Category: News

Payment rate changes: How will 2014 compare to 2013?

On August 1, CMS released the skilled nursing facilities (SNF) prospective payment system (PPS) Final Rule for FY 2014 that will update the payment rates used under the PPS for SNFs for 2014. According to the final rule, there will be a net rate increase of 1.3% or $500 million for FY 2014. To see […]

CMS Releases SNF PPS Final Rule for FY 2014

On August 1, 2013, the Centers for Medicare & Medicaid Services (CMS) published the final rule for the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2014 in the Federal Register. Effective October 1, 2013, this final rule updates the payment rates used under the prospective payment system for SNFs […]

GAO releases report on implementation of Manual Medical Review process

On July 10, the United States Government Accountability Office (GAO) released a report to Congress about the implementation of the 2012 manual medical review (MMR) for Medicare outpatient therapy. According to the report, in 2011, Medicare paid about $5.7 billion to provide outpatient therapy services for 48 million beneficiaries. This report describes the Center for […]

CMS releases FAQ document on functional reporting for therapy services

On June 19, the Centers for Medicare & Medicaid Services (CMS) released a new Frequently Asked Questions (FAQ) document on functional reporting for PT, OT, and SLP services. The document includes FAQs on: Providers, plans, and payers subject to functional reporting How to report functional information Assessment tools Claims requirements Click here to access this […]

New final rule makes changes to requirements for LTC facilities; hospice services

A final rule, released on Thursday, June 27, will revise the requirements that an institution will have to meet in order to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program. These requirements will ensure that long-term care (LTC) facilities (SNFs and […]

CMS issues ICD-10 split claims billing instructions

CMS issued a MLN Matters article that offers instructions that clarify the policy for processing claims for certain institutional encounters that span the ICD-10 implementation date of October 1, 2014. Skilled Nursing Facilities (Inpatient Part B): Bill type: 22X Use FROM date Require providers split the claim so all ICD-9 codes remain on one claim […]

CMS releases new QAPI resources

On June 7, the Centers for Medicare & Medicaid Services (CMS) released a memo sent to state survey agency directors that announced the rollout of introductory materials to help nursing homes establish a foundation to implement and sustain the Quality Assurance and Performance Improvement (QAPI) transition. The introductory materials include: QAPI at a Glance: A […]

Diving In Deeper: MDS 3.0 RAI User’s Manual Update

The Centers for Medicare & Medicaid Services (CMS) recently released a revised version of the MDS 3.0 Resident Assessment Instrument (RAI) User’s Manual. Let’s take an in-depth look at the changes, which were fairly minimal, according to Diane Brown, BA, director of postacute education at HCPro, Inc. The changes (which are underlined) were mostly clarifications […]

CMS releases updated MDS 3.0 RAI User’s Manual

The Centers for Medicare & Medicaid Services (CMS) recently released the RAI Manual v1.10 Replacement Manual Pages and Change Tables and the RAI Manual v1.10 and Change Tables. MDS 3.0 RAI Manual v1.10 Appendix B was also updated. The updated MDS 3.0 RAI Manual v1.10 was effective May 8, 2013. This version of the MDS […]

2014 SNF Proposed Rule Analysis: Revising and rebasing the SNF market basket

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that is proposing to rebase and revise the SNF market basket for 2014 and subsequent years to reflect more recent data. The current SNF market basket reflects data from 2004 and CMS is proposing to revise and update the SNF market basket […]