Articles and Blogs

In an effort to reduce fraud, waste and abuse of the Medicare program, the Affordable Care Act (section 6401A) implemented new risk screening criteria that require revalidation of enrollment by providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011.  Under the new screening criteria, newly-enrolling and revalidating providers and…Read More

As of March 2011, the Centers for Medicare & Medicaid Services (CMS) implemented new screening criteria in the Medicare provider/supplier enrollment process.  Newly enrolling and revalidating providers and suppliers are placed in one of three categories – limited, moderate, or high – each representing the level of risk to the Medicare program for that provider’s/supplier’s…Read More

As stated in the Health Law News article, for certain types of non-IPPS hospitals the statutory payment window is only one (1) day preceding the patient’s admission.  To clarify, those non-IPPS hospitals are psychiatric hospitals and units, inpatient rehabilitation hospitals and units, long-term care hospitals, children’s hospitals and cancer hospitals.  Critical access hospitals are not…Read More

The Centers for Medicare and Medicaid Services (“CMS”) published the FFY 2012 Final Rule for the Inpatient Rehabilitation Facility (“IRF”) Prospective Payment System (“PPS”) in the Federal Register on August 5, 2011. The Final Rule provides for a 2.2% increase to IRF payment rates for FFY 2012 and implements other adjustments, including updates to the…Read More

On August 1, 2011, the Centers for Medicare and Medicaid Services (CMS) issued its Fiscal Year (FY) 2012 Inpatient Prospective Payment System (IPPS) Final Rule clarifying which outpatient services are required to be bundled with inpatient services in submission of Medicare claims.  This billing policy is commonly known as the 3-Day Window Rule and is…Read More

While Congress was able to present the President with a compromised solution to cut Federal spending and raise the Government’s debt ceiling earlier this month, all long-term care providers should anticipate future reimbursement changes.  Under the current law, the Budget Control Act of 2011t , Medicare and Medicaid are unchanged. However, the Act requires for the…Read More

On August 1, 2011, the Centers for Medicare & Medicaid Services (CMS) published the Federal Fiscal Year (FFY) 2012 Final Rule for Inpatient Prospective Payment System (IPPS) and the Long-term Care Hospital Prospective Payment System on its website. For FFY 2012, Providers will receive a net total increase of 1% to the standardized amount.  This net…Read More

Effective fiscal year (FY) 2012, The Centers for Medicare & Medicaid Services (CMS) final rule on Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2012, released July 29, reduces Medicare skilled nursing facility (SNF) Prospective Payment System (PPS) payments by 11.1%. CMS states this action was taken to “better align Medicare…Read More

The Centers for Medicare & Medicaid Services (CMS) increased fiscal year (FY) 2012 Medicare payments by 2.5% for hospice providers in a final regulation released July 29.  Also included in the final regulation are requirements for hospice providers to start collecting quality of care data and changes to the way CMS counts hospice patients for…Read More

SUMMARY On June 24, 2011, the United States Court of Appeals for the District of Columbia released a decision in Auburn Regional Medical Center v. Sebelius.  The decision reversed an unfavorable district court decision ruling that statutory deadlines to file appeals with the Provider Reimbursement Review Board (PRRB) were not subject to the doctrine of…Read More