CMS Issues Guidance on When a Hospital is a Hospital

Is your hospital really a hospital? Well, that depends on whether Medicare deems it so. Earlier this month, the Centers for Medicare & Medicaid Services issued clarifying guidance on what constitutes a hospital. Under these new guidelines, holding a state hospital license isn’t necessarily the end-all for receiving Medicare reimbursement. CMS says it will now […]

CMS Revamps Medicare Audit Strategy

Good news for some healthcare providers and not so good news for others. The Centers for Medicare & Medicaid has announced changes to its Medicare audit strategy in an effort to root out fraud and abuse. The new process is based on a pilot program that CMS introduced in 2014 in which the agency combined […]

Have Physicians Embraced the Use of End-of-Life Billing Codes?

It’s been about a year since the Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician fee schedule. A recent article in Modern Healthcare suggests that many physicians are using the codes to have important end-of-life planning conversations with patients. The codes (99497 and […]

CMS Proposes Changes to 2018 Medicare Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that will update Medicare payment and policies for doctors and other healthcare providers that the agency says “reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery […]

Backlog Backlash: HHS Says Clearing Medicare Backlog Not Possible

Just two months after a federal judge told the Department of Health and Human Services (HHS) to clear through a huge backlog of Medicare claims appeals comes word from the agency that not only will it not be able to comply, but that the backlog will actually grow by the time it’s supposed to have […]

CMS Issues Sweeping New Rules For HHA Participation in Medicare/Medicaid

Home health agencies have six months to comply with sweeping new changes that will impact their ability to participate in the Medicare and Medicaid programs. Earlier this month, The Centers for Medicare and Medicaid, released its final rules relating to the conditions of participation (CoPs) that home health agencies must meet to participate in the […]

CMS: Ignorance not an excuse when it comes to liability

The Centers for Medicare & Medicaid Services (CMS) recently released a policy change that provides additional conditions for determining when a contractor must assume a physician, provider, or supplier should have known about a policy or rule. Currently, CMS requires its contractors to consider at least one of three conditions when assuming that a provider, […]

CMS offers plan (again) in hopes of clearing Medicare appeals backlog

Hospital executives who are tired of waiting for their Medicare appeals cases to be settled are being presented with an option. The Centers for Medicare and Medicaid is offering to pay hospitals 66 percent of the net allowable for short-term inpatient stays in exchange for dropping their pending appeals of denied claims. CMS recently announced […]

Home Healthcare Agencies to Realize $130M in Medicare Reimbursement Cuts in 2017

Home healthcare agencies can expect to see a 0.7 percent drop in Medicare reimbursements next year, according to the Centers for Medicare & Medicaid Services. CMS announced the final changes to the Medicare home health prospective payment system (HH PPS) on Oct. 31. The new rule, which takes effect on Jan. 1, 2017, means Medicare […]

The end to ICD-10 code flexibility: How are you handling it?

It may be hard to believe, but ICD-10 recently celebrated its first birthday. So we thought it only fitting that we post this blog on 10-10. The change from ICD-9 to ICD-10 meant the addition of thousands of more very specific, and in some cases, very unusual diagnostic codes. Examples include: being pecked by a […]