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28th Feb

2014 OIG Work Plan

On January 31, 2014, the OIG Work Plan For Fiscal Year 2014 was released.  Areas pertaining to skilled nursing facilities are the following: Medicare Part A billing by skilled nursing facilities (new) – The OIG will describe SNF billing practices in

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24th Jan

Jimmo vs. Sebelius Settlement

It is official!  As part of its court-directed educational campaign, on December 6, 2013, the Centers for Medicare & Medicaid Services (“CMS”) published revisions to several portions of the Medicare Benefit Policy Manual pursuant to the settlement agreement in the

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23rd Dec

Happy New Year—A Budget Agreement Has Been Met!

A budget agreement has been met which cuts the deficit by about $300 million from FY 2014 – 2023, through a reduction of other healthcare spending.  Approximately $28 billion of the savings would come from a two year extension of

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12th Nov

PEPPER: Changing The Way We Look At Things

Wayne Walter Dyer is an American self-help author and motivational speaker who has been quoted as saying “If you change the way you look at things, the things you look at change.”  Such is the case with the release of

Limited Medicare Claim Reviews

Rep. Roger W. Williams (R-TX) introduced the “Medicare Established Provider Act”  on September 20, 2013 to cut down on a reimbursement backlog by identifying providers that are at low risk for fraud. The preferred providers would be subject to periodic

Get Paid For Co-Treatment Minutes

As of October 1, 2013, providers must capture the total number of therapy co-treatment minutes provided in the last seven days by discipline in the new MDS items (O0400A3A, O0400B3A and/or O0400C3A) and many providers are beginning to seek clarification

Long Term Care Commission’s Report

The Commission on Long-Term Care has issued its full report to Congress, fleshing out recommendations that it released last week addressing LTC service delivery, workforce issues and financing systems. Nothing in this report would surprise any reasonably well-informed long-term care

CMS Finalizes Fiscal Year 2014

On July 31, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1446-F] outlining fiscal year (FY) 2014 Medicare payment rates for skilled nursing facilities (SNFs). The major provisions of the final rule are summarized below.

What We Know And What We Don’t

We know that CMS released the final rule for FY 2014 on the Medicare Program Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014 and we know that the major provisions include the following: An increase

What’s Happening On The Regulatory Front!!

Final FY 2014 Inpatient Payment Rules Readmissions Reduction Program In October 2012, Medicare began encouraging to hospitals with excess 30-day readmissions to lower 30-day readmission rates for heart attack, heart failure, and pneumonia patients by reducing a portion of the