It’s a move sure to stir up controversy.  Under a recently passed Centers for Medicare & Medicaid Services (CMS) Final Rule, your Medicare enrollments will be judged not necessarily on your performance but based on your affiliations with other providers and suppliers. Yes, you read that right: “other providers and…
Oct. 1, 2019, marks the beginning of a new era of billing for skilled nursing facilities (SNFs). EDITOR’S NOTE: This article was published on Aug. 1, 2019, in the RACmonitor news and is reproduced today given the approaching deadline for coding compliance. Say goodbye to RUG-IV, and hello to the…
Under PDPM, reimbursement will be driven by coding and documentation. South Florida has historically been a hotbed of healthcare fraud, and there is a long list of those responsible other than Philip Esformes, who was sentenced to 20 years in prison on Thursday for fraud committed in connection with billings…
With the reimbursement so complex and antiquated, should Congress investigate? Medicare reimbursement payments to hospitals for graduate medical education are based on calculations so complicated, it boggles the mind.  The computation for direct graduate medical education (GME) payments starts with an allowable cost per resident (ARPA) determined in the early…
The Medicare Hospice Benefit proposed rule includes payment rates, wage index, and cap amount.  The Centers for Medicare & Medicaid Services (CMS) is proposing to increase hospice payments to $540 million in the 2020 fiscal year, an increase of 2.7 percent. CMS said the rate is based on the proposed…
April showers bring social determinants of health flowers The showers of April have brought a burst of blooms in the Social Determinants of Health (SDoH) reimbursement garden. First, the Centers of Medicare and Medicaid Services (CMS) released its 2020 rate sheet. As expected by the industry, Medicare Advantage and Part…
New strategy holds promise for future extensions of this technology.A medical practice can now bill and collect for a specific telehealth service without the strict rules of the originating sites being outside of a Metropolitan Statistical Area (MSA) or in a rural Health Professional Shortage Area (HSPA) located in a…
Confusion persists in understanding the definition of the two visits. We created a lot of buzz the past two weeks on our Talk Ten Tuesday broadcast an article on new versus established patient visits: so much, in fact, it was hard to keep up with all the email feedback, which…
CMS and ONC get serious about interoperability during HIMSS.During the HIMSS 19 conference in Orlando last week, the heads of the Office of the National Coordinator (ONC) for Health Information Technology and the Centers for Medicare & Medicaid Services (CMS) took extraordinary steps by discussing the content of two proposed…
A National Coverage Determination (NCD) will reimburse providers for diagnostic tests using sequencing.Today’s topic is DNA sequencing and its effect on society as a whole, on healthcare, and on Medicare. Sequencing is a laboratory procedure that maps the pattern of nucleotides in DNA. In 2003, sequencing an individual cost $2.7…