Tag: Medicare

CMS issues guidance on F-tag revisions for notification of a facility closure

On August 2, the Centers for Medicare & Medicaid Services (CMS) released a memo sent to state survey agency directors that detailed the revisions to F-tags F203 and F204 and the issuance of new F-tags F523 and F524 in the State Operations Manual (SOM), Appendix PP. These F-tags are related to the notifications of a […]

Ask the expert: Tube feeding coverage

Q: We have a lot of questions in our facility about tube feeders and Medicare Part A eligibility. Here is one example: A person getting tube fed uses 100 days of their benefit, goes off Medicare Part A, has a 60 day break in illness, and was then readmitted to hospital with a hip fracture. He […]

GAO releases report on implementation of Manual Medical Review process

On July 10, the United States Government Accountability Office (GAO) released a report to Congress about the implementation of the 2012 manual medical review (MMR) for Medicare outpatient therapy. According to the report, in 2011, Medicare paid about $5.7 billion to provide outpatient therapy services for 48 million beneficiaries. This report describes the Center for […]

Ask the expert: MAC audits

Q: We recently went through a Medicare probe at my facility and a part of the probe was denied because a MDS was not in the national repository.  How can I find out which MDS they were speaking about? I have submissions that state all of my MDS’ for this particular resident were accepted. A: You […]

2014 SNF Proposed Rule Analysis: MDS item addition

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for 2014. This rule also includes a proposed new item for the MDS Version 3.0. CMS will add MDS item O0420 Distinct Calendar Days […]

CMS issues proposed rule to increase rewards for reporting of fraud and abuse

On Wednesday, CMS issued a proposed rule that would increase incentives for people to report information that leads to a recovery of funds from individuals and entities that have or are engaged in Medicare fraud and abuse. This proposed rule would also improve CMS’ ability to detect new fraud schemes, and help ensure that fraudulent […]

Ask the expert: Medicare coverage

Q: A resident in a SNF has not used her Medicare benefit since 2005. She was receiving rehab therapy 5x week prior to qualifying for a hospital stay. Are we allowed to skill her upon re-admission? A: Your question cannot be answered without more information.  Did the beneficiary ever go 60 days without receiving skilled […]

Digging in deeper: MedPAC report’s SNF findings

On March 15, the Medicare Payment Advisory Commission (MedPAC) issued its annual report to Congress. In the report, MedPAC addresses the SNF PPS in Chapter 8. MedPAC states that most indicators of payment adequacy for SNFs are positive. Here are some findings published in the report: Access to SNF services remains stable for most beneficiaries. […]

Ask the expert: Changing of payers and PPS schedule

Q: I have always been instructed that if someone changes skilled payers, such as from a Medicare Advantage Plan to regular Medicare Part A, that the PPS schedule has to be restarted.  Someone asked me where to find the documentation for this, and I am having difficulty locating this. Can you please give me some […]

Fiscal cliff impact: SNFs facing more Medicare cuts

Provisions contained in American Taxpayer Relief Act (ATRA), known colloquially as the fiscal cliff deal, will further reduce Medicare payments for skilled nursing facility (SNF) care, according to a press release from The Alliance for Quality Nursing Home Care (AQNHC). An analysis from Avalere Health shows that by extrapolating from the Congressional Budget Office estimate […]