Posts Tagged ‘CMS’
OIG report finds claims filed on behalf of the dead
With Halloween just around the corner the HHS’ Office of the Inspector General just released a report showing that during a two-year period The Centers for Medicare & Medicaid (CMS) paid out nearly half a million dollars for claims made on dead people. Federal law requires CMS to establish policies and implement claim edits to…
Read MoreThe 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…
Read MoreCMS puts HHA pre-claim review process on hold in Florida, other states
Plans by the Centers for Medicare & Medicaid Services (CMS) to begin a pre-claim review process for home health services have been put on hold for now. The demonstration program was to launch this month (October) in Florida and Texas, but CMS announced a postponement, noting that additional education efforts were needed before moving forward.…
Read MoreCMS proposes changes to PACE designed to modernize program
The Centers for Medicare and Medicaid (CMS) is proposing a number of changes to the regulations that control the Programs of All-Inclusive Care for the Elderly. PACE, as it is known, allows seniors, most of whom are eligible for Medicare and Medicaid, to live and receive care at home instead of in a skilled nursing…
Read MoreTelemedicine gaining acceptance among payors
Although not entirely embraced by insurers, telemedicine is slowly becoming a more acceptable means of providing care. Even the federal government is starting to recognize telemedicine’s benefits. Earlier this month, The Centers for Medicare & Medicaid Services (CMS) proposed increasing telehealth coverage by adding new CPT codes for services beginning January 1, 2017 as part…
Read MoreCMS Proposes Changes to Meaningful Use Reporting Period
A reprieve could be on the way for the more than 200,000 healthcare providers who have been struggling to meet their electronic health reporting (EHR) requirements under the Meaningful Use Program. The Centers for Medicare and Medicaid (CMS) has announced a proposed rule that would  allow clinicians, hospitals and critical access hospitals to use a…
Read MoreFeds target healthcare fraud by looking for outliers
Last week, the U.S. Department of Justice announced the largest healthcare fraud takedown in its history. Approximately 300 defendants in 36 federal districts, including South Florida, were charged with engaging in fraudulent billings to the tune of more than $900 million. Charges included: conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering…
Read MoreFlorida Home Health Agencies Targeted by CMS for Pre-claim Review
Florida is one of five states that the Centers for Medicare & Medicaid Services (CMS) is targeting for a three-year Medicare pre-claim review demonstration for home healthcare services. However, just how this program will work has raised questions in the home healthcare community. CMS says the steps it is taking are designed to “provide timely…
Read MoreCMS looks to formalize six-year lookback period for Medicare self-referral disclosures
The Centers for Medicare and Medicaid recently published a notice proposing revisions to its self-referral disclosure protocol (SRDP). The SRDP allows healthcare providers and suppliers to self-disclose actual or potential violations of the physician self-referral statute, or Stark Law. Under the proposal, healthcare providers who use the SRDP will have to provide the agency with…
Read MoreCMS unveils new Medicare payment proposal
On April 27, The Centers for Medicare and Medicaid (CMS) released, for public comment, proposed changes to how Medicare will pay providers. The proposed rule for the Medicare Access and CHIP Reauthorization Act (MACRA), enacted a year ago by Congress, eliminates the Sustainable Growth Rate (SGR) formula for setting reimbursement rates and simplifies many of…
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