[10/14/11]
Posted on October 14, 2011 in Long-Term Care, Home Health & Hospice
Written by: Selby, Todd J.
On October 12, 2011, the U.S. Department of Justice unsealed an indictment charging Matthew Kolodesh a/k/a Matvei Kolodech, with conspiracy to defraud Medicare of more than $14 million. According to the indictment, Kolodesh’s business, Home Care Hospice, Inc. (HCH), located in Philadelphia, PA, submitted Medicare claims for approximately $14.3 million dollars for patients who... READ MORE
Tags: Audit, billing, claim review, cms, defraud, Department of Health and Human Services, Department of Justice, DHHS, false claim, hall render, Hospice, inelegible, Litigation and Risk Management, MAC, Medicare, oig, patient, payment, reimbursement, selby, terminal, terminally ill
[08/13/11]
Posted on August 13, 2011 in Long-Term Care, Home Health & Hospice
Written by: Bufford, David W.
Earlier this week, we highlighted the implementation by Centers for Medicare & Medicaid Services (CMS) of enrollment revalidations and screening categories, and which categories CMS places certain long-term care providers. It is important for providers and suppliers to understand what each screening category (limited, moderate, or high) entails and be aware of any events... READ MORE
Tags: 10 years, ACA, accountable care, assisted living, billing, bufford, cah, clinic, clinical laboratories, cms, database, dmepos, enrollment, excluded, fbi, final adverse action, fingerprint, group, hha, high, Home Health, home health agency, Hospice, hospital, initial enrollment, jent, license, limited, long term care, MAC, medicaid, Medicaid/Medicare Enrollment and Regulatory Compliance, Medicare, mental health, moderate, moratorium, new practice location, nursing home, oig, on site, on-site visit, payment, physcian, PPACA, practitioner, recertification, reimbursement, Rural Health, screening, selby, skilled nursing facility, snf, suspension, therapy, visit
[08/11/11]
Posted on August 11, 2011 in Long-Term Care, Home Health & Hospice
Written by: Selby, Todd J.
As an update to the previous post on the revalidation enrollment procedures it is important for hospices, home health agencies, and DMEPOS to know what level of screening they will receive from the Medicare Administrative Contractor (“MAC”). In some instances these providers and suppliers will be screened at either a “high” or “moderate” level... READ MORE
Tags: 855, ACA, accountable care, billing, bufford, cms, deactivation, dme, dmepos, enrollment, hha, Home Health, home health agency, Hospice, jent, long term care, Medicaid/Medicare Enrollment and Regulatory Compliance, Medicare, payment, selby
[07/29/11]
Posted on July 29, 2011 in Long-Term Care, Home Health & Hospice
Written by: Bufford, David W.
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... READ MORE
Tags: ACA, Affordable Care Act, bufford, case mix index, change of therapy, classification, cmi, cms, consolidated billing, COT, final rule, fy 2011, fy 2012, jent, long term care, market basket, Medicaid/Medicare Enrollment and Regulatory Compliance, Medicare, omra, other medicare required assessment, payment, PPACA, pps, recalibration, reduction, rug, rug-iv, selby, skilled nursing facility, snf, spike, therapy
[07/29/11]
Posted on July 29, 2011 in Long-Term Care, Home Health & Hospice
Written by: Bufford, David W.
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... READ MORE
Tags: ACA, accountable care, beneficiary, bufford, cap, cap accounting, cms, current method, days of care, elect, encounter, face to face, fiscal year, fy, fy 2011, fy 2012, fy 2014, Hospice, hospice cap, increase, jent, long term care, market basket, Medicaid/Medicare Enrollment and Regulatory Compliance, Medicare, october, payment, PPACA, qapi, quality assessment and performance improvement, rectification narrative, reduction, selby, terminal illness, two-percentage point, wage index