Tag: Medicare

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,” […]

Special requirements for billing urology supplies & updated DMEPOS fee schedule

Source: The Bottom Line Medicare covers urinary catheters and external urinary collection devices when they are used to drain or collect urine for a resident with permanent urinary incontinence or permanent urinary retention. According to CMS, permanent urinary retention occurs when the condition is not expected to be medically or surgically corrected within three months. […]

SNF PPS final rule published, new payment model to begin October 1, 2019

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register yesterday evening, the Patient-Driven Payment Model (PDPM)—the new case-mix methodology to replace RUG-IV)—is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. […]

CMS finalizes non-skilled service coverage as extra benefit to Medicare Advantage

A final rule posted April 2 will open up new business opportunities for private duty agencies to contract with Medicare Advantage plans to provide services such as cooking and light housekeeping as a supplemental benefit. In the rule that takes effect in 2019, CMS finalized new Medicare Advantage and Part D payment and policy updates […]

CMS updates to Medicare manuals could impact reimbursement

In an MLN Matters article dated March 16, 2018, CMS instructed providers to make sure their billing staff are aware of changes made to Medicare manuals. CMS stated that these updates to the Medicare manuals are intended only to clarify the existing content and to correct various omissions and minor technical errors. No policy, processing […]

New Medicare card project special open door forum March 20

CMS will host a Special Open Door Forum to give providers an opportunity to ask questions about the New Medicare Card Project on Tuesday, March 20 from 2:00pm-3:00pm, ET. Providers are encouraged to use this call to get answers to questions and get prepared to accept the new Medicare Beneficiary Identifier starting April 1, 2018. […]

MedPAC encourages Medicare beneficiaries to use higher-quality PAC providers

During the Medicare Payment Advisory Commission’s (MedPAC) public meeting on Thursday, March 1, analyst Evan Christman reviewed options for modifying Medicare’s hospital discharge rules to encourage beneficiaries to use higher-quality PAC providers. Christman pointed out that Medicare assigns responsibility for discharge planning to the hospital, and while part of this responsibility includes providing the beneficiary […]

New CMS policy could change inpatient rehab denial trend

In the past, Medicare contractors have been allowed to deny a claim for inpatient rehab if the required three-hour minimum of direct care mark was missed by mere minutes, even if the additional minutes were made up on a subsequent day. Now, however, due to new guidance released by CMS, this denial trend could change. […]

Ethical principles for long-term care billers

The following post is an excerpt from Medicare Guide for SNF Billing and Reimbursement by Janet Potter, CPA, MAS, and Frosini Rubertino, RN-CNE, CDONA/LTC, CPRA. The following ethical principles are based on the core values of The Billers’ Association for Long-Term Care. They apply to all members. Long-term care billing professionals shall do the following: […]