CMS announces Medicare appeals without administrative law judge hearings
By
Tim Mullaney
Jul 07, 2014
Long-term care providers will be able to appeal certain Medicare claims decisions without going through an administrative law judge hearing, the Office of Medicare Hearings and Appeals (OMHA) announced...
Charges that Omnicare forgave nursing providers’ debts as a form of kickbacks can proceed, judge...
By
Tim Mullaney
Jun 17, 2014
A whistleblower can pursue charges that long-term care pharmacy Omnicare ignored skilled nursing companies’ overdue bills in exchange for certain kinds of business, a federal district court recently...
Ultra-High therapy keeps surging: CMS
By
James M. Berklan
Jun 01, 2014
Providers aren’t just being accused of coding therapy patients in higher payment categories than ever before. The charge is being backed by hard numbers in a recent memorandum from the Centers for...
June 3 Super Tuesday webinar: why you need to pay attention to PEPPER reports
May 22, 2014
Providers will learn how the government’s PEPPER reports are connected to their facilities’ health during a June 3 McKnight’s Super Tuesday webcast. Featured speaker Leah Klusch, the...
More than half of skilled nursing facility rehab residents classified under Ultra-High, CMS finds
By
Tim Mullaney
May 07, 2014
Skilled nursing facility therapy billings in the Ultra-High RUG category increased steadily in recent years and passed a significant threshold in 2013, according to a government memorandum.
Palliative possibilities: Therein lies the rub
By
Shelly Mesure, MS, OTR/L
Apr 22, 2014
When a patient is referred to therapy, and they are receiving hospice care, then therapy needs to seek permission from the hospice company to provide any treatment. Hospice is required to reimburse the...
Part A claims under scrutiny
By
Tim Mullaney
Mar 01, 2014
Government investigators will issue a report on skilled nursing facilities’ Medicare Part A billing practices later this year, according to the latest annual work plan from the Department of Health...
OIG plans to scrutinize skilled nursing facilities’ Medicare Part A claims
By
Tim Mullaney
Feb 04, 2014
Skilled nursing operators can expect to see a new government report on Medicare Part A billing practices released in 2014, according to the latest annual work plan from the Department of Health and Human...
Ask the payment expert … about changes related to Jimmo v. Sebelius
By
Patricia Boyer
Jan 01, 2014
How come there are so many Medicare A denials when Jimmo v. Sebelius stated we could keep residents on Medicare A even if they are not improving?
CMS clarifies Medicare payment rules for SNF to SNF ambulance transportation
By
Tim Mullaney
Nov 08, 2013
A skilled nursing facility discharging a Medicare Part A resident to another SNF is responsible for ambulance transportation fees, and no separate Part B claim should be made for that service, the Centers...