Tag: Medicare coverage

Scrutinizing Medicare coverage for physical, occupational and speech therapy

This article has been republished with permission from the author, Judith Graham, Kaiser Health News. For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare. Services have been terminated for some seniors, such as those with severe cases of multiple sclerosis or Parkinson’s disease, […]

New CMS policy could change inpatient rehab denial trend

In the past, Medicare contractors have been allowed to deny a claim for inpatient rehab if the required three-hour minimum of direct care mark was missed by mere minutes, even if the additional minutes were made up on a subsequent day. Now, however, due to new guidance released by CMS, this denial trend could change. […]

Ethical principles for long-term care billers

The following post is an excerpt from Medicare Guide for SNF Billing and Reimbursement by Janet Potter, CPA, MAS, and Frosini Rubertino, RN-CNE, CDONA/LTC, CPRA. The following ethical principles are based on the core values of The Billers’ Association for Long-Term Care. They apply to all members. Long-term care billing professionals shall do the following: […]

First prick-free glucose monitor covered by Medicare announced

Medicare beneficiaries with diabetes now have access to Abbott’s FreeStyle Libre System, a device that allows individuals to keep track of their glucose levels without having to routinely prick their finger. The device was approved by the U.S. Food and Drug Administration in September and started being offered in U.S. pharmacies this past November. Patients […]

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,” […]

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 announces new Medicaid policy to combat the opioid crisis by increasing access to treatment options

Approves demonstrations in both New Jersey and Utah Last week, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to the President’s directive and […]

Draft bill could repeal Medicare Part B Therapy Caps by January 2018

Therapy caps were first established by the Balanced Budget Act of 1997 and limit the amount of therapy services a beneficiary can receive in a year, regardless of their condition. The 2017 therapy cap limits are: $1,980 for physical therapy (PT) and speech-language pathology (SLP) services combined $1,980 for occupational therapy (OT) services On Thursday, […]

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 […]

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 […]