Tag: regulations

Patients obtain opioid prescriptions from multiple healthcare providers

One in three American seniors who benefit from the U.S. Medicare program, receives painkiller prescription from several healthcare service providers, according to a study released by the British Medical Journal. This practice places seniors at risk for drug overdose, injury, and even death. Researchers analyzed the medical records of more than one million Medicare patients […]

Study finds discharge recommendations not followed

A recent study, published in the Journal of Aging Research, shows that almost 25% of recommendations made by the hospital discharge team to the nursing homes were not followed.  The goal for the research team was to document how often recommendations were not followed. The three most common recommendations not followed in the study were […]

2015 CMS updates provide increased quality and value for Medicare beneficiaries

The Centers for Medicare & Medicaid Services (CMS) has just released its 2015 proposal for payment and policy updates for Medicare Health and Drug plans. Beneficiaries can get greater protections, value, and care in the Medicare services they receive through the proposed policies. The 2015 Advance Notice and draft Call Letter takes steps to improve […]

Ask the Expert: Observation status

Q: A nursing home sends a SNF patient to the emergency room, after a fall.  A small scalp laceration is sutured, and a CT scan of the head shows no abnormality.  The patient is stable, and a decision is made by the treating physician, that the patient can return to the nursing home.  The patient’s primary […]

Ask the expert: Jimmo v. Sebelius settlement

Q: What is the most recent news in regard to the Jimmo v. Sebelius settlement? A: The Centers for Medicare & Medicaid Services (CMS) recently made a clarification to the Transmittal that details this settlement. The revisions in Transmittal 176 incorrectly indicated that skilled physical therapy services in the skilled nursing facility (SNF) setting must […]

Is your facility properly equipped with a sprinkler system?

The Centers for Medicare & Medicaid Services (CMS) released a memo sent to state survey agency directors about the past August 13 deadline that states that all nursing homes should have installed automatic sprinkler systems. The memo summarizes what surveyors need to understand about this new requirement including: Requirement: All nursing homes must be fully […]

CMS Releases SNF PPS Final Rule for FY 2014

On August 1, 2013, the Centers for Medicare & Medicaid Services (CMS) published the final rule for the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2014 in the Federal Register. Effective October 1, 2013, this final rule updates the payment rates used under the prospective payment system for SNFs […]

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 […]

CMS releases FAQ document on functional reporting for therapy services

On June 19, the Centers for Medicare & Medicaid Services (CMS) released a new Frequently Asked Questions (FAQ) document on functional reporting for PT, OT, and SLP services. The document includes FAQs on: Providers, plans, and payers subject to functional reporting How to report functional information Assessment tools Claims requirements Click here to access this […]

New final rule makes changes to requirements for LTC facilities; hospice services

A final rule, released on Thursday, June 27, will revise the requirements that an institution will have to meet in order to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program. These requirements will ensure that long-term care (LTC) facilities (SNFs and […]