Articles and Blogs

What Risk Categories Mean to Providers and Suppliers

[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 which…Read More

Update to Revalidation Enrollment Procedures

[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 of…Read More

Medicare Providers/Suppliers Must Revalidate Enrollment by March 2013

[08/11/11]

Posted on August 11, 2011 in Health Law News

Published by: Hall Render

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

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

[08/10/11]

Posted on August 10, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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

Medicare Changes to the 3-Day Window Rule

[08/10/11]

Posted on August 10, 2011 in Health Law News

Published by: Hall Render

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

CMS Issues FFY 2012 IRF PPS Final Rule

[08/09/11]

Posted on August 9, 2011 in Health Law News

Published by: Hall Render

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

Medicare Changes to the 3-Day Window Rule

[08/08/11]

Posted on August 8, 2011 in Health Law News

Published by: Hall Render

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

Providers Should Anticipate Reimbursement Changes in Debt Ceiling Agreement

[08/08/11]

Posted on August 8, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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

CMS Issues FFY 2012 IPPS Final Rule

[08/02/11]

Posted on August 2, 2011 in Health Law News

Published by: Hall Render

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

Medicare to Cut $3.87 Billion in Skilled-Nursing Facility Pay

[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 Medicare…Read More