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2 May 2019, 3:00 pm
” Administrator Verma reiterated in remarks to the Medical Device Manufacturers Association that “[t]his means the contractors cannot make local coverage decisions that automatically non-cover an item or service because it has a category III code. [read post]
22 Jul 2014, 6:47 am
As of January 1, 2010 The Centers for Medicare and Medicaid Services (CMS) no longer recognized consultation codes 99241-99245.What are consultations? [read post]
4 Aug 2016, 10:51 am
Furthermore, CMS reminds the public about a previously-announced Medicare Care Choices Model that allows Medicare and dual eligible beneficiaries with certain medical conditions to receive palliative care services from selected hospice providers without forgoing curative care services. [read post]
23 Nov 2021, 6:06 am
Since the OPPS was originally established, CMS has maintained the Inpatient Only (IPO) list, which is a list of services that Medicare will only pay for when performed in the inpatient setting, in large part due to their medical complexity. [read post]
10 Jun 2020, 11:29 am
As the Covid-19 pandemic has put huge stresses on medical systems around the globe, the strains have taken their toll: The credibility and authority — of federal agencies like the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services (CMS), and elite professional journals like the Lancet and the New England Journal of Medicine — have taken big hits in recent weeks. [read post]
23 Apr 2024, 11:05 am
After the medical record review is complete, CMS then calculates any overpayment amounts and submits an audit report to the MA plan. [read post]
8 Nov 2010, 4:19 am
If CMS or one of its contractors determines that the failure to meet the 12-month deadline was due to a CMS or CMS contractor error or misrepresentation; 2. [read post]
25 Sep 2018, 1:49 pm
CMS also proposes to allow hospitals to establish a medical staff policy describing the circumstances under which a pre-surgery/pre-procedure assessment for an outpatient could be utilized, instead of a comprehensive medical history and physical examination. [read post]
17 Dec 2014, 7:38 am
CMS believes that prior authorization will ensure that the ambulance service is medically necessary and meets the applicable Medicare coverage criteria. [read post]
20 Dec 2016, 6:38 am
As previously reported, CMS finalized regulations to require Medicare PA for certain durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) items that the agency characterizes as “frequently subject to unnecessary utilization. [read post]
30 Jun 2015, 1:25 pm
We will continue to monitor the Medicare & Medicaid Services (CMS) Proposed Rule and other developments in Medicaid. [read post]
15 Mar 2023, 5:00 am
Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule to implement requirements of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). [read post]
2 Nov 2012, 9:22 am
During the last few years, CMS’ Recovery Audit Contractors (RACs) have determined that millions of dollars paid to hospitals for inpatient treatment should be refunded to CMS because although the patient needed the medical services provided, the services should have been provided on an outpatient basis. [read post]
2 Nov 2012, 9:22 am
During the last few years, CMS’ Recovery Audit Contractors (RACs) have determined that millions of dollars paid to hospitals for inpatient treatment should be refunded to CMS because although the patient needed the medical services provided, the services should have been provided on an outpatient basis. [read post]
28 Apr 2023, 6:12 pm
Changes to Medical Care Advisory System The second rule, Ensuring Access to Medicaid Services (CMS-2442-P), also has a May, 3, 2023 scheduled publication date and a July 3, 2023 comment date. [read post]
2 Dec 2021, 12:10 pm
Department of Health and Human Services Xavier Becerra, CMS, Administrator for the CMS Chiquita Brooks-LaSure, Deputy Administrator of CMS Meena Seshamani, Deputy Administrator and Director of Center for Medicaid and CHIP Services Daniel Tsai, and the U.S. [read post]
3 Nov 2015, 4:25 am
Today the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would modify the discharge planning conditions of participation (COPs) for hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies (HHAs). [read post]
14 Nov 2013, 2:33 am
The order must also be documented in the medical record in accordance with the regulations, and a physician must certify the medical necessity of hospital inpatient services. [read post]
11 Nov 2013, 1:11 pm
The order must also be documented in the medical record in accordance with the regulations, and a physician must certify the medical necessity of hospital inpatient services. [read post]
1 May 2020, 11:45 am
CMS is now paying for Medicare telehealth services provided by rural health clinics in federally qualified health clinics, allowing beneficiaries located in rural and other medically underserved areas more options to access care from their home without having to travel. [read post]
