Medicare Part A

Four tips on making smarter purchasing decisions

Four tips on making smarter purchasing decisions

Rising drug costs and declining reimbursements significantly impact profits, and long-term care pharmacies today have to do more with less.

Medicare should pay for skilled nursing services without a qualifying hospital stay, experts tell Senators

Medicare should pay for skilled nursing services without a qualifying hospital stay, experts tell Senators

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The time has come to eliminate hospital stay requirements for beneficiaries to qualify for Medicare coverage of skilled nursing services, experts told a Senate committee Wednesday.

Bill addressing admission status receives praise

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A bill that would require hospitals to give patients a formal notice of their admission status has received strong support from healthcare associations.

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.

Charges that Omnicare forgave nursing providers' debts as a form of kickbacks can proceed, judge rules

Charges that Omnicare forgave nursing providers' debts as a form of kickbacks can proceed, judge rules

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A whistleblower can pursue charges that long-term care pharmacy Omnicare ignored skilled nursing companies' overdue bills in exchange for certain kinds of business, a federal district court recently ruled.

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.

June 3 Super Tuesday webinar: why you need to pay attention to PEPPER reports

June 3 Super Tuesday webinar: why you need to pay attention to PEPPER reports

Providers will learn how the government's PEPPER reports are connected to their facilities' health during a June 3 McKnight's Super Tuesday webcast. Featured speaker Leah Klusch, the executive director of the Alliance Training Center, will help attendees realize how these reports can affect their payments and affect operations.

More than half of skilled nursing facility rehab residents classified under Ultra-High, CMS finds

More than half of skilled nursing facility rehab residents classified under Ultra-High, CMS finds

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Skilled nursing facility therapy billings in the Ultra-High RUG category increased steadily in recent years and passed a significant threshold in 2013, according to a government memorandum.

Palliative possibilities: Therein lies the rub

Palliative possibilities: Therein lies the rub

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When a patient is referred to therapy, and they are receiving hospice care, then therapy needs to seek permission from the hospice company to provide any treatment. Hospice is required to reimburse the facility for the therapy services since the treatment also is included in the bundled payment rate from Medicare Part A. And, therein lies the rub.

Part A claims under scrutiny

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Government investigators will issue a report on skilled nursing facilities' Medicare Part A billing practices later this year, according to the latest annual work plan from the Department of Health and Human Services Office of the Inspector General.

OIG plans to scrutinize skilled nursing facilities' Medicare Part A claims

OIG plans to scrutinize skilled nursing facilities' Medicare Part A claims

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Skilled nursing operators can expect to see a new government report on Medicare Part A billing practices released in 2014, according to the latest annual work plan from the Department of Health and Human Services Office of the Inspector General.

Ask the payment expert ... about changes related to Jimmo v. Sebelius

Ask the payment expert ... about changes related to Jimmo v. Sebelius

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How come there are so many Medicare A denials when Jimmo v. Sebelius stated we could keep residents on Medicare A even if they are not improving?

CMS clarifies Medicare payment rules for SNF to SNF ambulance transportation

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A skilled nursing facility discharging a Medicare Part A resident to another SNF is responsible for ambulance transportation fees, and no separate Part B claim should be made for that service, the Centers for Medicare & Medicaid stated in a recent memorandum.

Ambulance company reaches $8 million settlement to resolve charges over improper skilled nursing facility arrangements

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The nation's second-largest ambulance services company has reached a settlement agreement over whistleblower charges of improper business dealings with skilled nursing facilities, Rural/Metro Corporation announced Tuesday.

Court nixes 3-day challenge, says doctors should decide

Court nixes 3-day challenge, says doctors should decide

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A federal district court in Connecticut has dismissed a case filed by more than a dozen beneficiaries who challenged Medicare's "three-day rule."

McDermott targets the 'three-day rule'

McDermott targets the 'three-day rule'

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Rep. Jim McDermott (D-WA) has introduced legislation that would eliminate a major hurdle to rehabilitation care and payments: the "three-day rule."

