Articles and Blogs

Pursuant to Section 6111 of the Affordable Care Act enacted on March 23, 2010, and the final rule published on March 18, 2011 in the Federal Register, a nursing facility must be offered the opportunity to request an Independent Informal Dispute Resolution (IIDR) if the Centers for Medicare & Medicaid Services (CMS) imposes a... READ MORE

CMS has just released the highly anticipated final regulations for accountable care organizations (ACOs) under Section 3022 of the Affordable Care Act (ACA).  The ACA requires accountable-care agreements to be offered under Medicare, starting in 2012.  READ MORE

Just weeks after ongoing development of the CLASS Act stalled, Secretary Sebelius announced today the implementation of the CLASS Act has been completely halted.  Reflecting concerns over the sustainability of the program and the potential for the development of a new entitlement program, the Department of Health and Human Services determined the financing plans related to the Act... READ MORE

On October 12, 2011, the U.S. Department of Justice unsealed an indictment charging Matthew Kolodesh a/k/a Matvei Kolodech, with conspiracy to defraud Medicare of more than $14 million.  According to the indictment, Kolodesh’s business, Home Care Hospice, Inc. (HCH), located in Philadelphia, PA, submitted Medicare claims for approximately $14.3 million dollars for patients who... READ MORE

Representative John Kline of Minnesota introduced the Workforce Democracy and Fairness Act last week in response to recent NLRB actions affecting employers.  One aspect of this Bill is the reversal of the NLRB’s Specialty Healthcare decision which altered the established standard for determining collective bargaining units in non-acute care health facilities.    READ MORE

As previously discussed, hospice providers are required to have a hospice physician or nurse practitioner perform a face-to-face encounter with each hospice patient whose total length of stay is anticipated to reach the third benefit period.  This encounter must be performed no more than thirty days prior to the third benefit period recertification, and... READ MORE

After October 31, 2011, DMEPOS suppliers will no longer be permitted to use the 07/09 version of the CMS-855S application and will be required to utilize the updated 07/11 version. The 07/11 version is available and may be used for submissions now. The newest version of the application has been updated to capture additional... READ MORE

The NLRB announced last week that it has postponed the implementation date for its new notice-posting rule (previously discussed here and here) by more than two months in order to allow for “enhanced education and outreach to employers”, particularly those who operate small and medium sized businesses.  The posting requirement for most private employers... READ MORE

McKight’s points to a recent study that suggests nursing uniforms laundered at home have not been adequately sanitized.  The study from the University College in London found residential washing machines only heated water to 104 degrees Fahrenheit, leaving substantial amounts of bacteria behind. Investigators found that thorough ironing after washing was successful in removing remaining Acinetobacter... READ MORE

Effective October 1, new PPS rules for fiscal year 2012 require nursing homes to diligently review claims prior to submission.  As previously discussed, significant cuts in SNF reimbursement are aimed mostly at therapy services.   SNFs submitting claims under the previous rules can expect high rates of denials and rejections.  Even facilities billing under the new... READ MORE