CMS has provided an FAQ document to address concerns regarding the 2 Midnight Inpatient Admission Guidance which begins October 1, 2013. Click to read the document on the CMS site. Q: Will CMS direct the Medicare review contractors to apply the 2-midnight presumption-that is, contractors should not select inpatient claims for review if the inpatient […]
This proposed rule would establish methodology and payment rates for a prospective payment system (PPS) for federally qualified health center (FQHC) services under Medicare Part B beginning on October 1, 2014, in compliance with the statutory requirement of the Affordable Care Act. This proposed rule would also establish a policy which would allow rural health […]
Under the Affordable Care Act, the federal government, states, insurers, employers, and individuals share the responsibility to reform and improve the availability, quality, and affordability of health insurance coverage in the United States. Starting in 2014, the individual shared responsibility provision calls for each individual to have health insurance coverage (known as minimum essential coverage), qualify […]
The FY2014 proposals are summarized below. Changes to payment rates under the SNF Prospective Payment System (PPS) Based on proposed changes contained within this rule, CMS estimates that aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in FY 2013. This estimated increase is attributable to the 2.3 percent […]
Proposed Rule Details BNAF phase-out. This proposed rule would implement the fifth year of the seven-year BNAF phase-out, reducing the BNAF by 15 percent, for a total reduction of 70 percent since FY 2010. The BNAF was implemented in 1997, when the former Health Care Financing Administration (HCFA), now CMS, moved from an outdated […]
The Office of the Inspector General has released a Special Fraud Alert related to physician owned entities that manufacture and/or distribute implantable medical devices. The OIG believes these to involve a high risk of fraudulent activity. Read the report here. Other special fraud alerts have been issued involving DME Suppliers and Hospice with Nursing Homes. […]
The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt […]