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CMS to launch new Patient-Driven Payment Model October 2019. The Centers for Medicare & Medicaid Services (CMS) was tired of paying too much for care in nursing homes. They were tired of fighting with lawyers and consultants driving up payments and gaming the system.  CMS is finally replacing the Resource…
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CMS E&M FAQ is likely to generate more questions than answers. Since the release by the Centers for Medicare & Medicaid Services (CMS) of the 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, many of us have been scurrying around trying to make sense of two evaluation and management (E&M)…
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Lawsuits initiated by whistleblowers under the False Claims Act. Last Wednesday, in a petition to the United States Supreme Court, Intermountain Healthcare (Intermountain), the largest healthcare provider in the Intermountain U.S., made headline legal news by challenging the constitutionality of the False Claims Act (FCA), one of the government’s most…
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Expect more mass production of audits. Looking forward to the remainder of 2019, we will see a number of exciting information technologies (IT) that will reshape healthcare and Medicare. These include artificial intelligence (AI), the cloud, DNA sequencing, in silico testing of new molecular entities (NMEs), and distributed ledger systems,…
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Original MLN memo is attached. The Centers for Medicare & Medicaid Services (CMS) today pulled its MLN Matters (No. SE19002), titled, “Total Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only (IPO) List and Application of the Two-Midnight Rule,” from its website. Originally posted on Tuesday, Jan. 8, 2018, the MLN…
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Issues abound in the newest edition of MLN Matters Most of us started our day this past Tuesday by finding the newest edition of the Centers for Medicare & Medicaid Services (CMS) MLN Matters (No. SE19002) in our email inbox. Titled “Total Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only…
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Provider-based facilities may share space with a freestanding entity. Any provider that has an arrangement under which there is a freestanding clinic in a building that also contains provider-based or hospital space needs to understand both the relevant Centers for Medicare & Medicaid Services (CMS) policy and the law related…
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Proposed changes will impact hospitals, critical access hospitals, inpatient rehabilitation facilities, and home health agencies. The Centers for Medicare & Medicaid Services (CMS) back in 2015 proposed changes to the Conditions of Participation (CoP) found in 42 CFR part 482. The rationale for the changes is provided in elegant detail…
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Keeping patients in LTACHs longer than necessary can increase reimbursement. Two years ago, on Monitor Mondays and in the RACmonitor eNews, Ronald Hirsch, MD told the story of one of his patients, Carl, whose stay at a skilled nursing facility (SNF) seemed to be stretched to 20 days to maximize…
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Lack of auditor response leads to an ALJ hearing. “A stitch in time saves nine” is a pretty famous heuristic expression, but most people I know do not have any idea what it means. Simply stated, it means that taking the time to do something correctly now will save time…