Articles and Blogs

Change Request (CR) 6421 was recently revised to remove chiropractors from the list of providers who may order or refer for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).  All other information in the CR remained the same.  As you will recall, in CR 6421, the Centers for Medicare & Medicaid Services (CMS) started the expansion of claim editing to... READ MORE

The Indiana Office of Medicaid Policy and Planning (“OMPP”) has released a revised prior authorization policy for early refills of prescriptions.  The change will be effective December 1, 2011 and requires that at least 85% of a prescription claim’s days transpire before subsequent claims or prior authorizations can be approved.  This is a change... READ MORE

The Occupational Safety and Health Administration (“OSHA”) has included nursing facilities in their Site-Specific Targeting 2011 (“SST-11”) Plan for facilities with high rates of injuries and illnesses experienced by workers.  The SST-11 selects individual facilities for inspection identified through the 2010 Data Initiative survey.  OSHA will target facilities with specific Days Away, Restricted, or... READ MORE

This past September, the Centers for Medicare & Medicaid Services (“CMS”) posted revised interpretive guidelines concerning the use of feeding tubes in nursing homes.  In late October, CMS retracted the Survey & Certification Letter detailing the revised changes so they could include instructions that pertain to the Quality Indicator Survey (“QIS”).  Further revised interpretive... READ MORE

While the final ACO Rules (“Final Rules”) have done away with the importance of participaitng phyisicians being meaningful users of an EHR under the HITECH EHR Incentive Program (“Meaningful Users”), the importance of meaningful use by participating primary care providers has not gone away. CMS sought to align an ACO’s use of Electronic Health Records (“EHR”) with... READ MORE

Oregon election officials took iPads into nursing homes in five Oregon counties for Tuesday’s election.  This effort was under a small pilot program designed to enable the state’s elderly and disabled population to vote.  The iPad was able to accommodate various disabilities, including enlarged font sizes and audible ballot reading for vision impaired voters, and... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) has released instructions to prospective Accountable Care Organizations (“ACO”) for applying to the Shared Savings Program. The application process has both automated and paper options, but CMS strongly recommends using the automated application system. All organizations wanting to participate in the Shared Savings Program must submit a... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) has released an updated Skilled Nursing Facility (“SNF”) Prospective Payment System (“PPS”) Factsheet.  The revised Factsheet includes background information and elements of the SNF PPS. Should you have any questions, please contact: Todd Selby at 317.977.1440 or tselby@wp.hallrender.com; Brian Jent at 317.977.1402 or bjent@wp.hallrender.com; or David Bufford at 502.568.9368 or dbufford@wp.hallrender.com, or... READ MORE

A Medicare beneficiary is not liable for custodial care services rendered by a Mississippi nursing home because the facility failed to give adequate notice the services were not covered by Medicare, a federal appeals court panel ruled on October 25.  The case (Mississippi Care Center of Morton LLC, Sebelius, 5th Cir., No. 10-60595, Oct.... READ MORE

The Centers for Medicare & Medicaid Services has posted a list of providers who have been sent a request to revalidate their Medicare enrollment information. You can access and review the list, then select “Revalidation Phase 1 Listing.”  The list will be updated monthly and providers are encouraged to review the list.  If you... READ MORE