CMS

CMS: Many skilled nursing providers have poor Medicare certification and recertification practices

CMS: Many skilled nursing providers have poor Medicare certification and recertification practices

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The rate of improper Medicare payments to skilled nursing facilities has increased largely due to issues with certification and recertification statements, according to a recently released government memorandum. The Centers for Medicare & Medicaid Services document summarizes requirements that SNF physicians, non-physician practitioners (NPPs) and billing staffs must meet for compliance.

Reducing emotion in long-term care

Reducing emotion in long-term care

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Long-term care may be a calling, but it's still a job, and it's an industry that would be served by a reduction of emotion. That's especially true when discussing the government, which is called out in histrionic terms fairly often.

Report: Long-term care providers pay the price for CMS' poor auditor oversight

Report: Long-term care providers pay the price for CMS' poor auditor oversight

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Long-term care and other providers could be facing unfair burdens due to ineffective government oversight of Medicare auditors, according to a new report from a federal watchdog agency.

Medicare Advantage organizations are unresponsive to provider questions, long-term care professionals tell CMS

Medicare Advantage organizations are unresponsive to provider questions, long-term care professionals tell CMS

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Several skilled nursing facility workers expressed frustration regarding communications with Medicare Advantage organizations during a public call with government officials Wednesday. Centers for Medicare & Medicaid Services representatives acknowledged that provider frustration in this area has been an ongoing issue, but they said that their hands essentially are tied.

Why be optimistic when anxiety is an option?

Why be optimistic when anxiety is an option?

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Depending on how you like to interpret the news, nursing home operators are either facing some of the worst of times, or they've been infused with new life.

CMS finalizes 1.4% increase for hospices

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Hospices can expect an estimated 1.4% increase in their payments for the fiscal year 2015, the Centers for Medicare & Medicaid Services announced Monday.

Better anti-fraud efforts are not appeasing lawmakers

Better anti-fraud efforts are not appeasing lawmakers

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Long-term care facilities and other Medicare providers increasingly have seen reimbursements influenced by the government's Fraud Prevention System, an official recently told a Congressional panel.

Looking at dementia beyond drugs and disease

Looking at dementia beyond drugs and disease

The emerging literature on "nonpharmacological interventions" has not succeeded in providing long-term solutions for many people, such that expressions of need continue to recur on a regular basis.

Medicare SNF rate finalized, reimbursements to increase by $750 million next year

Medicare SNF rate finalized, reimbursements to increase by $750 million next year

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Medicare skilled nursing facility reimbursements will increase by $750 million next year under a final payment rule announced Thursday by the Centers for Medicare & Medicaid Services.

Increased 'bed taxes' on nursing facilities warrant stricter federal oversight, report states

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States have been increasingly taxing skilled nursing facilities and other healthcare providers to fund Medicaid in recent years, and federal authorities should look more closely at this trend, according to a government report released Tuesday.

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.

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