Tag: billing

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 […]

Obstructing audits could now result in providers’ exclusion from Medicare and Medicaid

A new rule published on the federal register today by the Department of Health and Human Services (HHS) states that all individuals and entities convicted of interfering with or obstructing audits and investigations may face exclusion from Medicare and Medicaid. The HHS Office of Inspector General will be limited to a 10-year timeframe to pursue […]

Hospice compliance, staff turnover are billing issues

The top problem hospice billing departments face today is compliance in the midst of CMS’ changing reimbursement landscape, says Casey Fenton, a director at Precipio Health Strategies and co-author of The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy for a Shifting Payment Landscape, recently published by HCPro. Hospice billing saw quite a few changes […]

Affordable Care Act payment model continues to improve care, lower costs

On August 9, the Centers for Medicare & Medicaid Services (CMS) released a new analysis demonstrating that the Independence at Home Demonstration continues to provide high quality primary care services for chronically ill Medicare beneficiaries in the home setting while saving the Medicare program money. The Independence at Home Demonstration is a patient-centered model that […]