CMS

CMS changes mind on hospice drugs

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The Centers for Medicaid & Medicare Services has revised guidance on authorization of hospice drugs for those under Medicare Advantage and Part D plans, according to a new memo.

Long-term care facilities refusing free CMS resource on dementia, nurses association says

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Some nursing homes are not accepting a dementia training resource sent by the government, even though it is free and recommended, according to the American Association for Long-Term Care Nursing.

Congressional lawmakers grill top ALJ on appeals backlog, say too many providers are being put out of business

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Efforts to root out Medicare fraud have put far too many above-board providers in auditors' crosshairs, leading to a staggering backlog of appeals that has no easy fix, Congressional lawmakers and a top government official said during a hearing Thursday.

CMS updates manual to reflect F-Tag guidance dating back to 2003

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The Centers for Medicare & Medicaid Services has revised the manual that long-term care facility surveyors refer to, updating interpretive guidelines related to F-Tags.

CMS announces Medicare appeals without administrative law judge hearings

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Long-term care providers will be able to appeal certain Medicare claims decisions without going through an administrative law judge hearing, the Office of Medicare Hearings and Appeals (OMHA) announced Thursday.

AHA pushes for payment policies to benefit hospital-based skilled nursing facilities

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The government should adjust Medicare payment policies to better support the type of care provided in hospital-based skilled nursing facilities, the American Hospital Association urged in a recent letter to a top healthcare official.

Also in the news for June 26, 2014 . . .

Fraud prevention system doubled its improper Medicare payment collections ... Healthcare groups ask Supreme Court to declare False Claims Act penalty system unconstitutional ... New LTC administrator code of ethics updates discrimination and personal conduct language ... IA nursing home agrees to $500,000 settlement over improper therapy claims

ACO proposed rule coming soon, official says

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Centers for Medicare & Medicaid Services announced that a proposed rule addressing changes in the Accountable Care Organizations program is coming soon, an official said at the Accountable Care Organization Summit on June 19.

The benefits of a successful discharge plan

The benefits of a successful discharge plan

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It is critical to have a solid system for discharge planning that begins even before the resident is admitted to the facility. Individualized, resident-centered discharge planning will provide a solid system for quality transition and a crucial component of care at the preadmission assessment process.

Federal government needs to boost Medicaid managed care oversight, GAO says

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The government's oversight of Medicaid managed care organizations is not strong, even though these entities cover about 50 million people and are growing rapidly, according to a recently released report from a watchdog agency.

 New payment models present opportunities for SNFs

New payment models present opportunities for SNFs

For skilled nursing facilities, the Medicare SNF 3-day rule can make it difficult to place the right patients in the right setting at the right time. The 3-day rule requires that a Medicare beneficiary spend three nights in a hospital as an inpatient — observation stays do not count — before becoming eligible for Medicare-covered SNF care. This rule creates a challenge for SNFs as hospital lengths of stay decline for many of the conditions that SNFs treat.

Also in the news for June 13, 2014 . . .

Senators ask for provider input on healthcare data availability ... "Frailty index" can help predict post-surgery SNF admission ... Hospice association sues CMS over documentation rule ... Complex nursing home embezzlement case can go to trial

CMS to hold Medicare Advantage conference

The Centers for Medicare & Medicaid Services will hold its Medicare Advantage & Prescription Drug Oversight & Enforcement 2014 Program Audits conference on Tuesday, June 24 .It is designed to "provide insight into how MA and Part D organizations can best prepare for a CMS performance audit." Participants can attend in-person or virtually.

Health IT not a panacea for what's wrong in healthcare

Health IT not a panacea for what's wrong in healthcare

If you listen to the lobbyists for medical device manufacturers, health information technology is the answer to our biggest healthcare troubles. America's registered nurses have a different perspective.

Klusch: Providers must take ownership of their PEPPERs

Klusch: Providers must take ownership of their PEPPERs

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It is "totally wrong" for providers to let their PEPPERs fall into the hands of outside vendors, a leading long-term care coding and payment expert warned a national audience on Tuesday.

