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 […]
Category: Skilled Nursing Facility
Section 6102 of the Resident Protection Affordable Care Act of 2010 required skilled nursing facilities (SNF) to establish a compliance and ethics program by March 23, 2013. Most of us have an existing program that may or may not be up to date, so now is the time to ensure that your program is in […]
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 […]
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.
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 […]
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.
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, […]
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) […]
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 […]
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 […]