Category: News

New Medicare notices gives seniors a tool to help fight against fraud

Medicare beneficiaries will start receiving a redesigned statement of their claims for services and benefits that will help them spot potential fraud, waste, and abuse, according to a recent press release by the Centers for Medicare & Medicaid Services. The redesigned notice will make it easier for people with Medicare to understand their benefits, file […]

AHCA finds long-term care services underfunded by Medicaid

The American Health Care Association (AHCA) released a report today demonstrating that the long term care services are significantly underfunded by Medicaid. The report estimates that the nation will have the highest Medicaid shortfall on record for 2013—over 7.7 billion dollars. On a daily basis, the shortfall is $24.26 per Medicaid patient. This shortfall is […]

CMS announces post-acute participants for bundled payment initiative

The Centers for Medicare & Medicaid Services (CMS) has announced the most recent participants in its Bundled Payments for Care Improvement (BPCI) Initiative. Under the BPCI Initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower […]

CDC releases new report on the state of long-term care

The Centers for Disease Control and Prevention (CDC) has released a new report titled “National Study of Long-Term Care Providers”. According to the CDC, the report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the CDC’s National Center for Health Statistics (NCHS). This […]

Overpayments resulting from improper claims for ambulance services

On November 6, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 1311, which offered guidance on the contractor claim data, identified by suppliers, which were billing ambulance claims for SNF to SNF transfer separately under Part B. This was resulting in overpayments. As a result of overpayment for a transport between two SNFs […]

OIG releases report on Medicare A and B redeterminations

Earlier this month, the Office of the Inspector General (OIG) released a report titled, “The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness”. According to the OIG, the Medicare appeals process serves as an important protection for beneficiaries and providers. Their study represents the first examination of redetermination, i.e., the first […]

MDS 3.0 RAI User’s Manual Update: Expert analysis

The Centers for Medicare & Medicaid Services (CMS) recently released the MDS 3.0 RAI User’s Manual v1.11 Replacement Manual Pages and Change Tables and the RAI Manual v1.11 and Change Tables. The MDS 3.0 RAI Manual v1.11 Appendices A and F were also updated. In addition to the Manual changes, there are changes to the […]

CMS releases updated MDS 3.0 RAI User’s Manual

The Centers for Medicare & Medicaid Services released a revised version of the MDS 3.0 RAI User’s Manual. Effective October 1, 2013, this updated version incorporates clarifications to existing coding and transmission policy, integrates previously published Questions and Answers into the appropriate sections and addresses requested clarifications and scenarios concerning complex areas.

OIG releases new report on RAC program and improper payments

On September 3, the Office of Inspector General (OIG) released a report titled, “Medicare Recovery Audit Contractors and CMS’s Actions To Address Improper Payments, Referrals of Potential Fraud, and Performance.” The report found that in 2010 and 2011, Recovery Audit Contractors (RAC) identified half of all claims they reviewed as having resulted in improper payments […]