Articles and Blogs

The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional advisory agency that makes formal recommendations to Congress in March and June of each year.  MedPAC was created to advise Congress on issues affecting the administration of the Medicare Program.  While Congress is not obligated to follow MedPAC’s recommendations, the recommendations are heavily considered.  This... READ MORE

The 2012 Life Safety Code (LSC) contains numerous provisions that address culture change in nursing facilities.  These new provisions are somewhat of a liberalization of standards to permit a more home-like environment for residents, rather than an institutional setting.  I am expecting the Centers for Medicare & Medicaid Services (CMS) to release a Survey... READ MORE

An article in the New York Times discussed a growing trend away from the utilization of nursing facilities in favor of managed care and home care.  In light of reimbursement cuts from Medicare and Medicaid, the push to home health, managed care, and the Program of All-Inclusive Care for the Elderly (PACE) has received enthusiastic response from some... READ MORE

CMS recently issued guidance to the State Survey Agencies regarding changes to the survey procedures for Home Health Agencies (HHAs).  Effective January 1, 2011, the Centers for Medicare & Medicaid Services (CMS) Home Health Prospective Payment System (PPS) final rule amended the regulations for certification activities related to HHAs.  CMS’s goal in implementing these... READ MORE

On February 8, 2012, the Office of Inspector General (OIG) for the Department of Health and Human Services issued an Alert cautioning physicians who reassign their Medicare benefits. The Alert included precautions to physicians to perform appropriate due diligence of the entities to which they reassign their benefits. The OIG also alerted physicians to... READ MORE

As part of their on-going video series, the Office of Inspector General (OIG) has posted a video on their self-disclosure protocols. Self-disclosure is a key element of an effective compliance program, and can possibly reduce any civil monetary penalties (CMPs) associated with a violation or instance of noncompliance. The OIG has provided many videos... READ MORE

The Centers for Medicare & Medicaid Services (CMS) has published a transmittal detailing changes for coding hospice discharges, which will provide greater clarity as to why the patient has been discharged from hospice care.   READ MORE

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns.  Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January 1, 2012.   READ MORE

The New York Times (NYT) had an interesting article in their The New Old Age segment that described the issues men have in finding appropriate long-term care facilities.  The article highlighted an intuitive, yet often overlooked issue concerning the number of rooms a facility has versus the number of beds.  Many facilities have two... READ MORE

The Centers for Medicare & Medicaid Services (CMS) has responded to criticism detailing how Medicare contractors present hospice service charges in the Medicare Summary Notice (MSN) to beneficiaries.  In recent years, CMS has added new reporting requirements for visit data on hospice claims.  This resulted in an expansion of the information of the claim record to better understand... READ MORE