Medicare Part B

What administrators need to know about therapy metrics

What administrators need to know about therapy metrics

Administrators have multiple departments to oversee, so it is important that they have a method to determine if their therapy department is running efficiently, meeting its goals and adding to the strategic success of the facility. There are several metrics and indicators of a successful therapy department.

Darling becomes vice president at PAC

Darling becomes vice president at PAC

Stacy A. Darling, MBA, MPT, AT, RAC-CT, is the new vice president of operations in the long-term care consulting team at Post Acute Consulting, LLC.

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.

Are standardized assessment tools our future?

Are standardized assessment tools our future?

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With therapy documentation being put under the microscope more than ever, you would be wise to make sure standardized assessment tools are at your fingertips. Unbiased views of data and outcomes information are what you need for care planning and execution.

Providers rip huge backlog of therapy claims reviews

Providers rip huge backlog of therapy claims reviews

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A provider-sponsored survey recently uncovered huge backlogs of therapy claim reviews for beneficiaries who exceeded the Medicare Part B caps limits.

'Doc fix' bill calls attention to need for therapy fix, NASL leader says

'Doc fix' bill calls attention to need for therapy fix, NASL leader says

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Provider groups are urging lawmakers to address outpatient therapy payments in addition to fixes to Medicare's physician payment system, according to Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care.

Efforts to prevent, care for diabetic foot ulcers cut amputation rate in half, study finds

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Better ulcer care contributed to a nearly 50% decrease in diabetes-related leg amputations between 2000-2010, according to a study in the current issue of Foot & Ankle International.

Government presses therapy provider to repay $3 million in Medicare reimbursements

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A New Jersey-based outpatient therapy provider should pay back the government for $3.1 million in improper Medicare reimbursements identified in a recent audit, according to the Department of Health and Human Services' Office of Inspector General.

The G-codes are here for payment claims — ready or not

The G-codes are here for payment claims — ready or not

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Effective July 1, the Centers for Medicare & Medicaid Services will begin rejecting claims received for Medicare Part B patients that do not include the new requirement of G-coding. That really means providers need to be ready by June 1.

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?

AHCA praises bipartisan effort to repeal SNF therapy caps

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The American Health Care Association and National Center for Assisted Living came out in support of bipartisan legislation to permanently repeal Medicare Part B therapy caps for skilled nursing facilities. The legislation was introduced in both the House of Representatives and the Senate on Feb. 15.

Laws and policies in focus next week for LTC therapy and ancillary services providers

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A keynote address by Farzad Mostashari, MD, ScM, the National Coordinator for Health Information Technology, will highlight opening day of the annual winter Legislative and Regulatory Conference of the National Association for the Support of Long-Term Care.

Loopholes to help you track Medicare Part B therapy billing

Loopholes to help you track Medicare Part B therapy billing

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Every time we send our patients to the hospital for rehab-related tests, exams or services, these services are billed to Medicare Part B, and, therefore, reduce our cap allowances. Any small oversights could have major impacts on our ability to successfully track therapy cap levels. Here's some help.

Upon further review

Upon further review

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Instead of spending more time doing hands-on patient care, therapists who work with Medicare beneficiaries have been strapped with increased administrative tasks, sometimes leading to delayed services, or worse.

CMS wants burdens eased

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Providers will have their say about the future of Medicare Administrative Contractors.

The Manual Medical Review mess

The Manual Medical Review mess

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What a mess — and that's probably an understatement! Medicare Part B decided to roll out its new manual medical review process by dividing providers into three phases. If you are unfortunate to be part of the Phase One group, you have my deepest sympathies.

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.

Therapy cap exceptions process must be extended, advocates urge

Members of a Congressional conference committee need to authorize the longest possible exceptions extension for Medicare Part B therapy services, according to a coalition of therapy advocates.

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.

Doctors wait patiently for Congress to act on 'doc fix'

Doctors wait patiently for Congress to act on 'doc fix'

Doctors across the United States are taking a wait-and-see approach while Congress decides whether or not to allow a scheduled 23% cut in Medicare reimbursement rates to take effect on Dec. 1.

'Tis nursing home conference season

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It's hard to believe we're in the midst of another conference season. The American Health Care Association's annual meeting already has passed and the American Association of Homes and Services for the Aging's is about a week away.

Part D drug consolidation could save Medicare $150 million, CMS finds

Consolidating drugs covered by Medicare Part B and Part D under Part D could save Medicare nearly $150 million, according to a new report from the Centers for Medicare & Medicaid Services.

AHCA gears up for annual therapy caps fight, pushes to reform therapy rule

AHCA gears up for annual therapy caps fight, pushes to reform therapy rule

As the end of the year approaches, long-term care providers will be lobbying to extend the therapy caps exceptions process, which is set to end Dec. 31. Another therapy issue—a proposed rule to reduce payments when multiple therapy procedures are provided to a Medicare beneficiary in one day—also is on providers' radar screens.

Healthcare reforms brighten outlook for Medicare trust fund, trustees say

The financial outlook for the seniors' healthcare program has been "substantially improved" by the new healthcare reforms, according to a new report from the Medicare Board of Trustees released Thursday.

A new hit to therapy providers

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Another proposed rehab rule threatens to cut significant revenues from long-term care providers.

Long-term care leaders criticize Washington Post article on reimbursements

Long-term care leaders criticize Washington Post article on reimbursements

A recent Washington Post analysis of the use of "ultra-high" reimbursement categories for nursing homes "paints a negative, incomplete picture of the growing role and tangible benefits associated with skilled nursing facility (SNF) patient care," two leading long-term care advocates said.

Healthcare reform bill to delay implementation of RUG-IV until 2011

The RUG-IV classification system will not start until Oct. 1, 2011, under the new healthcare reform bill.

New draft legislation would extend therapy caps exceptions process

New draft legislation would extend therapy caps exceptions process

Senate Finance Committee leaders Thursday issued a draft of a jobs-creation bill. The legislation would extend the Medicare Part B therapy caps exceptions process and delay through Sept. 30 an impending 21% cut in payments for Medicare physicians.

Snowstorm in capital sidelines discussions on therapy caps, Medicare physician pay cut

Snowstorm in capital sidelines discussions on therapy caps, Medicare physician pay cut

A snowstorm that pummeled the East Coast this week has delayed the Senate's consideration of a jobs bill that would extend the Medicare Part B therapy caps exceptions process and prevent a pay cut for Medicare physicians, according to reports from Washington.

Need grows for therapy caps resolution

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My how things change. Just a month ago a healthcare reform bill seemed en route to passage. Now its very existence is in question and, by extension, some key long-term care services are too.

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