Changes to Nursing Home Star Ratings Are Here

Beginning this month, the Centers for Medicare & Medicaid (CMS) is changing its star ratings on Nursing Home Compare and its Five-Star Quality Rating System, which allows consumers to compare quality between nursing homes. CMS says the updates “reflect more transparent and meaningful information about the quality of care that each nursing home is giving […]

Groundbreaking Rules for Electronic Health Records Proposed

The U.S. Department of Health and Human Services is proposing new rules that could pave the way for increased exchange of healthcare data by 2020. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would allow patients to have access […]

CMS 2019 Medicare Fee Schedule Designed to Reduce Administrative Burdens

The Centers for Medicare & Medicaid Services (CMS) has released its 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule, which the agency says will “address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices.” However, a controversial payment component of the plan will be delayed […]

CMS Policy Changes to Drug Benefit Program Targets Opioid Abuse

Effective June 15, policy changes for the prescription drug benefit program finalized by the Centers for Medicare & Medicaid (CMS) take effect. CMS published the final rule updating Medicare Advantage (MA) and the prescription drug benefit program (Part D).  The new rule is expected to result in nearly $300 million in annual savings over five […]

OIG Report Finds Improper Billing for Telemedicine Services

As the push to increase the use of telemedicine grows, so too do concerns over questionable billing practices. In a recently released report, the U.S. Department of Health and Human Services Office of Inspector General (OIG) found that the Centers for Medicare and Medicaid Services (CMS) paid practitioners for services that did not meet Medicare […]

OIG: CMS Overpaid Providers Millions in EHR Incentive Payments

The Department of Health and Human Services’ Office of Inspector General (OIG) recently released a report finding that the Centers for Medicare & Medicaid Services (CMS) overpaid some $729 million in Medicare electronic health record (EHR) incentive payments to eligible providers who did not comply with federal meaningful use requirements. In its report, the OIG […]

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 […]

Why Labs Have a Lot to Lose Under CMS’ Clinical Laboratory Fee Schedule

Big changes are coming that will impact how Medicare will pay for clinical diagnostic laboratory tests (CDLTs). The changes, according to some in the industry, could result in a significant financial hit for labs across the country because they will result in substantial fee cuts. The changes, which take effect Jan. 1, 2018, were mandated […]

Judge Orders HHS to Clear Medicare Claims Appeal Backlog by 2020

Four years, that’s how long a federal judge has given the Department of Health and Human Services (HHS) to clear through a huge backlog of Medicare claims appeals. The Dec. 5 ruling, from Judge James E. Boasberg grew out of a motion for summary judgment filed in October by the American Hospital Association. At issue […]

OIG Says Free Labeling of Test Tubes, Collection Containers Could Violate Anti-Kickback Laws

The Office of Inspector General (OIG) recently issued an advisory opinion suggesting that a laboratory’s proposal to label test tubes and specimen collection containers at no cost to dialysis facilities could constitute remuneration under the anti-kickback statute and result in potential sanctions. The opinion issued this month came at the request of an unnamed laboratory […]

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