Tag: Medicare Part A

Adverse events occur during SNF stays

A recent study published by the Office of the Inspector General (OIG) found that over 20% of Medicare beneficiaries experience adverse events during their SNF stay. The study also found that an additional 11% experience temporary harm events during their SNF stay. The study estimated the national incidence rate, preventability, and cost of adverse events […]

Ask the expert: Part A to Part B billing

Q: When a Part A resident exhaust their Part A days and needs continued therapy under Part B, we have been writing the Part B POT and obtaining a signature by the MD. We have not billing for the Part B evaluation because it is a continuation of services. Is this correct?  Is there any CMS […]

Patients obtain opioid prescriptions from multiple healthcare providers

One in three American seniors who benefit from the U.S. Medicare program, receives painkiller prescription from several healthcare service providers, according to a study released by the British Medical Journal. This practice places seniors at risk for drug overdose, injury, and even death. Researchers analyzed the medical records of more than one million Medicare patients […]

2015 CMS updates provide increased quality and value for Medicare beneficiaries

The Centers for Medicare & Medicaid Services (CMS) has just released its 2015 proposal for payment and policy updates for Medicare Health and Drug plans. Beneficiaries can get greater protections, value, and care in the Medicare services they receive through the proposed policies. The 2015 Advance Notice and draft Call Letter takes steps to improve […]

New Medicare notices gives seniors a tool to help fight against fraud

Medicare beneficiaries will start receiving a redesigned statement of their claims for services and benefits that will help them spot potential fraud, waste, and abuse, according to a recent press release by the Centers for Medicare & Medicaid Services. The redesigned notice will make it easier for people with Medicare to understand their benefits, file […]

Ask the expert: ARD dates

Q: I work as a swing bed coordinator and I’m still learning the MDS. I have a patient that will be discharged on the 14th day. I set the 5-day PPS ARD for the 8th day (grace) and the next ARD for the 13th day. Do I need to submit a 14-day PPS since they are […]

AHCA finds long-term care services underfunded by Medicaid

The American Health Care Association (AHCA) released a report today demonstrating that the long term care services are significantly underfunded by Medicaid. The report estimates that the nation will have the highest Medicaid shortfall on record for 2013—over 7.7 billion dollars. On a daily basis, the shortfall is $24.26 per Medicaid patient. This shortfall is […]

OIG releases 2014 work plan

The Office of Inspector General (OIG) released a report that focused on its fiscal year 2014 Work Plan. The work plan summarizes the activities the OIG plans to pursue with respect to HHS programs and operations during the current fiscal year (FY) and future years. The OIG Work Plan for FY 2014 provides brief descriptions […]

Ask the expert: Physician visit schedule

Q: My question is in regard to physician visits and certification. When a resident who is in a Medicare A stay, returns to the hospital and is admitted, does the 14, 30, 60, etc. physician visit schedule start over? I cannot locate this information. A: When a resident in a Medicare Part A stay is […]

Overpayments resulting from improper claims for ambulance services

On November 6, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 1311, which offered guidance on the contractor claim data, identified by suppliers, which were billing ambulance claims for SNF to SNF transfer separately under Part B. This was resulting in overpayments. As a result of overpayment for a transport between two SNFs […]