Tag: Medicare coverage

CMS waives provider screening requirements in TX, LA during Hurricane Harvey recovery efforts

The Centers for Medicare & Medicaid Services (CMS) today approved suspending certain Medicare enrollment screening requirements for healthcare providers and suppliers that are assisting with Hurricane Harvey recovery efforts in areas impacted in Texas and Louisiana. CMS Administrator Seema Verma said the agency has established a hotline for healthcare providers in the two impacted states […]

CMS ordered to impose penalties for incidents of unreported abuse/neglect in SNFs

According to an ongoing review of incidents of elder abuse and neglect in skilled nursing facilities and nursing homes, the OIG determined that problems still remain with the quality of care being delivered and the reporting and investigation of such incidents. Regulations mandate that SNFs ensure that all alleged violations, such as mistreatment, neglect, or […]

CMS launches Jimmo Settlement Agreement webpage

Looking for information about the Jimmo Settlement Agreement? Visit the new Jimmo Settlement Agreement webpage for: Background on the settlement Links to resources Frequently Asked Questions (FAQs) CMS reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s […]

CMS announces new, more targeted Medicare audit process

After reporting favorable results from a pilot program started in 2014 to reduce errors in the Medicare claims submission process, CMS announced last week that they will move forward with the new auditing strategy—which combines a review of a sample of claims with education—changing the process slightly by moving from a broad “Probe and Educate” […]

CMS scrutiny of updates to Part B therapy coding to begin January 2018

In a recent MLN Matters article, the Centers for Medicare & Medicaid Services (CMS) published revisions to editing of Part B “Always Therapy” services, identifying outpatient therapy (OPT) services that must always be accompanied by a discipline-specific therapy modifier. CMS states that Change Request (CR) 10176, intended for therapists, physicians, and certain other practitioners billing […]

LeadingAge publishes report: A New Vision for Long-Term Services and Supports

Long-term services and supports (LTSS) are for individuals who need help with everyday activities such as bathing, eating, or dressing. Currently, individuals needing these services total 50% of people over 65. LTSS are costly and not currently covered by Medicare. LeadingAge reports that many individuals must pay out of pockets, depleting their savings accounts and […]

CMS corrects error in rejecting claims made to SNF CB on or after January 1, 2015

In an MLN Matters article published August 4, 2017, CMS announced that change request (CR) 10163¾which provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS)¾corrects an error impacting certain claims with dates of service on […]

“Repeal and delay” bill dies in Senate, “skinny repeal” now being considered

  After years of failing to pass a bill that would “repeal and replace Obamacare,” the Senate’s alternate solution, a “repeal and delay” bill, was also rejected in a final vote of 45-55 on Wednesday. Many cast their vote with concern for the Congressional Budget Office’s prediction that repealing Obamacare without an immediate replacement would […]

CBO predicts 32 million will be without health coverage in 2026 with new repeal-and-delay bill

After the Senate’s recommendation for repeal-and-replace of the Affordable Care Act (ACA) failed due to lack of support, Majority Leader Mitch McConnell is now suggesting a repeal-and-delay strategy that, if passed, is predicted will leave 32 million individuals without health coverage by 2026, and 17 million without coverage by next year. That’s 1 million more […]