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6 May 2017, 4:25 am
§ 1395y(b)(2)(B)(ii), does not as a matter of law equate to any medical items, devices, supplies, or services that appear under in a single line-item charge on a payment summary form issued by CMS. [read post]
3 May 2017, 9:15 am
In addition, CMS solicits comments regarding possible future rulemaking to specify that: the referring physician’s and/or the acute/post-acute care facility’s medical record would serve as the basis for initial hospice eligibility determinations; and documentation of an in-person visit from the hospice Medical Director or the hospice physician member of the interdisciplinary group could be used as documentation to support initial hospice eligibility… [read post]
2 May 2017, 6:30 am
Also, CMS does not consider an Independent Medical Examination report a “medical record” for purposes of allocation review and approval. [read post]
1 May 2017, 9:34 am
For FY 2020, CMS is proposing that SNFs begin reporting standardized patient assessment data in the following five categories, as required by law: (1) functional status; (2) cognitive function; (3) special services, treatments and interventions; (4) medical conditions and co-morbidities; and (5) impairments. [read post]
28 Apr 2017, 10:23 am
The Centers for Medicare & Medicaid Services (CMS) are on a crusade to make private health care accreditation data available to the public, believing that many major issues related to patient safety are being overlooked. [read post]
25 Apr 2017, 3:21 pm
Among other things, group health plans and their fiduciaries can face audits, litigation and enforcement actions by the Centers for Medicare & Medicaid Services and other health plans for improperly coordinating plan claims with other coverage as well as lawsuits from covered persons, their health care providers or other beneficiaries, the Department of Labor and CMS, or others seeking to enforce rights to benefits, penalties in the case of CMS or the Department… [read post]
23 Apr 2017, 11:55 pm
The definition of ‘business of a medical scheme’ in the Medical Schemes Act 1998 makes it clear that if you charge a premium or contribution for undertaking liability for providing a health service, for granting assistance in defraying the costs of a health service or to render a health service in association with a medical scheme, you will need to be registered as a medical scheme under the Medical Schemes Act. [read post]
23 Apr 2017, 11:54 pm
The definition of ‘business of a medical scheme’ in the Medical Schemes Act 1998 makes it clear that if you charge a premium or contribution for undertaking liability for providing a health service, for granting assistance in defraying the costs of a health service or to render a health service in association with a medical scheme, you will need to be registered as a medical scheme under the Medical Schemes Act. [read post]
18 Apr 2017, 8:25 am
And next year's circus Open Enrollment season promises to be even more stressful:"CMS Officially Shortens 2018 Individual Health Enrollment Period ... will move the end of the open enrollment period for 2018 individual major medical coverage to Dec. 15 [,2017], from Jan. 31, 2018. [read post]
17 Apr 2017, 9:30 pm
Most recently, the AHCA sued the Secretary of Health and Human Services and the Acting Administrator for CMS over the rule, contending that HHS and CMS acted beyond the scope of their authority because they cannot regulate dispute procedures. [read post]
14 Apr 2017, 12:08 pm
Also, CMS has gotten an early start on the calendar year (CY) 2018 rules, with the proposed updates for outpatient hospital departments/ambulatory surgical centers, home health agencies, end-stage renal disease providers, and suppliers of durable medical equipment, prosthetics, orthotics, and supplies all pending at OMB. [read post]
5 Apr 2017, 6:30 am
Also note that CMS does not state that effective 10/1/2017 the MACs are to deny payment for all post-liability settlement injury-related medical care, rather, they are to “deny payment for items or services that should be paid from an LMSA or NFMSA fund. [read post]
29 Mar 2017, 2:48 pm
The Court focused on whether each of the respective medical directorship arrangements satisfied the “written agreement” requirement for either the Stark fair market value compensation (FMV) or personal services exceptions. [read post]
28 Mar 2017, 6:57 am
The Centers for Medicare & Medicaid Services (“CMS”) recently introduced a new education initiative for Chronic Care Management (“CCM”) patients and providers. [read post]
23 Mar 2017, 6:30 am
This often includes the company reaching out to treating physicians to confirm current care regimens or clarity regarding ongoing medication and treatment prior to submission of the MSA to CMS. [read post]
16 Mar 2017, 10:36 am
Hargan to serve as Deputy Secretary of Health and Human Services. [read post]
13 Mar 2017, 7:53 am
However, as per the Center for Medicare & Medicaid Services (CMS) of consumer protections at long-term care facilities, the new law will have no legal effect on the feasibility of prevailing pre-dispute arbitration agreements. [read post]
9 Mar 2017, 1:31 pm
In 2014, the OIG issued an unfavorable advisory opinion in response to a specialty pharmacy’s proposal to pay local retail pharmacies that don’t dispense specialty drugs a fee for certain “support services” provided in connection with referring patients to the specialty pharmacy.[9] These “support services” would include services such as accepting prescriptions for specialty drugs, recording the patient’s medication… [read post]
8 Mar 2017, 2:01 pm
CMS also must consider the highest amount bid by a winning supplier in a CBA, along with relative travel distances and costs, volumes of items and services, and number of suppliers in CBAs and non-CBAs. [read post]
8 Mar 2017, 4:47 am
The Center for Medicare and Medicaid Services (CMS) is part of the Department of Health and Human Services and oversees two of the largest medical programs in the country, covering millions of Americans. [read post]
