Tag: Medicare Part A

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 […]

OIG finds Medicare’s “two-midnight stay” limits SNF care

The OIG has identified vulnerabilities in CMS’ “two-midnight” policy in a report published December 19, 2016. The two-midnight policy mandates that beneficiaries be admitted to the hospital for “two midnights” in order to be considered an inpatient admission and receive Medicare Part A coverage. In order for beneficiaries to be covered under Medicare for treatment […]

Medicare requires a Medicare Part A PPS Discharge Assessment, effective October 1

Under the IMPACT Act, SNFs are required to submit patient assessment data regarding a resident’s admission to and discharge from a Medicare Part A Assessment, effective as of October 1, 2016. Providers who fail to submit this required data (used for quality measures calculation) may face a 2%-point market basket rate reduction effective October 2018. […]

Upcoming webcast: Medicare Part B: Get the Most Out of Your SNF Reimbursement

Join us tomorrow for this Medicare Part B webcast. Expert speaker, Janet Potter, from Marcum, LLP will help you understand the many requirements for billing Medicare Part B, including what items can be billed by the SNF and how to maximize reimbursement for your facility. Questions and issues will arise regarding claim discrepancies, and you’ll need to […]

Upcoming webcast: ACOs and Bundling: The New Dating Game

In recent years, the skilled nursing reimbursement system has continually evolved, and to find a suitable partner, you must now develop an appealing profile. In the new ACO payment system, it’s vital to know which skills are most valuable and how diagnosis coding can affect relationships with potential “suitors.” During this program, expert speaker Maureen […]

MedPAC releases its June 2016 Report to Congress

On June 15, the Medicare Payment Advisory Commission (MedPAC) releases its June 2016 Report to the Congress: Medicare and the Health Care Delivery System. The report examines a variety of Medicare payment system issues, including: Medicare drug spending in its broader context Medicare Part B drug and oncology payment policy issues Improving the Medicare Part […]

CMS to discuss Data Element Library and IMPACT Act today!

Thursday, April 14 from 2 to 3 pm ET To Register: Visit MLN Connects Event Registration. Space may be limited, register early. During this call, CMS subject matter experts discuss the development of the Data Element Library. A question and answer session will follow the presentation, including an opportunity for registrants to provide feedback on the […]

Strengthening Medicare Advantage and Part D

On April 4, CMS released final updates to the Medicare Advantage and Part D programs through the 2017 Rate Announcement and Call Letter. These policies seek to provide stable payments to plans, and make improvements to the program for plans that provide high quality care to the most vulnerable beneficiaries. CMS released the Advance Notice […]

CJR has launched

On April 1, CMS launched the Comprehensive Care for Joint Replacement Model (CJR)–a major step toward transforming care delivery in Medicare. This model looks to improve care and quality for the most common procedures that Medicare beneficiaries have, hip and knee replacements. In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement, […]