Mar 06, 2020
 | 
The Bottom Line

The Centers for Medicare & Medicaid Services (CMS) has created a series of fact sheets explaining the basics of HIPAA Administrative Simplification transactions and code sets. These fact sheets are designed to help the healthcare industry understand the purpose of HIPAA adopted transactions (ncluding billing) and to explain which standards and operating rules govern each transaction

Mar 06, 2020
 | 
The Bottom Line

In a recent report, the Office of Inspector General (OIG) determined that Medicare made Part B payments to ambulance suppliers for transportation services that were also included in Medicare Part A payments to Skilled Nursing Facilities, as part of consolidated billing requirements. CMS developed the Ambulance Fee Schedule and Medicare Transports (PDF) Booklet to help you bill correctly

Mar 06, 2020
 | 
The Bottom Line

CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well. For further COVID payment guidance, view CMS' fact sheet.

Feb 27, 2020
 | 
The Bottom Line

Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. CMS states it will correct this issue in October.

Feb 14, 2020
 | 
The Bottom Line

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.

Feb 14, 2020
 | 
The Bottom Line

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."

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