CMS 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 […]

Florida 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 […]

CMS 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 […]

CMS issues new condition code for home health claims

The Centers for Medicare and Medicaid Services (CMS) has added a new condition code that will allow home health claims for subsequent episodes to process, even if skilled nursing services are not required. The change takes effect July. 1 Currently, any home health claim that is submitted without skilled nursing visits are automatically returned to […]

CMS clarifies 60-day overpayment rule

The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule that details the reporting and returning of Medicare Part A and B overpayments. The proposed rule left providers asking many questions. The final rule provides needed clarity and consistency in the reporting and returning of self-identified overpayments. It is designed to […]

How whistleblowers are helping to fight healthcare fraud

Earlier this month, the Department of Justice announced it had resolved a $237 million judgment against Toumey Healthcare System in South Carolina for violations of the Stark Law. In this particular case, the hospital was alleged to have entered into contracts with 19 specialists that required them to refer their outpatient procedures to the hospital […]

OMHA to expand Medicare appeals process

Faced with skyrocketing processing times, the Office of Medicare Hearings and Appeals (OMHA) says it plans to expand its Settlement Conference Facilitation pilot project in an effort to clear through the ever-growing backlog of claims appeals. The pilot project, which began in June 2014, is an alternative dispute resolution process. It was created to bring […]

CMS to cut providers a break when it comes to ICD-10 deadline

With the implementation of ICD-10 just around the corner (Oct. 1) comes word from the Centers for Medicare & Medicaid Services that it will not deny claims made under the Part B physician fee schedule if there are coding errors. The guidance notice, which was issued with the blessing of the American Medical Association, is […]

Latest Medicare fraud sting should serve as wake-up call

This week’s takedown by the Medicare Fraud Strike Force of 243 people nationwide should serve as a wake-up call to everyone in the medical profession. The arrests, according to federal officials, were due in large part to the government’s increasing use of sophisticated computer programs designed to detect patterns of potential fraud – which in […]

ICD-10 implementation clock ticking

With the deadline for implementation of ICD-10 just five months away, a lot is being written about whether medical practices are prepared. As late as April 30, Rep. Ted Poe of Texas introduced a bill that would prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code […]

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