Articles and Blogs

President Obama introduced his fiscal year (“FY”) 2015 budget yesterday, and there are many proposed cuts to post-acute care providers.  Some of the highlights include a number of bundled payment initiatives, a $100 co-pay for home health patients not discharged from a hospital and re-admission penalties for skilled nursing facilities (“SNFs”) with high hospital... READ MORE

Earlier this week, McKnight’s reported on a study from the Mount Sinai School of Medicine in New York relating to the length of stay at for-profit versus nonprofit hospice providers.  This study showed that, of the 600 Medicare certified hospices nationwide, for-profit hospices were more likely to have patients with a longer expected stay than... READ MORE

The Indiana Court of Appeals (“Court”) ruled that a daughter who signed a skilled nursing facility admissions agreement as her mother’s “responsible party” was not liable for her mother’s unpaid skilled nursing facility bill because the daughter did not have authority over her mother’s finances or access to her mother’s finances. READ MORE

On October 30, two Medicare Administrative Contractors, Palmetto GBA and CGS, announced their intent to focus on certain hospice claims for patients located in Skilled Nursing Facilities (“SNFs”). Palmetto GBA announced that it has identified top providers with a large number of beneficiaries receiving hospice services in SNFs, and it intends to initiate a... READ MORE

Recently, the Centers for Medicare & Medicaid Services (“CMS”) released the results of a study of hospice general inpatient care (“GIP”) based on an analysis of Medicare Part A hospice claims for beneficiaries who received GIP in 2011.  The intent was to identify suspected abuse of GIP in hospice inpatient facilities by hospice providers because... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently released a Survey and Certification Letter updating the State Operations Manual (“SOM”) guidelines  on surveys of deemed status long-term care (“LTC”) providers when the provider has been found to have a condition level instance of noncompliance, including immediate jeopardy (“IJ”), in a complaint survey.  This change... READ MORE

In a transmittal issued on April 5, 2013, CMS provided guidance on survey activities that will be affected by the sequestration cuts.  The transmittal provides guidance on several areas that will have an immediate and potentially negative effect on nursing homes and post-acute care providers.  These changes will affect the survey process as conducted by the state survey... READ MORE

The Medicare Payment Advisory Commission’s (“MedPAC”) March 25th Report to Congress outlines inefficiencies they believe exist in the post-acute world and lead to excessive Medicare payments to providers. MedPAC recommendations include Congress evaluate post-acute provider reimbursement and encourage use of the lowest cost mix of services necessary to achieve the best outcomes. READ MORE

In a suit brought against an Ohio nursing facility related to improper medication administration, the U.S. Court of Appeals for the Sixth Circuit allowed the use of res ipsa loquitur in finding a facility responsible for lapses in a resident’s medication regime.   READ MORE

On January 2, 2013, the Department of Health and Human Services (“HHS”) announced that it had reached a settlement with a hospice provider (“Hospice”) arising from potential violations of the Security Rule under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  HHS learned of the circumstances giving rise to the enforcement action... READ MORE