Payment & policy
I thought the Recovery Audit Contractors were on hold, so why did I receive a request from our RAC for a Medicare Advantage resident?
The debate over whether Recovery Audit Contractor audits are an incentive-laced system of provider harassment or a necessary tool to redistribute misspent Medicare funds continues. Neither side appears to be backing down
The White House Conference on Aging is collecting comments from long-term care stakeholders through a series of regional forums across the U.S. about their concerns regarding the future of Medicaid funding.
In a move that could greatly expand the visibility and adoption of telehealth systems, Congress is proposing that Medicare reimburse telehealth services at the same rate as in-person medical visits.
Long-term care providers' hopes for eliminating hospital observation stays may be fading after some Medicare Payment Advisory Commission members said they were re-thinking their positions on changing the policy.
Medicaid fee-for-service is in a steep decline, and signs suggest trends will continue in their current direction, a new report reveals.
The prospects of politician intervention with Medicare audits has sparked some debate over whether elected officials are exerting undue influence, or simply defending providers' rights against government overreaching.
The National Association of Medicaid Directors is asking for more guidance on the dual-eligible program and for regulators to "articulate next steps for existing financial alignment demonstrations."
Federal agencies have issued guidance for how healthcare providers should prepare for an active shooter emergency. The 33-page document covers threat assessment, actions to take during and after an emergency, and other best practices.
In a sign that the economy continues its recovery from the devastating recession of 2008, most states are committed to raising Medicaid fees in fiscal years 2014 and 2015, research from the Kaiser Family Foundation's Commission on Medicaid has found.
Seven years after filing for Medicare benefits for diabetes complications, Glenda Jimmo of Bristol, VT, finally qualified for skilled home health maintenance coverage. The obstacle that caused the long delay was Medicare's "improvement standard," which officials used to deny coverage for beneficiaries deemed to be "unlikely to improve."
Recovery Audit Contractors collected $1.8 million in Medicare overpayments made to skilled nursing facilities in fiscal year 2013, according to a Congressional report released in late September.
The Centers for Medicare & Medicaid Services should openly urge Congress to change therapy reimbursement, the nation's largest long-term care provider association stated in recent written comments to CMS Administrator Marilyn Tavenner.
The Centers for Medicare & Medicaid Services recently updated instructions on coding hospice claims. Billing staffs should be aware of these changes, which went into effect Oct. 1, CMS stated in a memorandum about the Medicare manual update.
A California healthcare system recently became the latest dropout from the Pioneer Accountable Care Organization program, citing the fact that payments are not adjusted by region. Sharp HealthCare announced the move in its third-quarter financial report.
A Congressional proposal to provide low-wage hourly employees with more stability and workplace protections could hit nursing homes.
Medicare Recovery Audit Contractors returned a record $100.4 million in identified underpayments to providers between April and June.
The government should adopt Medicare payment policies that better support hospital-based skilled nursing facilities, the American Hospital Association urged in a recent letter to a top healthcare official.
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.
The predominance of fee-for-service payment methods is the greatest barrier to improving efficiency in the nation's healthcare system, according to a May 29 report from a panel of White House advisors. The President's Council of Advisors on Science and Technology criticized the FFS payment model because it focuses on the volume of services provided rather than on better outcomes.
Government health programs could save money and health outcomes could improve if more dual-eligible beneficiaries were to go from hospitals to well-staffed long-term and post-acute facilities, according to research from Brown and Harvard universities.
Medicare would increase hospice reimbursements by 1.3% in fiscal year 2015 under a payment rate proposed in May. This would be a $230 million boost, according to the Centers for Medicare & Medicaid Services.
Healthcare providers face unfairly reduced reimbursements if they serve economically disadvantaged patients, according to a recent National Quality Forum draft report. The government rejected recommendations to address this problem.
A long-term care facility that has been slapped with a civil monetary penalty has 10 days to file for an independent informal dispute resolution process, according to a recent manual update from the Centers for Medicare & Medicaid Services.
Seniors will not have to stop curative care to receive hospice benefits under a new demonstration program, the Centers for Medicare & Medicaid Services recently announced.
Long-term care staffers' understanding of the Minimum Data Set and its Quality Indicators is "mediocre at best," according to recent survey results. Lack of exposure and involvement are key reasons why nurse aides especially feel they are out of the loop.
Federal investigators recovered more than $10 million in incorrect Medicaid payments made to nursing homes in 2013, an annual review shows.
A long-term care provider that requested clearance for a system of paying an agency to refer patients is in the clear.
Providers who want to have an administrative law judge consider a Medicare claim appeal can save their breath and memos for now.
The Department of Health and Human Services' watchdog arm recently said hospice providers need stronger oversight measures. It also noted more than $5.8 billion in recoveries in fiscal 2013.
The Centers for Medicare & Medicaid Services has seen enough and wants to gain more control over drug-prescribing practices for the Medicare Part D program.
So far, some providers have been put through a wringer without enough verification that it's been worth it, according to a new Government Accountability Office report.
A provider-sponsored survey recently uncovered huge backlogs of therapy claim reviews for beneficiaries who exceeded the Medicare Part B caps limits.
The Medicare Payment Advisory Commission could be getting closer to formally recommending more uniform payments to skilled nursing facilities and inpatient rehabilitation facilities.
Federal regulators have come out strongly against facility-wide policies that prohibit cardiopulmonary resuscitation for residents in distress.
A second group of contracts in a competitive bidding program for durable medical equipment items showed savings of more than one-third, according to the Centers for Medicare & Medicaid Services.
Earlier this year, the Department of Health and Human Services released an action plan for tackling Alzheimer's diagnostics, treatment and funding.
Federal regulators have expanded the use of escrow accounts so that as of this month, providers will be subject to their use for any kind of deficiency from a standard or complaint survey that draws a civil monetary penalty.
Federal regulators say surveyors need to prevent providers from possibly "gaming" the system when it comes to the timing of surveys and sales.
Federal regulators have added another layer of bureaucracy for hospice providers operating within skilled nursing facilities.
Long-term care groups are among those hailing a federal study that raises critical questions about hospitals' apparent over-use of "observation stay" designations for patients.
Organizations may serve as authorized representatives for nursing home residents in the Medicaid application and enrollment process, according to a final rule issued by the Centers for Medicare & Medicaid Services.
The Centers for Medicare & Medicaid Services should consider a higher market basket update for nursing homes due to improper calculations that could be costing providers, the American Health Care Association maintains.
Independent Medicare auditors are criticizing two measures that would put stricter controls on Recovery Audit Contractors.
States have run their respective long-term care ombudsman programs in differing ways for nearly 20 years, but that would change if a new proposal advances.
Large-scale bundling of government reimbursements is needed, say researchers who have studied the topic. Post-acute care was the fastest growing major healthcare spending category for government programs between 1994-2009, according to Harvard University researcher Amitabh Chandra, Ph.D., and co-authors.
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.
The Centers for Medicare & Medicaid Services has issued a fact sheet, that clarifies the conditions the terms under which "maintenance therapy" will be covered by Medicare.
Skilled nursing operators now have greater flexibility in allowing non-physicians to do certain tasks. The Centers for Medicare & Medicaid Services clarified what may be delegated in an April 3 brief.
A federal agency is again offering to put its money where its mouth is when it comes to employee background checks for long-term care providers. All direct-care employees could potentially be affected.