Tag: payment

CMS updates the Medicare physician self-referral law

CMS issued a final rule that aims to modernize and clarify Medicare physician self-referral law, also called “Stark Law” On November 20. Stark Law was first introduced in 1989, and has not been meaningfully updated since. The law aims to protect patients and nursing home residents from physicians pushing services that are in their own […]

CMS creates resource page for hospice VBID

CMS has created a special online resource page for the hospice Value-Based Insurance Design (VBID) demo. This page relays key information related to the model, including: an overview, coverage information, participating plans, billing and payment information, outreach and education and frequently asked questions. CMS is testing the inclusion of the Part A Hospice Benefit within […]

CMS releases FY 2019 proposed rule, includes RCS-1 replacement

CMS has posted a proposed rule for FY 2019. The proposal not only changes payment rates, but also proposes a new case mix grouping called the Patient-Driven Payment Model, or PDPM. This model replaces the RCS-1 that was proposed in May of last year. According to CMS, this new system has 80% fewer groupings and […]

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. […]

President Trump signs bill that creates new home health payment model

Source: Home Health Line On Friday, February 9, President Trump signed into law a bill designed to keep the federal government funded through March 23. The bill contains several home health provisions, including revisions to the face-to-face requirement and the addition of a new payment model similar to the Home Health Groupings Model (HHGM). Among […]

CMS works to ensure correct processing of disaster-related home health claims

The following comes from Home Health Line. Agencies submitting claims under a waiver authorized in response to recent hurricane and wildfire emergency events no longer will be at risk to have claims returned to provider (RTP’d) in error because of a failure to match the claim with a corresponding OASIS. Change Request 10372 issued Jan. […]

MedPAC makes recommendation that RCS-1 replace PPS in FY19

In their November meeting, the Medicare Payment Advisory Commission (MedPAC) discussed a way to increase the equity of payments within each post-acute care (PAC) setting before implementing a unified payment system by using a blend of the setting-specific and PAC PPS relative weights to establish payments in each setting. On Thursday, December 7, MedPAC official […]

Official cancellation of bundled payment models opens the door for a different approach to health system change

On Thursday, following a proposed rule published in August, CMS finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. CMS Administrator Seema Verma stated that CMS intends to focus on “developing different bundled payment models and engaging more providers,” […]

CMS still seeking feedback on RCS-1

During their SNF/LTC Open Door Forum call yesterday, CMS announced that, although the comment period for an advanced notice of proposed rulemaking (ANPR) published in May officially closed this August after receiving more than 200 comments, the agency encourages providers to continue submitting feedback by sending comments, questions, or concerns to CMS’ email inbox at […]

CMS decides not to move forward with Home Health Groupings Model in 2019

The following is an excerpt from Home Health Line. Agencies can breathe a deep sigh of relief. CMS won’t launch its drastically revised home health payment model after all. In the 2018 final PPS rule released Nov. 1, CMS announced that it would not launch the Home Health Groupings Model (HHGM) in 2019. “We are […]