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 Federal officials seek enhancements to the Medicare program through payment realignment. The Centers for Medicare & Medicaid Services (CMS) has finalized Medicare rules adjusting payments for three types of providers: inpatient psychiatric facilities (IPFs), skilled nursing facilities (SNFs), and hospices. First, the CMS final rule applying to IPFs issued last…
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Based on latest filed Medicare cost reports, a little over 12 percent of all skilled nursing facility or “SNF” patients are Medicare recipients. This is excluding Medicare Advantage patients.  By comparison, over 57 percent of patient days were for Medicaid patients.  It is critical to understand that Medicare pays two…
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The new coronavirus is linked to 1,502 deaths among residents of nursing homes and assisted-living facilities in Florida, a new state report shows. It’s an increase of 145 deaths in one week. This is particularly sad when we remember the patients that died in the Rehabilitation Center of Hollywood Hills following Hurricane Irma.  While there was…
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As some states begin to reopen, others are seeing increasing numbers of COVID-19 cases with hospitals reporting rising ICU utilization and near-capacity conditions. But one thing has not changed throughout the pandemic, the question of when a skilled nursing facility (SNF) or swing bed may accept a patient Part A…
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Providers nationwide are seeking to identify ways to mitigate the uncontrolled spread of the virus amid vulnerable populations. Since the first American case of COVID-19 was reported in January, approximately 80,000 people have died, and one-third of those deaths have been patients living in nursing facilities. The index facility, LifeCare…
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 The COVID-19 pandemic has caused all of us to expand our minds. EDITOR’S NOTE: During recent weeks, the Centers for Medicare & Medicaid Services (CMS) has been announcing revisions to its regulatory requirements on a near-daily basis, in an attempt to ease administrative and logistical burdens on providers amid the…
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EDITOR’S NOTE: RACmonitor asked Dr. Ronald Hirsch to monitor the CMS townhall conference call on Tuesday. The following is his summary of that call. In a Centers for Medicare & Medicaid Services (CMS) town hall call on April 14, CMS took questions from across the country on COVID-19 billing and…
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On Friday, March 13, President Donald Trump issued a national emergency declaration due to the COVID-19 pandemic, creating several key implications for care management and utilization review professionals. This declaration led to what is called a 1135 waiver, which gives the Centers for Medicare & Medicaid Services (CMS) broad authority…
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Health systems are grappling with custodial/social admissions from the ED. A specific quandary is playing out in emergency departments (EDs) all over the country, and no one seems to have a clear answer on how to address it. The situation? Patients presenting to EDs because they are unable to care…
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The biggest hurdle providers face is the prospective nature of the payment system. It was always a black hole. The Medicare Provider Reimbursement Review Board, or the PRRB, as it is commonly called, decided whether hundreds of Medicare cost report appeals would move forward or would be blocked for “jurisdictional…