Tag: Medicare Part B

Current antipsychotics quality measure is too hard on long term care providers

A new study published in the International Journal of Geriatric Psychiatry explains that an updated quality measure could produce a clearer picture of nursing homes’ antipsychotic prescribing practices. In 2012, the Centers for Medicare & Medicaid Services introduced the quality measure, which assesses how many long-stay residents are on antipsychotic medications and do not have […]

Medicare reimbursements to be cut by 24% starting April 1

Congress will be racing against the clock until the payments that doctors receive in exchange for treating Medicare patients are cut significantly. If Congress fails to pass legislation by March 31, the 685,000 doctors that participate in Medicare will see their reimbursements cut by 24% starting April 1. The cut is based on the sustainable […]

Ask the expert: Beginning skilled therapy

Q: What day should a new admit to a skilled nursing facility begin the skilled therapy that is ordered by a physician if that resident is going to be Medicare Part A secondary to therapy? A:  Most of the time patients have other nursing skilled needs in addition to the therapy.  However, in order to be […]

Medicaid Fraud Control Units recover over $10 million in 2013

Medicaid Fraud Control Units recovered about $10.3 million from nursing facilities in FY 2013, according to an annual report issued Friday. Practically every state operates a fraud control unit, and the report from the Department of Health and Human Services Office of the Inspector General compiled results from all of these units. The investigations included: Allegations of […]

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 […]

Ask the Expert: Observation status

Q: A nursing home sends a SNF patient to the emergency room, after a fall.  A small scalp laceration is sutured, and a CT scan of the head shows no abnormality.  The patient is stable, and a decision is made by the treating physician, that the patient can return to the nursing home.  The patient’s primary […]

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 […]

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 […]