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9 Dec 2015, 12:12 pm
In fiscal year 2014, the Centers for Medicare & Medicaid Services (CMS), conducted audits of more than one billion claims in an effort to curb approximately $60 billion in improper Medicare payments. [read post]
7 Dec 2015, 9:12 am
The Centers for Medicare & Medicaid Services ("CMS") recently announced a proposed rule primarily aimed at discharge planning requirements for hospitals and other service providers, including home health agencies (HHAs). [read post]
7 Dec 2015, 4:12 am
The Centers for Medicare & Medicaid Services (“CMS”) recently announced a proposed rule primarily aimed at discharge planning requirements for hospitals and other service providers, including home health agencies (HHAs). [read post]
1 Dec 2015, 3:11 pm
Prior to January 1, 2011, the Centers for Medicare and Medicaid Services ("CMS") had not expressly prohibited Medicare providers such as Fresenius from billing for overfill. [read post]
1 Dec 2015, 3:11 pm
Prior to January 1, 2011, the Centers for Medicare and Medicaid Services ("CMS") had not expressly prohibited Medicare providers such as Fresenius from billing for overfill. [read post]
30 Nov 2015, 9:48 am
On December 2, 2015, CMS is publishing its annual proposed Notice of Benefit and Payment Parameters, which would govern participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017. [read post]
30 Nov 2015, 9:37 am
CMS is holding a town hall meeting on February 16, 2016 to discuss fiscal year (FY) 2017 applications for add-on payments for new medical services and technologies under the Medicare IPPS. [read post]
23 Nov 2015, 5:14 pm
Medicare national and local coverage policies are translated for the new medical coding standard, International Classification of Diseases, version 10 (ICD-10), and to receive payment, providers must bill using ICD-10 codes for services rendered on or after October 1, 2015. [read post]
19 Nov 2015, 10:20 am
CMS is particularly interested in the submission of suggested topic areas such as communication with providers, rehabilitation, functional status, pain management/control or non-pain symptom management, discharge planning, family training, rehabilitation services, medical and nursing care, interdisciplinary team goal setting, and care planning. [read post]
16 Nov 2015, 12:11 pm
From 2008 to 2012, the Department of Health and Human Services conducted a series of studies pertaining to hospital adverse events, which are injurious outcomes from medical care. [read post]
16 Nov 2015, 8:08 am
Care episode groups describe the patient’s clinical problems at the time items and services are furnished during an episode of care, such as clinical conditions or diagnoses, whether hospitalization occurs, and the principal services furnished. [read post]
Energy and Commerce Health Subcommittee Advances Mental Health, Medicaid, Synthetic Drug Legislation
16 Nov 2015, 8:02 am
HR 2446, to require states to have in place an electronic visit verification system for personal care services furnished under the Medicaid program. [read post]
12 Nov 2015, 8:52 am
” CMS plans to prioritize such admissions for medical review. [read post]
10 Nov 2015, 11:19 am
This practice allegedly violated federal healthcare program rules limiting payment to services that are reasonable and medically necessary for the treatment and diagnosis of an individual patient’s illness or injury. [read post]
9 Nov 2015, 8:26 pm
The Centers for Medicare and Medicare Services (CMS) has invoked the element of time to encourage workers' compensation settlements to be finalized. [read post]
3 Nov 2015, 11:40 am
The newest additions to the work plan are: • Medical device credits for replaced medical devices • Medicare payments during Medicare Severity Diagnosis Related Groups (MS-DRG) payment window • Content Management System (CMS) validation of hospital-submitted quality reporting data • Skilled nursing facility prospective payment system requirements • Orthotic braces-reasonableness of Medicare payments compared to amounts paid by other payers •… [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]
2 Nov 2015, 2:09 pm
Defendants replied that the “medically reasonably and necessary” determination was made by CMS, not by individual doctors, and there were “no allegations that CMS would make a different decision as to whether Avastin is medically reasonable and necessary for any particular use. [read post]
30 Oct 2015, 1:02 pm
Thus payments by hospitals to induce physicians to reduce or limit medically unnecessary services no longer implicate the Gainsharing CMP. [read post]
25 Oct 2015, 11:12 am
A Patient’s Guide to HIPAA (Health Insurance Portability and Accountability Act) Medical Records Privacy from Privacy Rights Clearinghouse Understanding Health Information Privacy by the U.S. [read post]
