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10 Nov 2022, 10:00 pm
The Centers for Medicare & Medicaid Services (CMS) delayed the publication of the final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). [read post]
10 Nov 2022, 10:00 pm
The Centers for Medicare & Medicaid Services (CMS) delayed the publication of the final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). [read post]
10 Nov 2022, 10:00 pm
The Centers for Medicare & Medicaid Services (CMS) delayed the publication of the final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). [read post]
9 Nov 2022, 5:00 am
In a recent news release, the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) announced revisions to the Special Focus Facility Program (SFFP), which addresses poor nursing home performance, that will have the effect of increased scrutiny of these troubled facilities. [read post]
7 Nov 2022, 5:00 am
On October 7, 2022, the Centers for Medicare & Medicaid Services (CMS) published a request for information (RFI) notice seeking public comment on a proposed national healthcare provider directory. [read post]
6 Nov 2022, 11:21 pm
In addition, the Second Circuit rejected Pfizer’s argument that the AKS should be read more narrowly than the beneficiary inducement statute (BIS), a civil statute that prohibits a person from offering to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence such individual to order or receive from a particular provider, practitioner, or supplier any item or service for which payment may be made, in whole or… [read post]
4 Nov 2022, 12:58 pm
The Centers for Medicare and Medicaid Services (CMS) continue to delve into nursing home ownership models, specifically scrutinizing understaffing at for-profit nursing homes. [read post]
2 Nov 2022, 1:39 pm
In the 2023 Outpatient Prospective Payment System Final Rule (OPPS Final Rule), released in pre-publication form on November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) adopts final regulations governing REHs. [read post]
2 Nov 2022, 5:00 am
As many healthcare providers may know, UPICs are the primary program integrity contractors for the Centers for Medicare & Medicaid Services (CMS) and the only program integrity contractors with authority to review both Medicare and Medicaid claims. [read post]
27 Oct 2022, 9:05 pm
The Centers for Medicare & Medicaid Services (CMS) imposed stricter accountability standards on nursing homes with a history of poor performance. [read post]
26 Oct 2022, 5:00 am
The following month, in July 2022, the Centers for Medicare & Medicaid (CMS) issued a guidance reiterating federal obligations placed on hospitals and health care providers by EMTALA. [read post]
24 Oct 2022, 12:10 pm
In 2021, for example, thirteen percent (800,000) of" "LIS enrollees were expected to pay an average of $27/month for Part D premiums in plan year 2022 if they did not switch to a premium free plan.In many cases, the reason these individuals are paying premiums is inertia.People who qualify for the full Medicare Part D LIS do not pay premiums if they enroll in plans with “benchmark” prescription drug premiums.Benchmark plans have premiums at or below a cut-off in each… [read post]
24 Oct 2022, 12:08 pm
The Centers for Medicare and Medicaid Services (CMS) announced last Friday that it’s bolstering scrutiny for chronically under-performing nursing homes through revisions of its Special Focus Facility Program. [read post]
20 Oct 2022, 7:05 pm
Department Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) on October 7, 2022, seeking input on creation of a national provider directory for use by patients, regulators, and insurers. [read post]
20 Oct 2022, 9:04 am
In addition, recipients of federal Medicare and Medicaid funding remain obligated under the federal Centers for Medicare & Medicaid Services (CMS) interim final rule, which was upheld by the Supreme Court of the United States early this year. [read post]
18 Oct 2022, 1:58 pm
The Centers for Medicare and Medicaid Services (CMS) is responsible for enforcing EMTALA. [read post]
17 Oct 2022, 3:04 pm
The Centers for Medicare and Medicaid Services (CMS) pay Medicare Advantage plans monthly and give more money to companies that care for sicker people. [read post]
17 Oct 2022, 5:00 am
The UPIC may also persuade the Centers for Medicare & Medicaid Services (CMS) to revoke the provider’s Medicare billing privileges because the UPIC’s probe audits have made it appear as though the provider has a pattern of submitting claims that do not meet Medicare requirements. [read post]
10 Oct 2022, 5:01 am
Civil Investigative Demands are often at the center of the government’s investigative efforts prior to deciding whether to intervene in a qui tam. [read post]
5 Oct 2022, 10:25 am
United States Department of Health and Human Services case arose from a 2019 Centers for Medicare & Medicaid Services (CMS) rule prohibiting nursing homes from requiring residents to sign binding arbitration agreements. [read post]
