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…
Plaintiffs allege they were forced to pay thousands for SNF care following outpatient/observation status assignment. A federal judge has denied the government’s bid to put a stop to a landmark class-action lawsuit centering on patient status, paving the way for a trial expected to begin later this year. In Alexander…
The federal watchdog did not, however, decide to demand recoupments. It is said that great minds think alike. And that proved to be true when the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released its report (CMS improperly paid millions of dollars…
Weighing the difficult decisions being made in the business of healthcare. Medicine has commonly been considered one of the most altruistic professions.  From long years spent in training to long hours spent caring for others and the perpetual drive to heal those who are hurt and comfort those who are…
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…
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…
Skilled service must be is reasonable and medically necessary on a daily basis. Years ago – when I was first entering healthcare and pilgrims were coming over on the Mayflower – the Centers for Medicare & Medicaid Services (CMS) initiated a sea change in the manner in which skilled nursing…
Many hospitals have found that putting SIBRs into place is incredibly challenging. The Case Management Society of America’s (CMSA’s) 28th Annual Conference and Expo recently took place in Chicago, and I was fortunate enough to be a part of it. Attracting professionals represented within CMSA’s strategic mission – collaborators across…
Better ED quality measures, and, ultimately, greater patient satisfaction are among benefits cited. The placement of registered nurse (RN) case managers in the emergency department, with a focus on determining appropriate admission status and making status recommendations to admitting physicians, has proven to be very successful at Waukesha Memorial Hospital…
Those in post-acute care should frequently check for any new reports on this subject. The Centers for Medicare & Medicaid Services (CMS) sponsored an FAQ call on June 21 concerning IMPACT (Improving Medicare Post-Acute Care Transformation), which is directed by the legislation of the same name enacted in 2014. This…
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