CMS Fraud Prevention System identified or prevented over $210 million in...
CMS reports that its Fraud Prevention System (FPS) identified or prevented more than $210.7 million in improper Medicare fee-for-service payments during fiscal year 2013, its second year in...
View Article2015 IPPS Final Rule released
A significant portion of updates in the Fiscal Year 2015 IPPS final rule pertain to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the...
View ArticleICD-10 compliance date officially set for October 1, 2015
HHS will release the final rule, Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD–10–CM and ICD-10-PCS) Medical Data...
View ArticleProposed law would mandate minimum direct care nurse hours
A bill that would establish around-the-clock registered nurse staffing hours at Medicare and Medicaid nursing homes and skilled nursing facilities was introduced by an Illinois congresswoman last week....
View ArticleQ&A: Can we charge ED visits if patients don’t see a physician?
Q: We have a new ED director who wants to capture all of our ED visits to be sure we get our productivity credits and revenue. He wants to charge a low-level ED visit for the patients who come in, are...
View ArticleCMS focuses on quality measures in 2015 IPPS final rule
CMS’ recently released 2015 IPPS final rule focuses on quality initiatives mandated by the Affordable Care Act (ACA), including updates to Hospital Value-Based Purchasing (VBP) Program, the Hospital...
View ArticleCMS issues four home health policy change requests
CMS, hoping to promote compliance and cut down on program vulnerability, recently issued four change requests that address home health policy and claims processing issues. Change Request 8699, inspired...
View ArticleDrug resistant pathogen discovered in Ohio long-term care facility
A type of drug-resistant Pseudomonas aeruginosa discovered in an Ohio long-term care facility has killed one person and infected six others, according to research published in Antimicrobial Agents and...
View ArticleQ&A: Why are we getting edits for PET scans?
A: Certain radiopharmaceuticals can only be reported with specific PET scan procedures. While you don’t indicate what the HCPCS codes are for the procedure or the radiopharmaceutical, you can take some...
View ArticleSenate report recommends RAC payment changes
by Jaclyn FitzgeraldThe Senate’s Special Committee on Aging recently released a report about improving Medicare audits and suggested a shift in the payment structure for Medicare Recovery Audit...
View ArticleGAO advices CMS to ramp up oversight and guidance for postpayment claims reviews
A new report from the U.S. Government Accountability Office (GAO) found that CMS does not have reliable data or sufficient oversight to measure and prevent duplicative postpayment claims reviews. The...
View ArticleMore oversight needed for SNFs to correctly report abuse allegations
Only about half of nursing facilities correctly reported abuse or neglect allegations in 2012, indicating that the government needs to provide more guidance and oversight, according to a new report...
View ArticleQ&A: Can we bill a clinic visit with only status indicator N services?
Q: Our provider-based clinics occasionally perform only status indicator N (no additional payment, payment included in line items with APCs for incidental service) services. For example, a patient...
View ArticleOIG report targets EHR certification vulnerabilities
by Jaclyn Fitzgerald, Editor The Office of the National Coordinator’s (ONC) EHR certification test procedures may not have addressed issues such as password complexity, emergency access logs, and...
View ArticleHome health stakeholders give "lukewarm" reception to Medicaid managed care,...
A new report from the National Council on Medicaid Home Care reveals a less-than-enthusiastic reception of Medicaid managed care from the home health industry. “The survey results reflect a reaction to...
View ArticleQ&A: Billing pulmonary rehabilitation along with other therapy services
Q: Our MAC is reviewing our pulmonary rehabilitation and physician therapy (PT) and occupational therapy (OT) charges. Therapists provide our services and we bill the therapy using the HCPCS code for...
View ArticleRestrictive diets provide little benefit for residents in long-term care
Research has shown that restrictive diets add little benefit for older adults in long-term care, and they might even be harmful. Concerning issues are weight loss and meal rejection. The Centers for...
View ArticleCMS offers deal to hospitals to reduce backlog of appeals
In an effort to reduce the backlog of Medicare claims appeals that has hindered long-term care and other providers, CMS is offering a new way to settle some cases. Hospitals could receive a partial...
View ArticleQ&A: How does CMS decide skin substitute classifications?
Q: We have been using the skin substitute called BioDfence® Dry Flex in our wound clinic. This is classified as a low-cost item under the OPPS and we are paying a lot for this item. How do we get CMS...
View ArticleCMS, ONC finalize changes to the EHR Incentive Programs
by Jaclyn Fitzgerald, Editor CMS and ONC recently released a final rule that offers enhanced flexibility for eligible professionals, eligible hospitals, and critical access hospitals using certified...
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