Medicare Part B
Nursing home background checks, foot care being scrutinized by OIG
November 06, 2014Government investigators are preparing reports on skilled nursing facilities' Part B billing practices and background check processes, according to the recently released annual work plan from the Health and Human Services Office of Inspector General.
Medicare Part B could have saved $110 million, OIG asserts
September 18, 2014If the Medicare Part B program had used average Medicare Part D drug dispensing and fee rates, it would have saved the government $110 million in 2011, according to a report from the Department of Health and Human Services Office of Inspector General released Sept. 16.
Federal judge dismisses nursing home 'kickback' case; upholds large X-ray company's 'swapping' method of billing
September 02, 2014The way mobile x-ray company Mobilex bills nursing homes is acceptable, a federal judge recently determined. Mobilex is the nation's largest provider of mobile diagnostic services. It had been facing whistleblower charges that it effectively paid kickbacks to nursing homes through an arrangement known as "swapping."
What administrators need to know about therapy metrics
August 08, 2014Administrators 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
July 28, 2014Stacy 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
July 07, 2014Long-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?
May 20, 2014With 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
January 01, 2014A 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
July 29, 2013Provider 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
July 23, 2013Better 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
June 21, 2013A 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
May 23, 2013Effective 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
May 08, 2013While 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
February 19, 2013The 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
February 08, 2013A 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
February 06, 2013Every 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
February 01, 2013Instead 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
February 01, 2013Providers will have their say about the future of Medicare Administrative Contractors.
The Manual Medical Review mess
October 29, 2012What 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
April 06, 2012A 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
February 15, 2012Members 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
July 29, 2011The 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'
November 16, 2010Doctors 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
October 22, 2010It'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
October 20, 2010Consolidating 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
October 13, 2010As 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
August 06, 2010The 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
July 09, 2010Another proposed rehab rule threatens to cut significant revenues from long-term care providers.
Long-term care leaders criticize Washington Post article on reimbursements
March 31, 2010A 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
March 23, 2010The RUG-IV classification system will not start until Oct. 1, 2011, under the new healthcare reform bill.
