The search for a solution might begin with CMS. We have a problem in America. We spend way too much money on healthcare, and the outcomes we do get are not great. I am pretty darn tired of hearing about the move from volume to value. Do you know what…
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.…
Could recoupments be unconstitutional? Case law is changing in favor of healthcare providers who accept Medicare and/or Medicaid. Without question, accepting Medicare and/or Medicaid payments creates a legal risk of regulatory audits. Because the reimbursements constitute tax dollars, the federal and state governments (sometimes via a contracted entity) have the…
Guidance expected to address when a provider-based location shares space with a clinic or another hospital. At the American Health Lawyers Association Medicare and Medicaid conference in March, David Wright, acting deputy director for the Center for Clinical Standards and Quality from the Centers for Medicare & Medicaid Services (CMS)…
CMS cited by GAO for insufficient documentation. The Government Accountability Office (GAO) issued a report on March 27 stating that the Centers for Medicare & Medicaid Services (CMS) should assess documentation necessary to identify improper payments. The study was performed on Medicare and Medicaid fee-for-service (FFS) improper payment data for…
Major takedown by DOJ sends shivers through skilled nursing facilities. Philip Esformes, the operator of 16 skilled nursing and assisted living facilities in South Florida, was found guilty Friday of 20 charges, including paying bribes and kickbacks to bring Medicare patients into his businesses. According to Assistant Attorney General Brian…
Hospitals may consider abandoning their contracts. There are few things managed Medicare plans have come up with that are more unfair to hospitals than denials due to readmission. Hospitals with contracts with managed Medicare payers often must endure these denials, as they are not often excluded in contracts. Managed Medicare…
Weighting changes will be implemented for the 2019 calendar year. Important changes for the 2019 calendar year in healthcare include Merit-Based Incentive Payment System (MIPS) category weighting changes. The quality category will decrease in importance, with a shift of 5 percent, going from 50 to 45 percent of the overall…
The debate over the controversial two-midnight rule rages on. Ok, I surrender. “This is not the hill I intend to die on” is an accurate metaphor. There has been here at RACmonitor a flurry of concern, debate, troubled investigation, and notice of dodging by health plans, and, as we’ve come…
New CMS pharmacy dashboards include data sets from 2013 to 2017. The Centers for Medicare & Medicaid Services (CMS) has released its latest “CMS Drug Spending Dashboards.” While the dashboards are interactive (you can look up specific drug data), we took a broader approach and downloaded and analyzed the source…