Articles and Blogs

The July 2011 version of the CMS-855A, Medicare Enrollment Application (the “855A”) contains new disclosure requirements arising from risk screening criteria found in the Affordable Care Act (the “Act”). These reporting requirements apply not only to applications for new providers enrolling in the Medicare program, but to existing providers that will be required, under Section…Read More

The National Fire Protection Association (NFPA) has recently released the 2012 Edition of the Life Safety Code (LSC).  Currently, the Centers for Medicare & Medicaid Services (CMS) enforces the 2000 Edition of the LSC.  The updated LSC includes many changes for health facilities, and addresses cultural changes for nursing homes.  For instance, to move a…Read More

The Department of Health and Human Services by the end of the year is expected to publish its final regulations implementing changes to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) arising from the Health Information Technology for Economic and Clinical Health Act (“HITECH”).  With these regulations pending and a trend toward increasing enforcement…Read More

Executive Summary In a flurry of regulatory activity aimed at improving efficiencies in health care delivery, on October 24, 2011, the Centers for Medicare and Medicaid Services (“CMS”) issued, among other rules1, a proposed rule to eliminate anachronistic and burdensome regulations (“Proposed Rule”).   The Proposed Rule applies to a variety of health care providers.  The…Read More

The Centers for Medicare & Medicaid Services (“CMS”) just released a Survey & Certification Letter (S&C: 12-04-NH) to address a recent report of a nursing facility resident death due to a smoking accident.  A resident who was deemed appropriate to smoke unsupervised, but failing to wear a smoking apron, died as the result of injuries…Read More

The Centers for Medicare & Medicaid Services (CMS) issued transmittal updating the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule by 2.4 percent on January 1, 2012.  The DMEPOS fee schedules are updated on an annual basis in accordance with statute and regulations.  This annual update in payment rates is tied to the Consumer Price Index…Read More

Change Request (CR) 6421 was recently revised to remove chiropractors from the list of providers who may order or refer for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).  All other information in the CR remained the same.  As you will recall, in CR 6421, the Centers for Medicare & Medicaid Services (CMS) started the expansion of claim editing to meet…Read More

The Indiana Office of Medicaid Policy and Planning (“OMPP”) has released a revised prior authorization policy for early refills of prescriptions.  The change will be effective December 1, 2011 and requires that at least 85% of a prescription claim’s days transpire before subsequent claims or prior authorizations can be approved.  This is a change from…Read More

The Occupational Safety and Health Administration (“OSHA”) has included nursing facilities in their Site-Specific Targeting 2011 (“SST-11”) Plan for facilities with high rates of injuries and illnesses experienced by workers.  The SST-11 selects individual facilities for inspection identified through the 2010 Data Initiative survey.  OSHA will target facilities with specific Days Away, Restricted, or Transferred…Read More

This past September, the Centers for Medicare & Medicaid Services (“CMS”) posted revised interpretive guidelines concerning the use of feeding tubes in nursing homes.  In late October, CMS retracted the Survey & Certification Letter detailing the revised changes so they could include instructions that pertain to the Quality Indicator Survey (“QIS”).  Further revised interpretive guidelines…Read More