News

HIV/AIDS payments, in particular, are under the microscope. The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV and AIDS patients. In 2016, there were 15,807 deaths among…
HHS OIG uncovered irregularities in 2016 reimbursements. Payments for hospice services were in the news this week, with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) reporting that the Centers for Medicare & Medicaid Services (CMS) had repeatedly paid twice for such services during…
California-based Zing Health latest to join SDoH market of payers. Since 2018, there has been common language introduced by insurers that includes the verbiage “so-and-so is uniquely positioned to address the SDoH (social determinants of health),” all followed by, “with new programming” promising to: Enhance health outcomes; Be customized to…
Federal regulation is causing headaches for providers performing home sleep studies. I often comment that I learn a new rule every week and that my clients constantly teach me new things. This story combines those two truths.  A client taught me about a rule you need to know if your…
The allegations in the case focused on CCs and MCCs. EDITOR’S NOTE: This story appeared Aug. 20, 2019, in the ICD10monitor news. A Texas federal judge recently dismissed a False Claims Act lawsuit alleging that Dallas-based Baylor Scott & White Health overbilled Medicare by improperly upcoding claims. The whistleblower lawsuit, filed…
The CMS Administrator could have chosen a better example to highlight plans for lower costs during recent remarks. With the release of the 2020 Inpatient Prospective Payment System (IPPS) Final Rule and the 2020 Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule rules, Centers for Medicare & Medicaid…
Changes are effective Oct. 1, 2019 In this article, we aim to continue to remind Inpatient Rehabilitation Facilities (IRFs) of the looming transition from utilizing Functional Independence Measures (FIMtm) for the purposes of assigning patients to a case-mix group (CMG) to the use of key quality indictor data – specifically…
Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted;…