Tag: payment

CMS increases Medicare payment for COVID-19 monoclonal antibody infusions at home

CMS has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished – including in a physician’s office, health care facility or at home, CMS states in the […]

Latest RAP-related claims error involves placeholder HIPPS code

Some agencies are facing new payment issues related to the no-pay RAPs that began January 1, 2021. MACs Palmetto GBA and CGS, collectively responsible for claims in 31 states, have recently alerted agencies to a potential issue where Medicare’s system is sometimes not replacing the placeholder HIPPS code used to match RAPs and final claims. […]

Legislation would delay 2% Medicare sequestration payment reductions

The Medicare Sequester COVID Moratorium Act, H.R. 8840 legislation, was introduced by Reps. Brad Schneider, D-Ill., and David McKinley , R-W.Va., “to extend the suspension of the two percent Medicare sequestration payment reductions through the COVID-19 public health emergency (PHE),” according to a December 3, 2020, National Hospice and Palliative Care Organization (NHPCO) press release. […]

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 […]