EDITOR’S NOTE: Lisa Banker, MD contributed to the following report.Medicare Advantage Organizations (MAOs) were warned by federal health officials last week to issue an appealable organization determination when denying or recouping part or all of a payment from a non-contracted provider. The directive came in the form of a Centers for…
Medicare spending on acute-care inpatient hospital services will increase by about $3.5 billion in FY 2021 As the healthcare industry continues to be buffeted by the unrelenting coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) has released the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH)…
The move is already stirring up questions and concerns. Amid the more than 300 pages of the Coronavirus Aid, Relief, and Economic Security (CARES) Act signed into law back in March was a clause of great interest to healthcare providers: a provision to increase the weighting factor of the applicable…
Released Aug. 4, the Outpatient Prospective Payment System (OPPS) proposed rule for 2021 would eliminate the Medicare inpatient-only list of services while increasing the number of Ambulatory Service Center (ASC)-eligible procedures. The rule would also increase 340B payment cuts, and looks to overhaul the hospital star-rating system. The Centers for…
CMS will leverage existing evaluation and management (E&M) payment codes to reimburse eligible providers for the coronavirus counseling services.  The Centers for Medicare & Medicaid Services (CMS) will make payment available to physicians and providers for counseling patients at the time of COVID-19 testing about the importance of self-isolation after they are…
The move comes amid localized spikes in COVID-19 cases occurring nationwide. Federal officials said Friday that they are ending an emergency blanket waiver intended to reduce administrative burden on nursing homes amid the continuing COVID-19 pandemic. The Centers for Medicare & Medicare Services (CMS) said that effective August 14, nursing…
The Centers for Medicare & Medicaid Services (CMS) has provided some guidance within the “Medicare and Medicaid Programs Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” interim final rule (IFR), allowing for remote patient monitoring, or RPM. This type of patient care is very helpful for…
Agencies have implemented legislation guaranteeing coverage of COVID-19 diagnostic testing, including antibody testing, and certain related services without cost sharing for enrollees with private health coverage. As coverages and regulations continue to broaden, often on a day-to-day basis, guidelines related to the COVID-19 pandemic frequently open up additional factors to…
The Centers for Medicare & Medicaid Services (CMS) released an update to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which was published on April 15. This update applies to Inpatient Prospective Payment System (IPPS) facilities, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs). The provisions are found…
COVID-19 TalkBack follow-up.  During the Talk Ten Tuesdays weekly Internet radio broadcast last week, we received many questions which we never got to answer. I am going to share some of those answers with you now. Stacey asked, “can nurses charge for telehealth visits?” There are two parts to this…