An insider’s guide to managed care contract exclusions
By
Susie Mix
Dec 18, 2023
There’s a key question more providers need to know the answer to: What is a contract exclusion? A contract exclusion details the medications and treatments that are not included in the levels of a managed...
Medicare Advantage: A not-so-advantageous deal for beneficiaries and providers
By
Brendan Williams
Nov 29, 2023
Open enrollment is well underway for Medicare, as television viewers inundated with cheesy insurance company ads can tell. Those ads must work. For the first time 2024 will see most Medicare...
Ready, set, review!
By
Renee Kinder
May 11, 2023
We’ve all been waiting for this. We knew it was coming! What am I speaking of? The May 4, 2023, notice of Skilled Nursing Facility (SNF) 5-Claim Probe and Educate Review, of course! Since the initiation...
Loophole allows low volume Medicare providers exemption from auditing
By
Kristin Walter
Dec 15, 2017
The current implementation of Medicare’s sliding scale ADR limit policy is preventing the recovery of improper payments and has afforded a significant portion of providers with immunity from billing...
Obtaining critical claims data may soon get easier
By
John O'Connor
Jun 05, 2015
The government plans to make new claims data and other resident-care information available to providers and entrepreneurs as never before. Is it too good to be true?
Providers suffering Medicare appeals backlog — at their own hand?
By
James M. Berklan
Apr 29, 2015
If providers were charged a fee for challenging Recovery Audit Contractor findings, there wouldn’t be the current overwhelming backlog of Medicare appeals, says the administration — and, surprise,...
The Jimmo scorecard and CMS compliance update
By
Steven Littlehale
Nov 25, 2014
In some ways, 2014 has been a monumental year. But it’s not over yet, especially with regard to Centers for Medicare & Medicaid Services steps regarding the historic Jimmo settlement agreement signed...
Taking care of Medicare and Medicaid’s dual-eligibles: A job for Super- , er, Ombudsman
By
Tim Mullaney
Jul 16, 2013
Giving long-term care stakeholders a reason to cheer, California recently requested a federal waiver to implement Cal MedConnect, a demonstration project meant to improve care coordination for people who...
Of Purell and payment reform
By
Tim Mullaney
Apr 16, 2013
I was sympathetic when the Partnership for Sustainable Health Care called for a speedier shift away from fee-for-service last week — and I also thought about Purell. Yes, that Purell.
Why long-term care operators are wary – and weary – of sequestration fiasco
By
John O'Connor
Feb 22, 2013
Well, here we go again. Less than three months after President Obama and Congress narrowly avoided walking off a fiscal cliff, we’re bracing for Round 2. Only this time, we’re all a bit worse...