In its latest MLN Connects newsletter, CMS stated that the Office of Inspector General (OIG) determined that payments for Inpatient Rehabilitation Facility (IRF) services did not comply with Medicare billing requirements.
Recently, CMS released the proposed Medicaid Fiscal Accountability Regulation (MFAR) proposed rule, but according to a recent blog post by Seema Verma, CMS' administrator, the proposed rule is not intended to reduce Medicaid funding, as many fear. Instead, she argues, it is "aimed at strengthening accountability and increasing transparency to ensure that every Medicaid dollar is claimed and spent in accordance with federal law while supporting the interests of Medicaid recipients." She goes on to say that "nothing in our proposed rule would stop states from using supplemental payments, provided that they are used and financed in a way that is in compliance with federal statute and regulations."
The 2021 federal budget includes some aspects that SNFs may want to note. For one, it includes a proposal for site-neutral Medicare payments, a transition that would take five years and reduce the growth of post-acute payments. However, there is still more work to be done in that area. Another topic of concern is the expansion of prior authorization as a cost control measure by the agency. CMS seeks to target expanded authority to conduct prior authorization on certain items or services that are prone to high improper payments.
On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020. The rule includes an 8% cut from Medicare payments for physical and occupational therapy services starting in 2021.
Seema Verma, administrator for the Centers for Medicare & Medicaid Services, sat down for a rare one-on-one interview with Kaiser Health News senior correspondent Sarah Varney.
They discussed her views on President Donald Trump’s plan for sustaining public health insurance programs, how the administration would respond if Obamacare is struck down by the courts in the future and her thoughts on how the latest “Medicare for All” proposals would affect innovation and access to care.
Are you in compliance with Qualified Medicare Beneficiary (QMB) billing requirements? People with Medicare who are in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. Medicare providers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. Providers who inappropriately bill individuals enrolled in QMB are subject to sanctions.
A study published December 18 in the Journal of the American Geriatrics Society, “Performance and Penalties in Year 1 of the Skilled Nursing Facility Value‐Based Purchasing Program,” examined the performance scores and penalties of 14,558 SNFs over the past year since the VBP program implementation.