The U.S. Government Accountability Office (GAO) found that opportunities remain for improving the backlog appeals process. On Thursday, June 9th, 2016, the GAO released their report, which found that despite numerous attempts by multiple government agencies, the backlog of Medicare appeals continues to grow. This is a result of pending appeals that remain undecided after statutory time frames. The GAO was asked to examine Levels 1 through 4 of Medicare’s appeals process.
On June 6, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to incorporate regional fee-for-service (FFS) expenditures into the methodology for establishing, adjusting, and updating the benchmarks of Accountable Care Organizations (ACOs) that continue their participation in the Medicare Shared Savings Program (Shared Savings Program) after an initial three-year agreement period. This final rule also adds a participation option to encourage ACOs to transition to performance-based risk arrangements and provides greater administrative finality around the program’s financial calculations.
After months of anticipation, the official deadline is finally here. Beginning July 1, LTC providers will be required to submit staffing data to CMS under the agency’s payroll-based journal (PBJ) regulations announced last year.
Over the last several months, providers have been scrambling to understand the new requirements, coordinate with vendors to accurately export data, and test submissions through CMS’ voluntary testing period that kicked off in October. But there are eleventh-hour concerns with any new major regulation, and PBJ is no different.