Tag: Medicare billing and reimbursement

New voluntary bundled payment model announced

On January 9, 2018, CMS’ Innovation Center announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of […]

CMS recommends billing staff become aware of updates to “Always Therapy” code edits

The Centers for Medicare & Medicaid Services (CMS) recently published an update that deleted the procedure code 97532 from the list of “Always Therapy” codes used to track the Medicare Part B therapy caps. The coding requirement change is effective for services furnished on or after January 1, 2018. CMS notes that this update contains […]

Official cancellation of bundled payment models opens the door for a different approach to health system change

On Thursday, following a proposed rule published in August, CMS finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. CMS Administrator Seema Verma stated that CMS intends to focus on “developing different bundled payment models and engaging more providers,” […]

Long-Term Care Quality Measures: A Guide to Data Analysis, Performance Improvement, and Public Reporting, coming soon!

Increasingly, we rely on data and data analysis to objectively view the quality of care delivered in our long-term care facilities. The data gathered and reported by the quality measures (QM) systems designed for long-term care are information-rich and provide guidance, direction, statistics, frequency, and monitoring of potential quality problems. Armed with this information, facilities […]

The transition to a unified payment system for PAC facilities could start as early as 2019, suggests MedPAC

In response to a Congressional mandate, in 2016 The Medicare Payment Advisory Commission (MedPAC) recommended design features of a unified payment system, the post-acute-care (PAC) prospective payment system (PPS), to pay for services in the four post-acute care settings (home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals). In a meeting […]

CMS still seeking feedback on RCS-1

During their SNF/LTC Open Door Forum call yesterday, CMS announced that, although the comment period for an advanced notice of proposed rulemaking (ANPR) published in May officially closed this August after receiving more than 200 comments, the agency encourages providers to continue submitting feedback by sending comments, questions, or concerns to CMS’ email inbox at […]

Facilities with a full-time nurse providing direct care to residents may have better chance of reducing avoidable hospitalizations

CMS’ final evaluation report of phase one of their Initiative to Reduce Avoidable Hospitalizations among Nursing Facility (NF) Residents found that intervention sites with a full-time nurse at each facility providing direct care to residents had the strongest improvements in both cost and quality. These models demonstrated greater changes in facility culture, greater support for […]

The essential role of MDS 3.0 in RCS-1

Written by Steven Littlehale, MS, GCNS-BC, executive vice president & chief clinical officer for PointRight. The full article originally appeared in the October issue of PPS Alert for Long-Term Care. The clinical and technical eligibility requirements for skilled care coverage in a SNF are unchanged under the proposed RCS-1 system—and frankly, those are just about […]

Reduce your audit risk: How to analyze the UB-04

For an in-depth look at each element of the UB-04, join Janet Potter on Wednesday, October 25 from 1:00-2:30PM, ET, during our live show as she explains how to analyze your UB-04 data, how to incorporate findings from your review into your facility’s compliance program, and how to ensure that claims are complete and complaint. […]

20% of Medicare ambulance claims have inappropriate billing for transport

CMS reports that in a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number […]