Tag: admission

CMS updates guidance on certain NOA reporting

On Sept. 10, 2021, CMS provided updated guidance on certain claims as agencies transition from the monthly RAP to a one-time Notice of Admission (NOA) in 2022. As previously noted by CMS, for beneficiaries receiving home health services in 2021 whose services will continue in 2022, the agency will need to submit a one-time, artificial […]

CMS outlines changes for notice of admission replacing RAPs in 2022

The notice of admission (NOA), expected to replace RAPs beginning January 1, 2022, will be submitted just once establishing the agency as the primary provider. That will cover all contiguous 30-day periods until discharge, according to updates to the Medicare Claims Processing Manual released May 11. This will end a monthly routine for agencies that […]

Carefully log admission source as CMS focuses on hospital errors

CMS recently released an MLN article targeting hospitals and billing for patient care that involves a home health admission. When patients are transferred, a hospital is typically paid at per diem rate. An OIG report last year found improper payments tied to hospital claims that should have been subject to the transfer policy because the […]

Study finds method to predict SNF admission from hosital admission profile

A June 2019 study in JAMA found that it’s possible to predict at the day of admission a patient’s risk of SNF discharge. Researcher’s noted strong indiciators for SNF admission included impaired mobility and impaired ability to bathe, as well as living alone. The study used a  retrospective cohort of 11,380 hospitalized patients. View the […]

CMS proposes initiative to address improper SNF discharges

According to a memo published by the Centers for Medicare & Medicaid Services (CMS) on December 22, 2017, post-acute care discharges that violate Federal regulations continue to be one of the most frequent nursing home complaints made to State Long Term Care Ombudsman Programs. The memo, addressed to state survey agency directors, announces CMS’ consideration […]

25 national organizations join AHCA in letter to CMS regarding observation stays

On June 20, 2017, a broad coalition of beneficiary and provider advocacy groups submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) in response to the matter of observation stays in hospitals, an ongoing issue that prevents thousands of beneficiaries from being able to access their skilled nursing benefit because of […]

Evidence-based criteria for determining whether services are skilled

Editorial Note: This post is an excerpt from HCPro’s title Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement by Elizabeth McLaren. Chapter 8 of the Medicare Benefit Policy Manual, Section 30.2.2 (“Principles for Determining Whether a Service is Skilled”) starts to look more closely at the criteria for assessing a skilled need. […]

49 states have reduced avoidable hospital readmissions

On September 13th, CMS released data showing that 49 states (all but Vermont) have reduced avoidable hospital readmission rates since 2010. To address the problem of avoidable readmissions, the Affordable Care Act created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions such as: […]

Physicians and health care providers continue to improve quality of care, lower costs

Affordable Care Act Accountable Care Organization initiatives put patients at the center of their care while generating more than $1.29 billion in total Medicare savings since 2012. The Centers for Medicare & Medicaid Services (CMS) announced on August 25, 2016, the 2015 performance year results for the Medicare Shared Savings Program and the Pioneer Accountable […]

Digital Standards and Operating Rules adopted by HHS under HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required HHS to establish digital standards for business-related tasks like submitting claims and getting paid. The goal is to reduce paperwork and streamline business processes across the health care system. Standards allow information to be shared digitally in consistent ways. With common standards for content […]