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13 Mar 2020, 6:16 pm
According to the Long Term Care Community Coalition, The Knolls is considered a “Special Focus Facility Candidate,” meaning that it has been identified by the Centers for Medicare & Medicaid Services as having a record of poor care that may merit inclusion in CMS’s limited list of facilities that receive enhanced oversight. [read post]
9 Mar 2020, 10:26 am
CMS can revoke the Medicare billing privileges of a provider or supplier: Submits a claim for services that have not been furnished to a specific individual on the date of service. [read post]
9 Mar 2020, 10:26 am
Under 42 CFR Sec. 424.535(a) (8), CMS can revoke the Medicare billing privileges of a provider or supplier: Submits a claim for services that have not been furnished to a specific individual on the date of service. [read post]
9 Mar 2020, 6:06 am
CMS also released fact sheets about coverage for COVID-19 services in the individual and small group markets, Medicaid and CHIP, and Medicare. [read post]
5 Mar 2020, 8:19 am
On Wednesday March 4, 2020, the Centers for Medicare & Medicaid Services (CMS) released three guidance documents for health care providers relating to the coronavirus. [read post]
5 Mar 2020, 5:32 am
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would extend and modify the Comprehensive Care for Joint Replacement (CJR) Model, under which CMS makes a “bundled” payment to participant hospitals for an “episode of care” for lower extremity joint replacement (LEJR) surgery, covering all services provided during the inpatient admission through 90 days post-discharge (with certain exceptions). [read post]
4 Mar 2020, 11:31 am
The Centers for Medicare and Medicaid Services (CMS) has engaged a number of third-party, UPIC contractors (such as Qlarent, AdvanceMed, the CoventBridge Group, and SafeGuard Services LLC) to perform program integrity audits of Medicaid dental claims around the country. [read post]
2 Mar 2020, 11:04 am
Today (March 2, 2020) is the deadline for employers and other health benefit program sponsors, insurers, plan administrators and fiduciaries, health care providers, PBMs and other interested persons to comment on proposed federal rule change that would require insured health plans to count drug rebates and price concessions retained by pharmacy benefit managers (PBMs) as administrative expenses for purposes of determining if the issuing insurer is required to rebate premiums under the… [read post]
27 Feb 2020, 3:01 am
CMS has done extensive analysis of historical data and, through the use of artificial intelligence tools, feel they can better predict what kind of services and how often a patient will need them through the PDGM. [read post]
25 Feb 2020, 3:00 pm
Various medical liability reforms [$40.3 billion in government-wide savings]. [read post]
21 Feb 2020, 10:30 am
BestCare provided clinical testing services for nursing home residents, many of whom were Medicare beneficiaries. [read post]
18 Feb 2020, 9:05 pm
The first rule, proposed by the Centers for Medicare and Medicaid Services (CMS) within HHS, would update the Organ Procurement Organization (OPO) conditions for coverage. [read post]
17 Feb 2020, 12:37 pm
The Administrator of the Centers for Medicare & Medicaid Services (CMS) serves as Secretary of the Board. [read post]
17 Feb 2020, 10:48 am
CMS proposes to make a series of changes to its Medical Loss Ratio calculations. [read post]
17 Feb 2020, 10:46 am
The Centers for Medicare & Medicaid Services (CMS) has proposed updates to its standards for health plan issuers offering plans through federally-facilitated and state-based Exchanges for 2021. [read post]
17 Feb 2020, 9:01 am
”[7] A more in-depth discussion of these Medicare telemedicine restrictions can be found at this linked article.[8] Despite the fact that coding and fee schedule guidance regarding Medicare covered telemedicine services wasn’t even published until November 2001, by March 2003 the Department of Health and Human Services (HHS), Office of Inspector General (OIG) had already found it necessary to issue a Special Fraud Alert entitled “Telemarketing By Durable… [read post]
10 Feb 2020, 8:27 am
.: The Senate Armed Services Committee will hold a hearing on the U.S. strategy in Afghanistan. [read post]
4 Feb 2020, 10:58 am
The ten EHB categories are: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services, including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric… [read post]
3 Feb 2020, 12:42 pm
.: The House Armed Services Committee's Future of Defense Task Force will hold a hearing on supercharging the innovation base. [read post]
28 Jan 2020, 9:05 pm
Each year, the federal Centers for Medicare and Medicaid Services (CMS) adjusts this limit on out-of-pocket expenses for all households to reflect changes in the price of private health insurance. [read post]
