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CMS: Pay attention to telehealth billing rules

CMS is reminding providers to ensure that Medicare claims for telehealth are correctly billed. The agency issued broadly expanded telehealth services as part of its response to the COVID-19 public health emergency. However, a 2018 Office of Inspector General audit found that CMS paid practitioners for some telehealth claims that did not meet Medicare requirements […]

OIG warns providers about COVID-19 vaccine fraud and abuse

The Department of Health and Human Services Office of Inspector General is reminding providers of the rules around administering the COVID-19 vaccine after complaints from patients charged for the vaccine and other reports of fraud and abuse around vaccine distribution. OIG is reminding all participating providers that they: must administer COVID-19 Vaccine with no out-of-pocket […]

Q&A: Leveraging coders to improve HCC accuracy

Q: We’re looking for ways to bring our CDI and coding teams together to improve documentation and coding for appropriate Hierarchical Condition Categories (HCC) capture. Are there any recommended models and should other departments or individuals be working alongside them? A: Fine-tuning coding and documentation to support accurate HCCs is a team effort. The coding […]

President signs sequestration suspension bill into law

On April 14, President Joe Biden signed into law H.R. 1868, which extends a suspension of Medicare sequestration, according to The White House. The move is welcome news to Medicare providers who were preparing for 2% payment cuts if the measure was not approved. The bill was working through Congress last month in an attempt […]

Risk of Spreading COVID-19 to Relatives Justifies Abandoning Work, AR Court Rules

All of us are facing the uncertainty and burdens of dealing with COVID-19’s impact on the workplace. One issue revolves around when employees have good cause to abandon their jobs because of the risks created by the virus. The Arkansas Court of Appeals recently addressed the question and sided with the employee. Tracy Keener was […]

CMS proposes hospice rule changes to rates, CoPs, quality measures

CMS released several proposed rules late Thursday, including the FY 2022 Hospice Payment Rate Update. “Despite the continuing public health emergency (PHE) generated by COVID-19, the Centers for Medicare & Medicaid Services (CMS) is pushing forward with significant changes for hospice,” the National Association for Home Care and Hospice noted in its initial analysis of […]

CMS updates QRP and VBP programs for FY2022

On April 8, 2021 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1746-P) that provides updates to and proposals for the fiscal year (FY) 2022 Skilled Nursing Facility Quality Reporting Program (SNF QRP).  This rule includes two new measure proposals: the Skilled Nursing Facility (SNF) Healthcare-Associated Infections (HAI) Requiring Hospitalization Measure and […]

Re-evaluating Payment After a Year of COVID

With us today is Maureen McCarthy. Maureen is president of Celtic Consulting, LLC, and CEO and founder of Care Transitions, LLP, a care coordination service provider. We discuss how reimbursement avenues have changed in the past year, and how SNFs need to consider what might change as the pandemic hopefully improves. Post-Acute Advisor · Re-evaluating […]

High intensity therapy may lead to better outcomes for residents

SNF residents who receive high intensity therapy have the lowest 30-day hospital readmission rates, according to a new study conducted by the American Occupational Therapy Association, and the American Physical Therapy Association. High intensity therapy is defined as 90 to 219 hours during the time of care. While the study shows that high intensity therapy […]

What Is the FAMILY Act?

The Family and Medical Insurance Leave (FAMILY) Act was reintroduced in Congress in 2021 and is known as S. 463 and H.R. 1185. The Act has been introduced repeatedly during legislative sessions for the past 7 years but has yet to progress. The FAMILY Act strives to create paid time off at a portion of […]