Mar 15, 2019
 | 
The Bottom Line

This March, Congress will re-introduce legislation with bipartisan support to allow Medicare beneficiaries that are hospitalized in observation to qualify for SNF coverage following their hospital stay. Currently, under the three-midnight rule, beneficiaries mThis March, Congress will re-introduce legislation with bipartisan support to allow Medicare beneficiaries that are hospitalized in observation to qualify for SNF coverage following their hospital stay. Currently, under the three-midnight rule, beneficiaries must have been categorized as being an inpatient in a hospital for three midnights in order to qualify for a Medicare Part A SNF stay.

Feb 22, 2019
 | 
Billing Alert for Long-Term Care

Between 2011 to 2016, Medicare fee-for-service drug spending increased from $17.6 billion to $28 billion under Medicare Part B. Medicare Part D total spending has almost doubled from 2010 to 2016, increasing from $77.5 billion to $146.1 billion, with costs projected to increase further, according to the Centers for Medicare & Medicaid Services (CMS). Drug prices for beneficiaries in the U.S. are also on the rise and can be found in places like Europe for up to 80% cheaper, according to NPR. The cause? A market full of hurdles and barriers to creating biosimilars (drugs with the same or similar active ingredients as the original and often available at a reduced price); current laws that prevent vendors from negotiating drug prices; and outrageous prices for essential drugs that treat ever-more-common chronic conditions, such as cancer, rheumatoid arthritis, and hepatitis C.

Feb 08, 2019
 | 
The Bottom Line

Earlier this month CMS announced the release of a new app, “What’s Covered,” that allows people to quickly look up what Original Medicare covers using their mobile device. In addition to the “What’s Covered” app, CMS is enabling beneficiaries to connect their claims data to applications and tools developed by innovative private-sector companies to help them understand, use, and share their health data through Blue Button 2.0.

Feb 01, 2019
 | 
Billing Alert for Long-Term Care

After speaking with a few subject matter experts about the new tax laws, Billing Alert for Long-Term Care has the good, the bad, and the salvageable for 2019 tax reform. For some long-term care (LTC) facilities, these changes will have significant dollar impacts on 2018 tax returns, while other facilities will slip through the IRS’ narrow cracks mostly unaffected. Just as the care plan for each resident should be individualized to his or her care needs, each facility’s approach to taxes this year should be customized to its unique situation. Here are a few changes to keep in mind and discuss with your certified public accountant (CPA) before submitting this year’s tax return.

Jan 25, 2019
 | 
Billing Alert for Long-Term Care

The assisted living and skilled care industry today is going through a rocky patch. A solid half of the skilled nursing facility (SNF) industry is struggling due to Medicare Advantage, softer demand, pervasive reliance on Medicaid for census, labor shortages, rising wage pressure, tight Medicare reimbursement, and new regulations, etc. While its struggles are not as pervasive as SNFs’, assisted living is facing challenges due to softer census, overcapacity, rising resident acuity, labor costs and shortages, and increasing regulatory scrutiny. The relative strength in the overall senior and postacute sector is home health and independent housing; however, while home health demand is good, regulatory overburden is still present, along with tight reimbursement and labor challenges. Independent housing’s market and sub-market rent side remain strong; however, many high-end providers are still struggling with census challenges and soft demand in certain markets.

Jan 04, 2019
 | 
Billing Alert for Long-Term Care

When the Centers for Medicare & Medicaid Services’ (CMS) new Patient Driven Payment Model (PDPM) goes into effect October 1, 2019, providers will have a few new acronyms to add to their dictionary, as well as some old ones that will have increased importance to quality care and reimbursement. The following list and words of advice from experts will will help you prepare.

ARD—Assessment reference date

The assessment schedule under PDPM is more streamlined and simplified than the assessment schedule under RUG-IV. The assessment reference dates are listed in Table 1 for the different Medicare MDS assessment types.

Dec 27, 2018
 | 
The Bottom Line

CMS finalized a rule with new requirements for accountable care organizations (ACO) last week, reducing the amount of time an ACO is allowed to stay in the program without assuming risk and expanding the three-day stay waivers for nursing homes. “Most Medicare ACOs do not currently face financial consequences when costs increase, but a review of the data on ACO performance shows that over time those ACOs that take accountability for costs perform better than those that do not,” said CMS administrator Seema Verma in a blog post dated December 21, 2018.

Nov 30, 2018
 | 
The Bottom Line

CMS will hold an informational call on December 11 at 3:00pm, ET, to help providers prepare for the new RUG-IV replacement, the Patient Driven Payment Model (PDPM), to be implemented October 1, 2019. Participants can submit questions prior to the call by sending an email to PDPM@cms.hhs.gov with the subject line “December 11 Call.” Click here to register.

Pages

Members-only webcasts

Enjoy past webcast events with your AMBR Membership! Click here!

Access sample white papers, tools, analysis, and resources.

Tuesday, October 15, 2019 - 07:00

2019 Revenue Integrity Symposium

The 2019 Revenue Integrity Symposium covers topics essential to revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings.

AMBR Forums

To participate in the AMBR forum discussions, you must be a member of the AMBR community. Please subscribe today or login for access.

jfitzgerald@hcpro.com
Karen A. Thomas
Victorine Courtois