Verma acknowledges lingering gripes about the RACs, pledges to do better. In touting the federal government’s efforts to make the realities of dealing with Recovery Audit Contractors (RACs) more palatable for providers across the country, one of the nation’s top health officials apparently couldn’t help but take a swing at…
Prices of certain drugs continue to spiral out of control as alternatives are sought. ol·i·gop·o·ly (äləˈɡäpəlē), noun: a state of limited competition, in which a market is shared by a small number of producers or sellers. I have been looking at data from the Centers for Medicare & Medicaid Services…
There are winners and losers in the recently posted proposed rule. Weighing in at 1,824 pages, the Inpatient Prospective Payment System (IPPS) proposed rule for the 2020 fiscal year had something for everyone – and, in some cases, nothing at all. To the latter point, there’s no doubt that Ronald…
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 &…
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…