit Medicare bills for payment issues are pushing back hard against a hospital association plea for more favorable short-stay reimbursements, adding to the ongoing unwelcome specter of audits among all providers, including those in long-term care.

CMS delays repayment final rule a year

CMS delays repayment final rule a year

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The Centers for Medicare & Medicaid Services on Tuesday made official its plan to postpone implementation of a new rule on collecting hundreds of millions of dollars in overpayments until Feb. 16, 2016 — but providers remain on the hook for returning the money before then.

Changes to Five Star expected, providers fear lower ratings

Changes to Five Star expected, providers fear lower ratings

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The Centers for Medicare & Medicaid Services is expected to unveil major changes to Nursing Home Compare today that could cause facilities to lose rating stars, according to industry sources.

ICD-10 transition going better than expected for healthcare operators

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Despite two delays and a host of costly implementation issues over the past year, most healthcare providers will likely make a successful transition to the 10th round of ICD codes, a General Accountability Office report has concluded.

Providers complain to feds about ACO structure, want more incentives

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A new rule proposing sweeping changes to the Medicare accountable care model offers few incentives and could dissuade greater participation, 34 leading healthcare organizations and industry groups said Friday in a joint letter to the Centers for Medicare & Medicaid Services.

Medicare Advantage funding could be cut

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Supporters of Medicare Advantage program are roundly criticizing President Obama's fiscal 2016 budget plan to slash more than $36 billion in its funding over the coming decade.

Provider groups push for RAC reform

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Hospital industry groups said Thursday they'd rather the government reform the Recovery Audit Contractor program than simply throw more money at fixing an onerous backlog of more than 800,000 Medicare appeals cases.

CMS to ease reporting rules for EHR Incentive program

The Centers for Medicare & Medicaid Services has proposed easing the reporting rules for providers implementing electronic health records, which could come as good news for long-term care providers increasingly pushed to move to adopt EHR in an effort to improve care transitions and become a part of bundled payment systems.

CMS awards Recovery Audit DME contract

The Centers for Medicare & Medicaid Services has given a recovery audit contract to Connolly LLC, a subsidiary of Connolly iHealth Technologies, in Region 5. The firm will oversee Medicare claims for Durable Medical Equipment, Home Health and Hospice, in this new, fifth nationwide region.

More than $80 million paid out to Pioneer ACO beneficiaries, report finds

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Nearly $81 million has been made in payments on behalf of beneficiaries in Pioneer accountable care organizations through Sept. 30, a new report finds.

3M receives specific codes

3M Critical & Chronic Care Solutions Division announced the Centers for Medicare & Medicaid Services assigned product-specific Healthcare Common Procedure Coding System codes for the 3M™ Coban™ 2 Layer Lite Compression System (Cat #2794).

Another revenue stream threatened?

Another revenue stream threatened?

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For just about every skilled nursing facility out there, this is probably a good time to break out the flop sweat. That is, unless the prospect of being culled from one of your most vital revenue streams is nothing to worry about.

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