Payment & policy

Panel slams fee for service

By

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.

Referrals funnel duals into lower quality nursing homes

Referrals funnel duals into lower quality nursing homes

By

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.

Hospice care scrutinized

By

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.

CMS pushes back on quality measure recommendations

CMS pushes back on quality measure recommendations

By

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.

Penalty process explained

By

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.

Hospice, curative care paid together in new program

Hospice, curative care paid together in new program

By

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.

MDS insight found lacking

By

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.

Feds recover $10 million in incorrect Medicaid payouts

Feds recover $10 million in incorrect Medicaid payouts

By

Federal investigators recovered more than $10 million in incorrect Medicaid payments made to nursing homes in 2013, an annual review shows.

Referral fees OK, says OIG

By

A long-term care provider that requested clearance for a system of paying an agency to refer patients is in the clear.

Extra audits clog and freeze  Medicare appeals process

Extra audits clog and freeze Medicare appeals process

By

Providers who want to have an administrative law judge consider a Medicare claim appeal can save their breath and memos for now.

OIG: Hospices often out of compliance, need framing

By

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.

CMS wants tighter oversight for Medicare prescriptions

CMS wants tighter oversight for Medicare prescriptions

By

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.

CMS improperly measuring outcomes, report claims

By

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.

Providers rip huge backlog of therapy claims reviews

Providers rip huge backlog of therapy claims reviews

By

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

MedPAC focuses on rehab

By

The Medicare Payment Advisory Commission could be getting closer to formally recommending more uniform payments to skilled nursing facilities and inpatient rehabilitation facilities.

Blanket 'no-CPR' policy can result in citation, CMS rules

Blanket 'no-CPR' policy can result in citation, CMS rules

By

Federal regulators have come out strongly against facility-wide policies that prohibit cardiopulmonary resuscitation for residents in distress.

DME bidding saved 37%

By

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.

PET scans for Alzheimer's rejected for Medicare pay

PET scans for Alzheimer's rejected for Medicare pay

By

Earlier this year, the Department of Health and Human Services released an action plan for tackling Alzheimer's diagnostics, treatment and funding.

Cases subject to escrow

Cases subject to escrow

By

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.

CMS puts surveyors on alert for those 'gaming' system

CMS puts surveyors on alert for those 'gaming' system

By

Federal regulators say surveyors need to prevent providers from possibly "gaming" the system when it comes to the timing of surveys and sales.

More hospice info wanted

By

Federal regulators have added another layer of bureaucracy for hospice providers operating within skilled nursing facilities.

OIG finds 'observation stay' problems, calls for reform

OIG finds 'observation stay' problems, calls for reform

By

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.

SNFs may help enroll: CMS

By

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.

Fix flaws before changing nursing home pay: AHCA says

Fix flaws before changing nursing home pay: AHCA says

By

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.

RACs recoil against bills

By

Independent Medicare auditors are criticizing two measures that would put stricter controls on Recovery Audit Contractors.

Proposal would bring unity to LTC state ombudsmen

Proposal would bring unity to LTC state ombudsmen

By

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.

Case for bundled pay made

By

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.

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

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

By

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.

CMS fact sheet gives rules on 'maintenance' caregiving

CMS fact sheet gives rules on 'maintenance' caregiving

By

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.

CMS eases doc delegation

By

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.

Feds offer more support for workers' background checks

Feds offer more support for workers' background checks

By

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.

State, CMS pair up on duals

By

The Centers for Medicare & Medicaid Services and the state of Illinois are teaming up in a dual eligible payment demonstration.

CMS wants burdens eased

By

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

Medicare has two more years to reclaim any overpayments

Medicare has two more years to reclaim any overpayments

By

Providers will have to hold their breath a little longer after receiving Medicare payments, thanks to a little-publicized provision of recently signed fiscal cliff legislation.

Ask the payment expert ... about inaccurate MDS therapy information

Ask the payment expert ... about inaccurate MDS therapy information

By

What happens if my therapy company makes an error on the MDS and as a result, a change of therapy was missed? Are we still responsible?

MedPAC is losing touch with reality, provider group says

MedPAC is losing touch with reality, provider group says

By

Providers are used to the Medicare Payment Advisory Commission promoting stingy or non-existent reimbursement recommendations.

Feds limit Medicaid picks

By

While the administration has been flexible about numerous aspects of Medicaid expansion called for in the healthcare reform law, there is at least one thing that is not negotiable: States will not get full federal funding from states that go only part way on expanding their Medicaid programs.

MFP program struggling

By

The government's so-called "Money Follows the Person" program has had a disappointing start, officials announced recently.

Medicare coverage to extend for some with chronic ills

Medicare coverage to extend for some with chronic ills

By

The Obama administration settled a lawsuit in November that opens the door for expanded skilled nursing care and rehab therapy for some individuals with chronic diseases.

OIG to study contractors

By

A new federal work plan declares that even the Medicare contractors charged with keeping close tabs on long-term care facilities will be put under the microscope during fiscal 2013.

CMS: Readmit penalties will be higher than first thought

CMS: Readmit penalties will be higher than first thought

By

A miscalculation by the Centers for Medicare & Medicaid Services means that more than 1,400 hospitals with comparatively high readmissions rates will lose more federal funding than previously thought, the agency revealed in October.

Claims facing more scrutiny from auditors, survey shows

By

If providers feels like they're under more intense scrutiny than ever before from Medicare recovery audit contractors, there is a good reason: They are.

GAO: Medicaid flaws found

By

People seeking Medicaid coverage for long-term care are subjected to differing asset-verification checks among the states, a new report finds.

Pay-for-performance test run  yields mixed results: report

Pay-for-performance test run yields mixed results: report

By

An Affordable Care Act provision testing pay-for-performance incentives faces an uncertain future after a federal demonstration program testing it has so far brought "disconcerting" results.

Full Medicaid denial sought

By

At least one high-ranking lawmaker is pushing to cut off Medicaid funding to providers who have unpaid taxes.

Court curtails union fees

By

The U.S. Supreme Court came down against organized labor recently in a 7-2 ruling that opens the door for objections to unexpected fee increases or special assessments.

Report: States headed for Medicaid funding upheaval

Report: States headed for Medicaid funding upheaval

By

Regardless of whether states choose to expand Medicaid under healthcare reform law, they are facing huge fiscal crisis conditions, largely due to rising healthcare costs and government pension obligations, new research says.

CMS extends overpayment payback window to one year

By

Federal regulators have relented and given state Medicaid programs a full year to collect and return overpayments made to providers.

Report: Loophole abused

By

Results of a new study confirm long-term care providers' suspicions that they are being denied access to many post-hospitalization patients due to hospitals' admitting and coding practices.

Overpayment rule is based on bad assumptions, expert says

Overpayment rule is based on bad assumptions, expert says

By

Regulators have severely underestimated added costs that would result under a proposed rule requiring the prompt return of self-detected reimbursement overpayments, according to at least one expert.

Don't miss any McKnight's news

Featured Articles