Ultra-High therapy keeps surging: CMS

Ultra-High therapy keeps surging: CMS

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Providers aren't just being accused of coding therapy patients in higher payment categories than ever before. The charge is being backed by hard numbers in a recent memorandum from the Centers for Medicare & Medicaid Services.

'Special' times ahead for more nursing homes, and that's not good

'Special' times ahead for more nursing homes, and that's not good

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As spring blends into summer, some nursing home operators are going to start feeling more heat — and it will have nothing to do with the weather. They will be given places on the proverbial hot seat. Well-earned seating arrangements, as it were.

3 value-based purchasing strategies to help you get ahead

3 value-based purchasing strategies to help you get ahead

Long-term care providers have a stronger hook than they probably realize regarding the toughening of penalties for hospitals with high readmission rates.

Close the infection loop to reduce outbreak risk

Close the infection loop to reduce outbreak risk

The readmission scores of nursing homes will be posted to the Nursing Home Compare website beginning in 2017, and the VBP program will begin Oct. 1, 2018. For the first time, facilities will not just face financial penalties, they will be incentivized to reduce readmissions

Federal government notes slowdown in nursing home spending

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Decreased payouts for nursing home care was one reason that healthcare spending grew more slowly for seniors than for any other age group between 2002 and 2010, the Centers for Medicare & Medicaid Services announced Monday.

Medicare hospice payments set to increase; Washington Post ties payment system to lack of care for suffering patients

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A troubling proportion of hospices fail to provide skilled nursing care to patients approaching death or who are experiencing a crisis such as increased pain, according to a lengthy Washington Post article published Saturday. The Post report appeared one day after the government proposed increasing Medicare hospice payments in 2015.

CMS: Medicare rate will increase 2% in 2015, boosting skilled nursing facility reimbursements by $750 million

CMS: Medicare rate will increase 2% in 2015, boosting skilled nursing facility reimbursements by $750 million

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Medicare would increase skilled nursing facility reimbursements by $750 million in 2015 under an updated payment rate proposed Thursday. CMS also will begin tying reimbursements to new statistical area designations set by the Office of Management and Budget.

COMS partners with Remedy

COMS Interactive LLC has announced a collaboration with Remedy Partners Inc. around the Bundled Payment for Care Improvement program.

Final rate notice signals continued pressure on Medicare Advantage payments

Final rate notice signals continued pressure on Medicare Advantage payments

CMS recently finalized Medicare Advantage plan payment rates for Calendar Year 2015 and announced other changes to payment and program policies for MA and Part D plans. Although the announcement included some positive changes for plans, the overall impact is mostly negative.

A time for nursing homes to embrace the cheddar while they can

A time for nursing homes to embrace the cheddar while they can

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It can almost be classified as a case of no good deed going unpunished. However, even though this is about long-term care, let's not be quite so skeptical. Progress is progress.

Proposed Life Safety Code updates encourage more homelike environments

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Updated fire safety regulations could encourage more home-like healthcare environments while increasing security to safeguard against wandering, according to a proposed rule announced Monday.

Emergency prep rule for long-term care should specify amount of supplies to have on hand, advocacy group says

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Long-term care facilities should have specified amounts of fuel and supplies on hand as part of a forthcoming regulation on disaster preparedness, a prominent consumer advocacy group argues.

Medicare manual revision addresses civil monetary penalty policies, survey timeframes

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A long-term care facility slapped with a civil monetary penalty has a chance for an independent informal dispute resolution, according to new manual guidance from the Centers for Medicare & Medicaid Services.

Feds looking to QAPI, not penalties, for help

Feds looking to QAPI, not penalties, for help

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Centers for Medicare & Medicaid Services officials said they consider the upcoming Quality Assurance and Performance Improvement guidelines, not harsher penalties, as the better way to reduce adverse events in post-acute care.

Expert panel recommends functional status quality measures for skilled nursing facilities

Expert panel recommends functional status quality measures for skilled nursing facilities

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An expert panel convened by federal regulators has offered recommendations for functional status quality measures in skilled nursing facilities. Released Friday was a summary of the experts' advice to create a functional status quality measure in SNFs, as well as inpatient rehabilitation facilities and long-term care hospitals.

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