Category archive: Medicare

CMS Unveils Websites for Comparing Rehabilitation and Long-Term Care Facilities

The Centers for Medicare & Medicaid Services has unveiled two new websites for consumers that include information comparing rehabilitation facilities and long-term care facilities. CMS says that these websites are optimized for mobile use. The sites are located at medicare.gov/inpatientrehabilitationfacilitycompare/ and medicare.gov/longtermcarehospitalcompare/ By Jonathan W. McCrary

Section 483.15 Admission, Transfer and Discharge Rights

Implementation Date: November 28, 2016¹ Section 483.15 replaces section 483.12 and requires the facility to establish an admissions policy. Section (a)(2) states facilities cannot request or require residents or potential residents to waive their rights to Medicare or Medicaid benefits or any rights conferred by applicable state, federal and local licensing or certification laws. Section(a)(2)(iii)…

CMS Final Rule – Comprehensive Analysis by Sandberg Phoenix LTC Team

Over the next few weeks, the Sandberg Phoenix Long-Term Care and Senior Housing Team will be rolling out its analysis of the new CMS Final Rule revising the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. We will address each revision and how it impacts both the care…

New Final Rule for National Emergency Preparedness for Medicare/Medicaid Providers & Suppliers

Following recent natural disasters, such as Hurricane Sandy or episodes of serious flooding; the Centers for Medicare and Medicaid Services (CMS) published a Final Rule to help Medicaid & Medicare providers and suppliers plan for natural and man-made disasters. The new regulations provide consistent emergency preparedness requirements with a goal of enhancing patient safety during…

Hospital Alert – Medicare Update Mandates the Use of Modifier JW for Billing Discarded Drug Waste

Discarded pharmaceuticals and the high cost of drugs continue to receive attention in the news, as well as from the Centers for Medicare and Medicaid Services (CMS). In response to these concerns, CMS recently issued a mandate updating the use by hospitals of the JW modifier to document discarded drugs or biologicals in patient’s medical…

CMS Issues Proposed Rule to Overhaul Part B Drug Payments

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule to reduce Medicare expenditures by changing the way it makes payments for Part B drugs. The proposal includes two phases. The first involves changing the percent of add-on to the Average Sales Price (ASP) of the drugs from 6% to 2.5% plus…

CMS Changes the Manual Medical Review of Therapy Claims Above the $3,700 Threshold and Extends Therapy Cap Exception

On February 9, 2016, CMS issued an update announcing changes related to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law on April 16, 2015. The changes extend the therapy cap exception process through December 31, 2017. MACRA also modifies the requirement for manual medical review for services over the $3,700…

Hospitals Beware – Inpatient Kyphoplasty Procedures Remain a False Claims Act Target

Kyphoplasty is a minimally invasive procedure used to treat certain spinal fractures often due to osteoporosis.  Since the filing of a qui tam action, more than 130 hospitals have entered settlements with the Department of Justice (DOJ) totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. On December 18, 2015,…

False Claims Update: OIG Continues to Focus on Ambulance Services

Reduction of fraud and abuse remains a focus of the government’s efforts to ensure providers accountability.  Recently, the Department of Justice (DOJ) announced a $3.199 Million settlement of alleged False Claims Act violations resulting from an ambulance “swapping” arrangement between a skilled nursing home and ambulance service (Regent settlement). Once again, the Department of Justice…

Anti-Kickback Update – HHS-OIG Settles Ambulance Swapping Case $3 Million Settlement from Nursing Home in Ambulance Swapping Case

Demonstrating the government’s commitment to combat health care fraud and keeping providers accountable, the U.S. Attorney’s office of Southern District announced that Regent Management Services L.P., a long term provider, agreed to pay approximately $3.199 Million to settle allegations that it received kickbacks from ambulance companies for referrals of Regent’s Medicare and Medicaid patients needing…

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