Tag: Medicare

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,” […]

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. […]