Tag: Medicare

ACOs should be allowed to waive 3 midnight requirement, MedPAC states

Accountable care organizations should be able to place patients in skilled nursing facilities more quickly and communicate which SNFs are preferred providers, the Medicare Payment Advisory Commission stated in a letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. The fee-for-service Medicare program currently covers skilled nursing services for beneficiaries only after they […]

Ask the expert: Medicare Part A

Q: The resident is on their Part A benefit and is scheduled for dialysis 3 days a week. If the resident leaves the facility @ 11:00PM and comes back at 4:00AM, would each of these dialysis days be considered skip days, needing the MDS scheduled assessment and claims to be adjusted?   A:  Yes – unless […]

20% of Medicare patients injured by medical care

Nearly one in five Medicare patients fall prey to medically related injuries unrelated to their underlying disease or condition, according to new research published in Injury Prevention online. Towson University researcher Mary Carter notes that the adverse events included wrong medication, allergic reactions to medications, and receiving treatments leading to complications over and above an existing […]

CMS makes improvements to Medicare drug and health plans

The Centers for Medicare & Medicaid Services (CMS) today issued final regulations for the Medicare Advantage and prescription drug benefit (Part D) programs that continue efforts to curb fraud and abuse and to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs.  The final rule is projected […]

LTC providers who obstruct audits could have their Medicare certifications revoked

Long-term care providers who obstruct audits soon could have their Medicare and Medicaid certifications revoked, according to a newly proposed rule from OIG. Currently, individuals and organizations can be removed from Medicare or Medicaid if they are convicted of obstructing a criminal investigation. The Affordable Care Act empowered the government to also kick out those […]

Federal government notes slowdown in nursing home spending

Decreased payouts for nursing home care was one reason that healthcare spending grew more slowly for seniors than for any other age group between 2002 and 2010, the Centers for Medicare & Medicaid Services announced Monday. Average annual growth in per capita healthcare spending was about 4% for the elderly during the eight-year period studied, […]

CMS announces special surveys on dementia care, MDS coding will launch by mid-year

Surveyors will scrutinize dementia care and Minimum Data Set coding in an upcoming pilot program to test more expansive oversight of these areas, the Centers for Medicare & Medicaid Services recently announced. Pilots of the dementia care and MDS coding “focused reviews” are scheduled to begin by mid-2014, according to a memorandum issued Friday.  About […]

Ask the expert: Medicare Advantage plan

Q: If a beneficiary changes from one Medicare Advantage plan to another, do they automatically get 100 new days of Skilled Nursing? MAO’s do not report days paid to the Common Working file and unless the SNF informs the new plan of days paid under another plan or that the beneficiary has had previous stays  we […]

Chronic underfunding of Older Americans Act leading to unnecessary LTC facility admissions

Chronic underfunding of the Older Americans Act is leading to unnecessary long-term care facility admissions, Sen. Bernard Sanders (I-VT) and 26 of his Democratic colleagues in the Senate said in a recent letter to Appropriations Committee leaders. The lawmakers requested a 12% increase over fiscal year 2014 funding levels for Older Americans Act (OAA) programs such as […]