Articles and Blogs

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

Current regulations (42 C.F.R 424.510(e)(1),(2)) require providers and suppliers to agree to receive Medicare payments via Electronic Funds Transfer (“EFT”) at the time of enrollment, revalidation, change of Medicare contractors or submission of an enrollment change request.  Additionally, the provider or supplier must submit a CMS-588 form to receive Medicare payment via EFT.  Section 1104... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) has made changes to the Medicare Overpayment Notification Process.  If an outstanding balance has not been resolved, providers previously received three notification letters regarding the overpayments:  (1) an initial demand letter, (2) a follow-up letter, and then (3) an intent to refer letter.  CMS would send the second... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) has reevaluated the revalidation requirements in the Affordable Care Act (“ACA”), and believe the ACA allows for the extension of the revalidation period for an additional two years.  This will extend the deadline for revalidation through March of 2015.  Providers are reminded that if they have... READ MORE

The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 2 and the national mail-order competitions are coming soon. Though the bidding schedule has not yet been released, suppliers interested in bidding should begin their preparations now to help avoid unnecessary delays or rejection of a bid application. Any supplier who... 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

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