Proposed legislation from the House of Representatives would decrease skilled nursing facilities’ Medicare rate updates, introduce new post-acute payment systems and institute readmissions penalties...
CMS begins new round of recovery audit contracts, says improvements will be seen
By
Tim Mullaney
Jan 06, 2015
Connolly LLC will be the recovery audit contractor responsible for reviewing durable medical equipment, hospice and home health claims on a nationwide basis, the Centers for Medicare & Medicaid Services...
Managed care plans need protection from ‘carve-outs’ to ensure services across the continuum,...
By
Tim Mullaney
Nov 26, 2014
State “carve-outs” and lack of transparency in rate-setting threaten the ability of managed care plans to support services across the whole continuum, the Medicaid Health Plans of America stated...
House leader urges HHS to end settlements meant to cut Medicare backlog
By
Tim Mullaney
Sep 17, 2014
The Department of Health and Human Services may not have had the authority to offer providers special settlements to help clear a huge backlog of Medicare appeals, a leading Congressman said in a recent...
High-profile consumer advocacy group sues over broken Medicare appeals process
By
Tim Mullaney
Aug 27, 2014
Long-term care providers have been outspoken in their criticism of the Medicare appeals process, which has all but ground to a halt. Now a class-action lawsuit says Medicare beneficiaries also are being...
Overdocumentation and cloning in electronic health records are overlooked risks, investigators say
By
Tim Mullaney
Jan 09, 2014
Auditors reviewing Medicare and Medicaid claims from electronic health records are largely treating them in the same manner as paper claims, even though they pose unique risks for overbilling and fraud,...
CMS releases new RAI Manual
By
Tim Mullaney
Sep 26, 2013
The Centers for Medicare & Medicaid Services has issued the latest version of the Minimum Data Set 3.0 Resident Assessment Instrument User’s Manual, which takes effect Oct. 1. Although CMS posted...
Hospital, nursing home information sharing to become ‘routine,’ government agencies say
By
Tim Mullaney
Aug 09, 2013
As sharing of electronic health information becomes standard across all care settings, using technology may become a prerequisite for providers to participate in the Medicare and Medicaid programs, according...
Hospital, nursing home information sharing to become ‘routine,’ government agencies say
By
Tim Mullaney
Aug 09, 2013
As sharing of electronic health information becomes standard across all care settings, using technology may become a prerequisite for providers to participate in the Medicare and Medicaid programs, according...
Long-term care groups applaud a pause in Medicare audits, urge permanent changes
By
Tim Mullaney
Feb 21, 2014
Long-term care stakeholders are praising the government’s decision to temporarily pause the recovery audit contractor program, which is associated with a huge backlog of Medicare claims appeals.