Tag: billing

CMS welcomes feedback on proposed case-mix rule, extends comment deadline

The Centers for Medicare & Medicaid Services (CMS) has extended the comment deadline for the advance notice of proposed revisions to case-mix methodology rule from June 26, 2017 to August 25, 2017. The advance notice of proposed rulemaking, titled “Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-mix Methodology,” was published […]

NEW: Billing boot camp for SNFs

HCPro’s new Skilled Nursing Facility Billing Boot Camp covers the latest Medicare billing rules and regulations so that you can help your facility bill appropriately for services and prevent payment denials. The bootcamp will be held Monday, August 14 – Tuesday, August 15, from 8:00 a.m. – 5:00 p.m. Skilled Nursing Facility Billing Boot Camp provides […]

Cardiac and orthopedic bundled payment models delayed to Jan 1, 2018

In a final rule published in the Federal Register today, May 19, the Department of Health and Human Services (HHS) finalized May 20, 2017 as the effective date of the bundled payment models and changes to the Comprehensive Care for Joint Replacement Model and delayed the implementation date of the final rule to January 1, […]

Understand special SNF billing cases to avoid claims rejections

Editorial Note: This post is an excerpt from HCPro’s title Consolidated Billing for Long-Term Care by Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC Often times, claim rejections and negative outcomes from billing compliance audits are results of ineffective or nonexhaustive billing processes within the skilled nursing facility (SNF). The below information will help providers lay the […]

Pre-pay audits target J5 providers in IA, KS, MO, NE and national

J5 Jurisdiction providers are being targeted for prepayment, service specific, complex medical reviews of Inpatient SNF services conducted by Wisconsin Physician Services Government Health Administrators (WPS GHA), a Medicare Administrative Contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS). J5 Jurisdiction includes skilled nursing facilities (SNF) that submit claims from Iowa, Kansas, Missouri, […]

CMS orders post-pay audit of SNF PPS claims

The Supplemental Medical Review Contractor (SMRC) is charged with conducting nationwide medical review as directed by the Centers for Medicare & Medicaid Services (CMS). Topics and timeframes for these reviews are dictated by CMS and are chosen to address specific agency interests regarding coverage, coding, payment, and billing practices. On March 17, 2017, SMRC announced […]

Quality Payment Program short training videos now available

The Centers for Medicare & Medicaid Services (CMS) have created a number of new, self-paced educational videos that are now available on YouTube (Go.cms.gov/QPPvideos) and the agency’s Events page. These videos help to explain aspects of the Quality Payment Program in approximately 10 minutes or less. The agency believes stakeholders will greatly benefit from this […]

GAO finds improved oversight of state Medicaid payment structures needed in MLTSS

In two January 2017 reports filed by Government Accountability Office (GAO), the agency found that: CMS’ oversight of state payment structure regarding Medicaid funding was limited. Data collected from the Centers for Medicare & Medicaid Services’ (CMS) systems used to describe the distribution of and spending on Medicaid personal care services is limited due to […]

Register now: Webinar on CMS’ annual MIPS call for measures and activities, February 16

Learn more about submitting measures and activities for MIPS The Centers for Medicare & Medicaid Services (CMS) opened the submission period for the Annual Call for Measures and Activities of the Merit-Based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP). The Annual Call for Measures and Activities allows providers and measure stewards […]

SNF M&A: The Provider Number Trap

Editorial Note: This post has been republished with permission from the author, Reg’s blog. Over my career, I have done a fair amount of merger and acquisition (M&A) work, including: Continuing care retirement communities (CCRC) Skilled nursing facilities (SNF) Home health agencies (HHA) Physician practices Hospice While each deal has many nuances and issues, none […]