Tag: outpatient therapy

CMS scrutiny of updates to Part B therapy coding to begin January 2018

In a recent MLN Matters article, the Centers for Medicare & Medicaid Services (CMS) published revisions to editing of Part B “Always Therapy” services, identifying outpatient therapy (OPT) services that must always be accompanied by a discipline-specific therapy modifier. CMS states that Change Request (CR) 10176, intended for therapists, physicians, and certain other practitioners billing […]

Congress reintroduces bill to count observation stays as three-day prerequisite for SNF coverage

Congress has reintroduced a bill that would ensure patients receiving hospital care under “observation status” could count that time as part of the three-day inpatient hospital stay required to receive skilled nursing care coverage under Medicare. The Improving Access to Medicare Coverage Act of 2017 (HR 1421) mirrors a similar bill introduced in 2015. In […]

Medicare to better explain maintenance therapy coverage, reject Improvement Standard

A plan proposed by the Department of Health and Human Services (HHS) has been accepted by a judge, ending the Jimmo v. Sebelius legal battle. The plan comes after plaintiffs of the case filed a motion in March of 2016, claiming that the Secretary had failed to meet requirements of the Jimmo Settlement Agreement, which […]

Senior living facilities can’t afford to house the severely obese

Nursing homes and assisted living communities are not prepared to accommodate the rapidly increasing number of severely obese (having a BMI of over 40) elderly applying for residency, according to a recent study. Along with the increased health risks that accompany this group, a majority of the expenses to provide the necessary care for these […]

CMS aims to improve the marketplace through innovation

The Health Insurance Marketplace has become a reliable source of health insurance coverage for millions of Americans, many of whom used to be locked out of coverage because it was either unaffordable or because of a preexisting condition. Thanks to the combination of the Health Insurance Marketplace, expanded Medicaid, and other provisions of the Affordable […]

CMS added six new quality measures to Nursing Home Compare

Today, the Centers for Medicare & Medicaid Services (CMS) added six new quality measures to its consumer-based Nursing Home Compare website (https://www.medicare.gov/nursinghomecompare/search.html). Three of these six new quality measures are based on Medicare-claims data submitted by hospitals, which is significant because this is the first time CMS is including quality measures that are not based […]

CMS will begin publicly reporting six new quality measures

During the March 3rd Skilled Nursing Facility/Long-term Open Door Forum, it was announced that starting in April, the Centers for Medicare and Medicaid Services will begin publicly reporting six new quality measures (QMs)—four short-stay measures (three claims-based and one MDS-based) and two MDS-based long-stay QMs—on the  Nursing Home Compare site. Then beginning in July, five […]

NOTICE Act is unanimously passed by Senate

On July 28, 2015, the Senate unanimously passed the NOTICE Act. This legislation was introduced by Congressmen Lloyd Doggett (D-TX-35) and Todd Young (R-IN-9) in the U.S. House of Representatives earlier this year. The NOTICE Act will require hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours. Outpatient status affects a patient’s […]

Ultrasound used as therapy for Alzheimer’s

Researchers at the University of Queensland in Australia have found that non-invasive ultrasound can break down the neurotoxic amyloid plaques associated with Alzheimer’s. Their research was published in the journal Science Translational Medicine. Researchers used repeated scanning ultrasound treatments of the mouse brain to remove the amyloid plaques, without the need for any additional therapeutic agent. […]

Five common misconceptions about the transition to ICD-10

To help dispel some of the myths surrounding ICD-10, the Centers for Medicare & Medicaid Services (CMS) recently talked with providers to identify common misperceptions about the transition to ICD-10. Here are five more facts addressing common questions and concerns CMS has heard about ICD-10: If you cannot submit ICD-10 claims electronically, Medicare offers several […]