Category: News

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 […]

SNF Quality and Compliance Seminar

Join us in Chicago for the only seminar that covers long-term care quality improvement while focusing on reducing financial risk. At this exciting seminar, HCPro’s regulatory expert Diane Brown, BA, CPRA, will dive right into the Quality Assurance and Performance Improvement (QAPI) initiative by providing hands-on guidance to launching a facility-specific QAPI program with a particular look at common clinical or survey concerns, plus the frequent billing, financial, and Medicare issues all SNFs face.

CMS releases new information on civil money penalties imposed for a deficiency

On August 30, the Centers for Medicare & Medicaid Services (CMS) released a memo sent to state survey agency directors that states that every civil money penalty (CMP) imposed for a deficiency in a nursing home will be subject to escrow and the nursing home may request an independent informal dispute resolution. Effective October 1, […]

CMS releases new article on dual eligible beneficiaries

The Centers for Medicare & Medicaid Services (CMS) released a new article titled “Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries”. The article finds that among dual eligibles and non-dual eligibles, the average number of diseases and case-mix scores are higher for long-term care (LTC) […]

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 […]