Special Bulletin

The PEPPER now gives hospitals an opportunity to peer behind the curtain and see how they perform relative to others. In the midst of a pandemic, the Centers for Medicare & Medicaid Services (CMS) has decided the time is right to add a new element to the quarterly Program for…
Federal authorities are touting the loosening of regulations governing physician referrals to outside services. Calling the applicable regulations “outdated” and the move “historic,” federal officials are touting the most significant changes made to the Physician Self-Referral Law, better known as the “Stark Law,” since its passage in 1990. Put simply,…
CMS said this week that its efforts have led to a $15 billion reduction in problematic claims. The incidence of improper payments by healthcare providers has declined for a fourth consecutive year, federal officials announced this week.  The Centers for Medicare & Medicaid Services (CMS) estimated in a press release…
November 5, 2020

Post-acute Waivers Urgently Needed

By Edward Hu, MD and Charles Locke, MD
Time to bring back post-acute waiversThe average American’s response to the COVID-19 public health emergency (PHE) in the spring of 2020 was swift and rapid, with personal mobility quickly reduced by over 50 percent and millions of people newly working from home. The actions of America’s hospitals were similarly rapid,…
October 26, 2020

Idaho Reaches Critical Levels of COVID Patients

By Day Egusquiza
Newly released data reveals that positivity rate for Idaho is now at 23.22, putting the Gem state in the top three of the nation. The impact of the coronavirus on rural hospitals and regional medical centers in Idaho reached critical levels Friday, resulting in the diverting of patients. All Idaho…
EDITOR’S NOTE: Lisa Banker, MD contributed to the following report. Medicare Advantage Organizations (MAOs) were warned by federal health officials last week to issue an appealable organization determination when denying or recouping part or all of a payment from a non-contracted provider. The directive came in the form of a Centers…
September 22, 2020

News Alert: CMS Orders Halt to Loan Repayment

By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
Action applies to the Medicare Accelerated and Advanced Payment Loan Program.  In March, the Centers for Medicare & Medicaid Services (CMS) expanded the Accelerated and Advanced Payment Program (AAP) due to the COVID-19 public health emergency (PHE), in an effort to increase cash flow to providers. Under the current terms, repayment for…
September 18, 2020

CMS Issues Early Release of MA Advance Notice

By Mark Spivey
The move contrasts with shorter timelines associated with the releases of the IPPS, OPPS rules. In an apparent effort to make providers’ lives a little easier, federal officials earlier this week issued Part I of the 2022 Medicare Advantage (MA) Advance Notice of proposed payment changes. “This announcement of Medicare…