Five LTC commissioners issue full alternative report

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Five members of the Congressional Commission on Long-Term Care have released a full report, providing an alternative to the commission report released last week. The five commissioners split with nine other panel members over that report, saying it should not be presented to Congress as the broad agreement of the group.

Medicare should cover SNF stays without prior hospitalization, American Medical Association asserts

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The American Medical Association will work to change the 72-hour hospitalization requirement for Medicare Part A coverage of skilled nursing care. Delegates approved this resolution at the AMA annual conference in Chicago on Monday.

Lower SNF spending improves Medicare solvency outlook, report says

Lower SNF spending improves Medicare solvency outlook, report says

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Government officials released good news about the long-term solvency of the Medicare program Friday. The projections were based in large measure on lower projected reimbursements for skilled nursing facilities.

CMS widens audits, hones in on Part A claims, expert says

CMS widens audits, hones in on Part A claims, expert says

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The Centers for Medicare & Medicaid Services has increased its scrutiny of Medicare Part A filings recently and as a result, has reclaimed more funds than ever from providers, a long-term care compliance expert noted at a recent McKnight's Super Tuesday webcast.

'Serious' CMS oversight should compel providers to be duly vigilant about compliance, expert says

'Serious' CMS oversight should compel providers to be duly vigilant about compliance, expert says

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Skilled nursing providers should ratchet up Medicare Part A compliance initiatives to meet the increasingly intense scrutiny of the Centers for Medicare & Medicaid Services, a compliance expert said in a McKnight's Super Tuesday webcast. "CMS is serious about this," said Leah Klusch, executive director of The Alliance Training Center.

Medically Complex Medicare Part B

Medically Complex Medicare Part B

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While CMS tries to figure out how to proceed with the manual medical review process, we continue to track our caps and apply our modifiers. In the meantime, has anyone noticed how our typical Medicare Part B patients have become more medically complex than just a few years ago?

CMS seeks operator input regarding skilled nursing facility therapy payment changes

CMS seeks operator input regarding skilled nursing facility therapy payment changes

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The Centers for Medicare & Medicaid Services is encouraging provider input as it seeks to change the payment system for therapy provided by skilled nursing facilities.

Fiscal molehill for rehab providers

Fiscal molehill for rehab providers

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Well, we didn't completely go off the "fiscal cliff," but we're definitely heading for a downward slope.

Providers would be overburdened by Medicare overpayment rule, expert notes

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A proposed rule that would require Medicare providers to return overpayments within 60 days of detection could significantly increase administrative time and costs, an expert says.

Better managing the Medicare Part A stay

Better managing the Medicare Part A stay

Discharge planning is the key element in managing Medicare Part A length of stay. A home assessment can significantly affect the process.

Managing the clinically anticipated Medicare Part A length of stay

Managing the clinically anticipated Medicare Part A length of stay

The Medicare adjustments of fiscal year 2012 have left the long-term care profession discussing and debating care strategies to ensure success and mitigate the reductions in reimbursement. A key indicator when analyzing clinical and financial solidity is the facility's clinically anticipated Medicare length of stay.

GAO: Medicare spent $48 billion on improper fee-for-service payments

The federal government spent nearly $48 billion on improper Medicare payments in 2010 according to a new report from the Government Accountability Office. The report was released just prior to a House Oversight Committee hearing on government efficiency.

Home healthcare costs often lower than post-acute care after hospitalization, analysis finds

Medicare beneficiaries with chronic health problems are far less likely to be readmitted to the hospital when discharged to their homes than if they receive other post-acute care services, a new analysis finds.

OIG: Medicare pays too much for nutrient therapy in nursing homes

Medicare's fee schedule for enteral nutrients under Medicare Part B was more than double the prices available to suppliers to nursing homes in 2006, according to a newly released report from the Department of Health and Human Services' Office of the Inspector General.

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