Category: Payment/economy

Appeals backlog slowly reduced, percentage of unfavorable rulings concerning

By Home Health Line. While the backlog of home health appeals at the Administrative Law Judge level is steadily being chipped away, data show a low reversal rate for appeals. In 2018, 54,875 home health appeals have been dismissed. That is compared to 958 dismissals in 2017 and 731 in 2016, according to an analysis […]

CGS to hold webinar about RAPs

By Home Health Line. Medicare Administrative Contractor (MAC) CGS is holding a webinar 1 p.m. to 2 p.m. EST Nov. 15 to discuss a transmittal that provides instructions to MACs about monitoring home health agencies’ misuse of requests for anticipated payment (RAPs). “We will discuss the implications to you as a home health provider,” CGS’ […]

Study finds older Americans filing for bankruptcy at high rate

A new study available at SSRN shows that older Americans are struggling with increased financial risks, namely inadequate income and unmanageable costs of healthcare. The study concludes that the increasing baby boomer population entering into old age does not alone account for the significant rise in older Americans filing for bankruptcy. According to the study: […]

Resources for a smooth transition to PDPM

Brought to you by Biller’s Association for Long-Term Care. As SNF and nursing home providers familiarize themselves with CMS’ new Patient Driven Payment Model (PDPM), The Bottom Line is here to keep you educated and up to date on the latest resources, guidance, and best practices as they are made available. Here are this week’s […]

Two strategic responses to bundled payment models

Source: HealthLeaders Media Medicare’s bundled payment programs are profoundly impacting the way acute-care providers are working with their post-acute care partners. Hospitals and health systems participating in federal hip and knee replacement bundles are adopting two post-acute care strategies: limiting referrals to skilled nursing facilities and integrating with SNFs. For hospitals, establishing strong relationships with […]

Free webinar on PDPM

The new SNF payment rule is final. Learn what you need to do to prepare in HCPro’s FREE webinar. When: Wed, Aug 22, 2018 1:00 PM – 1:30 PM EDT Register here. The Patient-Driven Payment Model (PDPM) is designed to replace the current SNF payment methodology known as RUG-IV. The effective date of the change […]

SNF PPS final rule published, new payment model to begin October 1, 2019

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register yesterday evening, the Patient-Driven Payment Model (PDPM)—the new case-mix methodology to replace RUG-IV)—is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. […]

Final rule: Hospice payments rise by 1.8%, PAs can be attending physicians

Brought to you by Home Health Line. The hospice industry will receive $340 million in increased payments in 2019, according to CMS’ final hospice payment rule posted Aug. 1 on the Federal Register. That’s nearly twice the payment increase from 2018. Hospices will receive 1.8% more in payments. The industry only received a 1% increase […]

Flowcharts to help you with the Medicare appeals process

Brought to you by Biller’s Association for Long-Term Care. Once an initial claim determination is made, beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions. There are five (5) levels in the Medicare A and B appeals process. Standard appeals give the resident the opportunity to have the SNF’s decision […]