Tag Archives | CMS

From Bundled Payment Reform to MACRA: Pick Your Poison

MACRA continues to be a subject that perplexes providers even as the program evolves. It has been recently confirmed that the Comprehensive Care for Joint Replacement (CJR) bundled payment has been cut from 67 to 34 percent in the program, and the carding rehabilitation incentive with bundled payments has been cancelled. The new political leadership […]

Continue Reading Comments { 0 }

OIG: Acute Care Hospitals Owe Medicare $51.6M, CMS Agrees to Provider Clawbacks

A new government report finds that Medicare improperly paid acute care hospitals for outpatient services they provided to patients who were inpatients at other facilities. And now Medicare wants the money back. The Centers for Medicare and Medicaid Services has agreed to claw back the $51.6 million and require hospitals to refund patient copays and […]

Continue Reading Comments { 0 }

You Should Worry about Medical Coding Guidelines Changing

Changes are coming with Evaluation and Management (E&M) coding guidelines. I will use this space to explain why these changes will be both a good thing and a challenge to physicians, particularly those who derive much of their income from office visits. CHANGE IS OVERDUE It has been 20 years since the 1997 E&M guidelines […]

Continue Reading Comments { 0 }

What Was Missing at the ICD-10 C&M Meeting?

Much was covered during the ICD-10 Coordination and Maintenance Committee (C&M) meeting last week at the Centers for Medicare & Medicaid Services (CMS) headquarters in Baltimore. The first striking item was that there were no procedure proposals made during this meeting. There was discussion about three root operations – creation, control, and extraction. The definition […]

Continue Reading Comments { 0 }

CMS Proposes 1.9% Increase in 2018 ASC Pay, Adding Total Joint Replacements

CMS released a proposed rule that would update the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System. Here’s what you should know about the ASC-related changes: 1. CMS is proposing to increase payment rates by 1.9 percent to ASCs that are meeting quality reporting requirements. CMS based the increase on the […]

Continue Reading Comments { 0 }

ICD-10 New Codes: Pressure Mounts as Deadline Approaches When New Codes Become Effective

Now it’s just a little less than three weeks until the beginning of October and when the fiscal year (FY) 2018 changes for ICD-10-CM take effect. Here is a summary of the new changes for ICD-10-CM: 360 new code additions 142 deletions 250+ revisions The Centers for Medicare and Medicaid Services (CMS) published a variety […]

Continue Reading Comments { 0 }

Elimination of LCDs Proposed

This is the year of many Centers for Medicare & Medicaid Services (CMS) regulatory requirement changes. This includes the Merit-Based Incentive Program (MIPS), the next steps toward mandatory Authorized Use Criteria (AUC) implementation for advanced imaging, defining more explicitly what is and what is not “quality” care, etc. It is important to understand that all […]

Continue Reading Comments { 0 }

Final Fiscal Year 2018 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities

Overview On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2018 final policies are summarized below. Updates to […]

Continue Reading

Final ICD-10-CM Codes for 2018 Contain a Few Surprises

The final codes include 322 more changes than what was proposed by CMS in April’s hospital IPPS rule. Starting Oct. 1, it will be possible to select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances, including alcohol, opioids, cannabis and nicotine. Those nine new […]

Continue Reading

Medicare Compliance: The Basics for Injury Settlement Recipients

Medicare is a government-provided health insurance program designed to assist certain people with hospital care, medical costs, and other expenses. Qualifying beneficiaries are people who are 65 or older, those younger than age 65 with certain disabilities, and people of all ages with permanent kidney failure. How to keep medicare eligibility If you were injured […]

Continue Reading

OIG Investigates Payments for Ambulance Transports of SNF Patients

Medicare’s Office of Inspector General (OIG) has issued a sixteen-question survey to many ambulance service suppliers. The survey is focused on SNF patients, and specifically why the ambulance service has billed Medicare Part B for transports while patients were in a Part A stay. During Part A stays, the nursing home receives Medicare payments that […]

Continue Reading

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

CMS pushed back the implementation of compulsory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program until 2018. CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The […]

Continue Reading

It is Time to be Change-Hardy with the new IPPS Proposed Rules

Be adaptable and ready for change if you are responsible for payer reimbursements in your healthcare organization. The Centers for Medicare & Medicaid Services (CMS) has announced a large number of changes to diagnosis-related groups DRGs for 2018, along with changes in ICD-10-CM and PCS. Here is a quick summary of the changes: 264 MS-DRGs […]

Continue Reading

CMS Tackles Opioid Prescribing

The Centers for Medicare & Medicaid Services (CMS) intends to align its Medicare plans, including Part D prescription plans, with the Centers for Disease Control and Prevention (CDC) opioid prescribing guidelines. On January 5, 2017, the agency released a statement justifying this action. Because of  “the growing body of evidence on the risks of misuse […]

Continue Reading

CMS Exempts Two Thirds of Clinicians From MIPS

The Centers for Medicare & Medicaid Services (CMS) has exempted about two thirds of physicians and other clinicians who provide care to Medicare beneficiaries from the Merit-based Incentive Payment System (MIPS), a pay-for-performance scheme that will determine part of physicians’ Medicare payments, starting in 2019. A CMS spokesman told Medscape Medical News, “CMS mailed approximately […]

Continue Reading

CMS Told To Crack Down On Improper Medicaid Payments

The Centers for Medicare & Medicaid Services needs to step up its involvement in states’ Medicaid integrity programs in order to strengthen oversight and identify overpayments, according to a new federal watchdog report. CMS oversees how states run their Medicaid integrity programs and supports fraud-fighting efforts through reviews, training and hiring contractors to audit providers. […]

Related Posts Plugin for WordPress, Blogger...
Continue Reading