Articles and Blogs

CMS Releases Application Instructions for ACO Shared Savings Program

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (“CMS”) has released instructions to prospective Accountable Care Organizations (“ACO”) for applying to the Shared Savings Program. The application process has both automated and paper options, but CMS strongly recommends using the automated application system. All organizations wanting to participate in the Shared Savings Program must submit a Notice…Read More

CMS Updates the Skilled Nursing Facility PPS Factsheet

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (“CMS”) has released an updated Skilled Nursing Facility (“SNF”) Prospective Payment System (“PPS”) Factsheet.  The revised Factsheet includes background information and elements of the SNF PPS. 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…Read More

Nursing Home’s Failure to Notify Leaves Beneficiary Not Liable for Custodial Care Services

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

A Medicare beneficiary is not liable for custodial care services rendered by a Mississippi nursing home because the facility failed to give adequate notice the services were not covered by Medicare, a federal appeals court panel ruled on October 25.  The case (Mississippi Care Center of Morton LLC, Sebelius, 5th Cir., No. 10-60595, Oct. 25,…Read More

Medicare Provider Revalidation Requests

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Brian D. Jent

The Centers for Medicare & Medicaid Services has posted a list of providers who have been sent a request to revalidate their Medicare enrollment information. You can access and review the list, then select “Revalidation Phase 1 Listing.”  The list will be updated monthly and providers are encouraged to review the list.  If you are…Read More

CMS Now Requires EFT Payment for All Providers and Suppliers After Revalidation

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

Current regulations (42 C.F.R 424.510(e)(1),(2)) require providers and suppliers to agree to receive Medicare payments via Electronic Funds Transfer (“EFT”) at the time of enrollment, revalidation, change of Medicare contractors or submission of an enrollment change request.  Additionally, the provider or supplier must submit a CMS-588 form to receive Medicare payment via EFT.  Section 1104 of…Read More

CMS Publishes List of Providers Already Requested to Revalidate

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (“CMS”) has posted a listing of providers who have already been sent a request to revalidate their Medicare enrollment information.  The listing contains the name and National Provider Identifier (“NPI”) of each provider, as well as the date the letter was sent.  Providers on the list, but have…Read More

CMS Changes Medicare Overpayment Notification Process

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (“CMS”) has made changes to the Medicare Overpayment Notification Process.  If an outstanding balance has not been resolved, providers previously received three notification letters regarding the overpayments:  (1) an initial demand letter, (2) a follow-up letter, and then (3) an intent to refer letter.  CMS would send the second demand…Read More

GlaxoSmithKline Agrees to a $3 Billion Settlement with the U.S. Government

[11/09/11]

Posted on November 9, 2011 in Health Law News

Published by: Hall Render

On November 3, 2011, GlaxoSmithKline (“GSK”) announced an agreement in principle with the U.S. government for the largest settlement to date to conclude ongoing government investigations against a pharmaceutical company marketing products in the U.S.  The $3 billion settlement against GSK, the world’s fourth largest pharmaceutical company, should be finalized in 2012 and is expected…Read More

Medicare Changes to the 3-Day Payment Window Rule Impact Physician Billing in 2012

[11/08/11]

Posted on November 8, 2011 in Health Law News

Published by: Hall Render

On November 1, 2011, the Centers for Medicare and Medicaid Services (CMS) issued its Calendar Year (CY) 2012 Medicare Physician Fee Schedule Final Rule (Final Rule) finalizing proposed changes that impact physician billing for services subject to a billing policy commonly known as the 3-Day Payment Window Rule (or 1-Day Payment Window Rule for certain…Read More

Possible Rural Health Clinic Deeming Authority on the Horizon – Comments Requested

[11/08/11]

Posted on November 8, 2011 in Health Law News

Published by: Hall Render

On October 28, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published a Federal Register notice to inform the public that an application for Rural Health Clinic (“RHC”) deeming authority was submitted by the American Association for Accreditation of Ambulatory Surgery Facilities (“AAAASF”).  If approved, AAAASF, in addition to CMS, will be able to…Read More