Articles and Blogs

An article in the New York Times discussed a growing trend away from the utilization of nursing facilities in favor of managed care and home care.  In light of reimbursement cuts from Medicare and Medicaid, the push to home health, managed care, and the Program of All-Inclusive Care for the Elderly (PACE) has received enthusiastic response from some... READ MORE

As part of their on-going video series, the Office of Inspector General (OIG) has posted a video on their self-disclosure protocols. Self-disclosure is a key element of an effective compliance program, and can possibly reduce any civil monetary penalties (CMPs) associated with a violation or instance of noncompliance. The OIG has provided many videos... READ MORE

The Centers for Medicare & Medicaid Services (CMS) has published a transmittal detailing changes for coding hospice discharges, which will provide greater clarity as to why the patient has been discharged from hospice care.   READ MORE

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns.  Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January 1, 2012.   READ MORE

The New York Times (NYT) had an interesting article in their The New Old Age segment that described the issues men have in finding appropriate long-term care facilities.  The article highlighted an intuitive, yet often overlooked issue concerning the number of rooms a facility has versus the number of beds.  Many facilities have two... READ MORE

The Centers for Medicare & Medicaid Services (CMS) has responded to criticism detailing how Medicare contractors present hospice service charges in the Medicare Summary Notice (MSN) to beneficiaries.  In recent years, CMS has added new reporting requirements for visit data on hospice claims.  This resulted in an expansion of the information of the claim record to better understand... READ MORE

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that enacts a provision of the Patient Protection and Affordable Care Act (PPACA) that seeks to make Medicaid reimbursement for medications more transparent and more closely aligned with what pharmacies pay for the drugs.  In a press release, CMS states the... READ MORE

The Department of Justice (DOJ) has recommended to the Supreme Court of the United States (SCOTUS) that only the provisions of the Patient Protection and Affordable Care Act (PPACA) that require insurers to accept everyone regardless of health status and to apply “community rates” be overturned if the Justices rule that the law’s mandate... READ MORE

The Centers for Medicare & Medicaid Services (CMS) released updated guidance on Section 6501 of the Patient Protection and Affordable Care Act (PPACA) that requires state Medicaid agencies to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or any other state Medicaid plan.   READ MORE

This week, the Centers for Medicare & Medicaid Services (CMS) updated Section 40.1 of Publication 100-1, the Medicare General Information, Eligibility and Entitlement Manual, to reflect Section 3108 of the Patient Protection and Affordable Care Act (PPACA).  This update permits physician assistants to perform the initial certifications and recertifications of a beneficiary’s need for skilled... READ MORE