Tag: Medicare

Direct patients to Medicare resources during open enrollment

A State Health Insurance Program (SHIP) is an insurance counseling service that is provided free of charge by the Administration on Community Living in partnership with the Centers for Medicare & Medicaid Services as well as state aging agencies to help assist Medicare beneficiaries and their caregivers. By discussing coverage, cost and convenience, the goal […]

DOJ pursuing criminal charges against SNFs that violate False Claims Act

The Department of Justice (DOJ) announced plans to pursue criminal charges against SNFs accused of violating the False Claims Act, according to Bloomberg Law. In the past, these violations have been treated subject to civil penalties, but the DOJ will now bring criminal charges against more egregious offenders. The False Claims Act penalizes providers that […]

2020 National Provider Enrollment Forum Speakers

We are seeking speakers to present at the 2020 National Provider Enrollment Forum, to be held April 19-22 in New Orleans at the Sheraton New Orleans Hotel. Click here to view and complete the speaker application. Presenters must complete the application prior to the September 30 deadline. Accepted speakers and co-speakers receive free admission to […]

Medicare improperly covered ambulance rides from hospitals to SNFs

The OIG reports that Medicare improperly paid $1.9 million to ambulance providers for transport from hospitals to SNFs from 2014 to 2016. As a result of this former study, the OIG released an updated report on September 11 regarding hospital-to-SNF transfer billing practices. The OIG audited 99 ambulance providers from 2015 to 2017 and found […]

CMS to hold SNF/LTC Open Door Forum

CMS will hold an open door forum on September 19 for SNFs and LTCs. Discussions will focus on: PDPM updates PBJ updates Policy Questions should be sent to: NHStaffing@cms.hhs.gov Technical Issues/Questions should be sent to: NursingHomePBJTechIssues@cms.hhs.gov PBJ Website MS-6058-FC Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process SNF […]

Patient recruiter found guilty in $1.3 million Medicare fraud scheme

A patient recruiter was found guilty of one count of conspiracy to pay and receive health care kickbacks and three counts of receipt of health care kickbacks, according to the U.S. Department of Justice (DOJ). Between 2009 and 2017, Dominic Trumbo, 45, of Lexington, Ky., owner of Trumbo Consulting Agency, participated in an illegal kickback […]

AHCA/NCAL urges CMS to define “inpatient” for three-day rule

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) penned a letter to CMS administrator Seema Verma in response to a tweet she published earlier in August. The tweet addressed the three-day rule, stating that a SNF resident must first spend three days as a hospital inpatient to be eligible for Medicare […]

CMS to hold open door forum about new Medicare cards

CMS to hold open door forum about new Medicare cards CMS will be hosting an open-door forum on September 11 to discuss the status of new Medicare cards and Medicare Beneficiary Identifiers (MBI). Beginning January 2020, Medicare will only accept claims submitted with MBIs. The updated cards are designed to offer better identity protection by […]

CMS reminds providers to use submit claims using SSN-free Medicare cards

Agencies have about four months to ensure they submit all claims using new Medicare beneficiary identifiers (MBIs). Providers will be required to use those MBIs on claims beginning Jan. 1, 2020. CMS completed all seven waves of its mailings earlier this year, and the push to transition to the new MBIs is ongoing. The federal […]

CMS posts webinar on Primary Care First Seriously Ill Population Model

CMS has set out to provide further information regarding the Primary Care First (PCF) Seriously Ill Population (SIP) model option with a two-part webinar series, hosted by the PCF Model Options Team. The model “encourages advanced primary care practices, including providers whose clinicians are enrolled in Medicare who typically provide hospice or palliative care services,” […]