The Office of the Inspector General (OIG) has published their annual Work Plan for 2013. The Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The Work Plan specifically targets skilled nursing facilities (SNFs), hospices, and home health agencies (HHAs). For all types of providers, the main goal of this Work Plan is to focus on measuring and quantifying the cost and quality of care. A brief overview of the OIG’s target areas for each provider type is listed below. (more…)
Archive for the ‘Medicaid/Medicare enrollment and regulatory compliance’ Category
OIG Publishes 2013 Work Plan
Authored By: David W. Bufford
CMS Issues Advance Copy of Long-Term Care Survey Protocol
Authored By: Todd J. Selby
On September 27, 2012, CMS issued an advance copy of the State Operations Manual (“SOM”) revisions to Appendix P of the SOM, which addresses Long-Term Care Facility survey protocol. The SOM guidance also makes changes to various survey forms resulting from the new quality measures reports. (more…)
Registration Open for DMEPOS Competitive Bidding Round 1 Recompete
Authored By: Kendra Conover
Centers for Medicare & Medicaid Services (“CMS”) has announced that registration is now open to all suppliers interested in participating in the Round 1 Recompete of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) Competitive Bidding Program.
In order to submit a bid for the Round 1 Recompete, suppliers will need to first register in the Individuals Authorized Access to the CMS Computer Services (“IACS”) online application. Once suppliers are registered in IACS, suppliers will receive a user ID and password to access the online DMEPOS Bidding System (“DBidS”). Suppliers must register even if they registered during a previous round of competition (i.e., Round 1 Rebid, Round 2, or the national mail-order competition). Suppliers that do not register will not be able to bid. (more…)
Internet-Based PECOS Improvements Increase Access to Information
Authored By: Todd J. Selby
The Centers for Medicare & Medicaid Services (CMS) implemented changes to Internet-based PECOS to allow providers easier access to information. The following enhancements are now available: (more…)
White House to Reach Sequestration Decision Within 30 Days
Authored By: David W. Bufford
The 2% across-the-board cut in reimbursement for Medicare providers, the result of last summer’s “Super Committee” failure, is scheduled to take place January 1, 2013. The President recently signed legislation requiring a report detailing how the sequestration process will affect Medicare providers. Skilled nursing facilities (SNFs) have already seen significant cuts to reimbursement; an additional 2% cut will further strain operations.
Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.
Nursing Home Compare Updates Highlight Differences for Anti-Psychotic Use Between MDS 3.0, CASPER
Authored By: David W. Bufford
As part of the Centers for Medicare & Medicaid Services (CMS) ongoing program to reduce the rate of anti-psychotic use in nursing facilities, the recent changes to the Nursing Home Compare (NHC) website included reports of the usage rates of anti-psychotics in a facility’s score. However, there is a discrepancy between the methodologies utilized by the CMS Certification and Survey Provider Enhanced Reporting (CASPER) and MDS 3.0 in calculating anti-psychotic use within a facility. This has lead to conflicting figures between the NHC website, which uses the MDS 3.0 measure, and that which is found in the CASPER Reports for the same facility. (more…)
CMS Publishes Provider Compliance Map
Authored By: David W. Bufford
Need a quick reference to find specific contacts at Medicare organizations that service your state? The Centers for Medicare & Medicaid Services (CMS) recently published an interactive Provider Compliance Group Map.
Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.
Study Reports SNF Providers Face Grim Reimbursement Future
Authored By: David W. Bufford
The Alliance for Quality Nursing Home Care (AQNHC) released the results of a study conducted concerning the future of skilled nursing facility (SNF) reimbursement. While SNF providers have recently seen their reimbursement rates improve, the study report projects SNF providers are facing $65 billion in reimbursement cuts over the next ten years.
The reimbursement cuts, the cumulative result of several different federal budgetary actions and regulatory changes, would, as stated by Alan Rosenbloom, President of the AQNHC, bring “one of America’s most important health sectors to the brink of operational viability.” (more…)
Home Health Agencies’ Claims for Ordered/Referred Services Must be Billed Using Individual Physician’s Name and NPI
Authored By: Todd J. Selby
In the near future, Regional Home Health Intermediaries (RHHIs) and Parts A and B Medicare Administrative Contractors (A/B MACs) will be contacting home health agencies (HHAs) that have previously submitted claims for ordered or referred services using a group name and national provider identifier (NPI). HHAs will be informed they should begin submitting such claims using the ordering physician’s name and NPI, not a group name and NPI. Once the Centers for Medicare & Medicaid Services (CMS) implements the edits for ordering/referring services into the coding system, claims submitted under a group NPI will be denied. (more…)
Another Antipsychotic Measure Fails to Pass
Authored By: David W. Bufford
In an on-going push to regulate the use of antipsychotic medications in nursing facilities, another piece of legislation has failed to pass Congress. The Senate did not pass a proposed regulation that would have standardized protocols for obtaining informed consent before administering antipsychotics for off-label use. (more…)
Topical Index
- Home Health (44)
- Hospice (40)
- Litigation and Risk Management (38)
- Long-Term Care (140)
- Medicaid/Medicare enrollment and regulatory compliance (70)