Special Bulletin

CMS pledging improved healthcare quality and expanded access for patients. The release of the Inpatient Prospective Payment System (IPPS) proposed rule for the 2020 fiscal year came with a bit of branding. “Rethinking Rural Health” and “Unleashing Innovations” were the two catchy slogans unveiled by the Centers for Medicare &…
Proposed rule calls amending regulations clarifying the determination as to whether a physician qualifies as a rehabilitation physician is made by the IRF. The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for the inpatient rehabilitation facility (IRF) prospective payment system for the fiscal year 2020.…
Plaintiffs allege they were forced to pay thousands for SNF care following outpatient/observation status assignment. A federal judge has denied the government’s bid to put a stop to a landmark class-action lawsuit centering on patient status, paving the way for a trial expected to begin later this year. In Alexander…
Safety-net providers once often overcharged for medications covered under the federal cost-saving program have a new resource to protect against it. The Health Resources & Services Administration (HRSA) has launched a new secure website intended to serve as a tool through which safety-net healthcare providers participating in the 340B federal…
Contrary to the belief of some, the rule remains alive and well. EDITOR’S NOTE: The rumor mill was churning recently regarding news from a Wisconsin health plan that reportedly was discontinuing adherence to the contentious two-midnight rule of the Centers for Medicare & Medicaid Services (CMS), believing that CMS was,…
Controversy Swirls: Payers vs Providers EDITOR’S NOTE: Attorney David Glaser reported this story live on Monitor Monday today. That statement may appear to be somewhat controversial, but it shouldn’t be. First, plans are required to provide the patient with benefits that are at least as generous as those required under…
Errors persist in another communication on a key knee procedure. Sixteen days after the original MLN Matters publication titled “Total Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only (IPO) List and Application of the 2-Midnight Rule” was released, it was reissued today with clarifications. If you’re not aware why it…
“Urgent” memo marks obvious disagreement among contractors. In what can only be described as highly unusual, a Medicare Administrative Contractor (MAC) has advised home health providers who have had claims audited and denied by the Comprehensive Error Rate Testing (CERT) contractor to appeal those denials. The announcement was made today…