Articles and Blogs

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

Late last week, a wide-ranging initiative to update federal human research protection regulations was announced by the U.S. Department of Health and Human Services (HHS) and the White House Office for Science & Technology Policy (OSTP) through issuance of an Advance Notice of Proposed Rulemaking (ANPRM), which aims to catch the regulations up to technological…Read More

As record-breaking temperatures scorch the Midwest, long-term care providers are reminded to evaluate their emergency preparation plans. Proper planning can mitigate a situation from a potential disaster to a mere inconvenience. CMS provides a checklist, Emergency Preparedness for Every Emergency, for providers to use to evaluate their current emergency plans. Federal regulations at 42 CFR…Read More

On May 4, 2011, we issued a bulletin alerting hospital clients that the Office of Inspector General (“OIG”) Office of Audit Services was in the process of sending numerous Contact Letters to hospitals across the country in an effort to verify their levels of compliance with Medicare billing requirements.  As part of this audit, the…Read More

Recently, the Office of Inspector General (“OIG”) published a report of its findings pertaining to the nearly 70% growth of Medicare spending for hospice care provided to nursing facility (“NF”) residents from 2005 – 2009.  During that time, Medicare spending on hospice care for residents in NFs increased sixty-nine percent (69%) from $2.55 billion to $4.31…Read More

On July 5, 2011, the Department of Defense (“DoD”) published a Proposed Rule (“Proposed Rule”) notifying the public of DoD’s pending implementation of a revised TRICARE payment methodology for Sole Community Hospital (“SCH”) inpatients.  This revised payment methodology is an important development since, once it is fully phased in, it will likely result in a…Read More

Effective August 1, 2011, the Centers for Medicare & Medicaid Services (CMS) is implementing two (2) significant changes affecting skilled nursing facilities (SNFs) and hospital swing-bed providers billing for Part A claims.  The changes include the following: 1.         Any Part A claim reporting an End of Therapy Other Medicare Required Assessment must include Occurrence Code…Read More