What’s happening: CMS released the Contract Year (CY) 2025 Medicare Advantage and Part D Final Rule last week. The rule finalizes revisions to policies governing...
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CMS has issued a concise fact sheet that addresses several complex billing scenarios for administering preventive vaccines to short- and long term residents in nursing...
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CMS posted a reminder in the February 8 MLN Connects newsletter that Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility,...
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What’s new: As of January 1, 2024, Medicare Advantage (MA) plans are subject to new regulations governing prior authorizations and utilization management strategies. AHCA/NCAL, in...
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How it works: Through December 31, 2024, anyone uninsured or covered by federal programs, such as Medicare or Medicaid, can receive US Government (USG)-procured, NDA-labeled...
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What’s new: On December 27, CMS issued a proposed rule, which establishes appeals processes for Medicare beneficiaries whose inpatient hospital stays were later reclassified to...
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What’s new: This month, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for nursing facility evaluation and management visits. Use...
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VHCA-VCAL highlighted a series of significant concerns with the CMS proposed rule on staffing requirements for nursing facilities. In comments to the agency, VHCA-VCAL noted...
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What’s happening: AHCA/NCAL will host a webinar on October 20 at 3:30 pm to discuss how to address 3.48 hours per resident day (HPRD) in comments...
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Since CMS initiated a Skilled Nursing Facility (SNF) 5-Claim Probe and Education Review program in June, AHCA has received inquiries from members that the letters...
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What’s new: CMS issued the proposed minimum staffing rule as part of the Biden-Harris Administration’s Nursing Home Reform initiative to ensure safe and quality care...
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What’s happening: New CMS skilled nursing facility value-based purchasing (SNF VBP) measures take effect October 1, 2023 that will determine Medicare Part A rates beginning...
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What’s new: The CMS final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2024 update includes a 4 percent...
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Do you bill correctly under the Patient Driven Payment Model? Medicare Administrative Contractors are reviewing five claims from every skilled nursing facility (SNF) based on their...
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As of July 1, 2023, a provider’s consultant pharmacy will no longer be able to bill Medicare for the administration fees associated with COVID-19 vaccines...
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What’s happening: CMS has reissued transmittal instructions for Medicare Administrative Contractors (MACs) to perform a five-claim probe and educate medical review on every skilled nursing facility (SNF)...
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What’s happening: CMS responded to stakeholder concerns about the uncertain status of certain important Medicare Part B telehealth waivers impacting residents of nursing facilities and...
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On Wednesday May 24, 2023, at 2:00 pm ET, CMS will host FY 2024 SNF PPS Proposed Rule Overview. The educational webinar will provide an...
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CMS issued a Request for Information (RFI) seeking comment on the Medicare Advantage program. Feedback will inform the Medicare Advantage policy development and implementation process....
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CMS reversed its proposed 0.7 percent cut to Medicare rates and has instead provided a 2.7 percent increase. The new rates go into effect on October...
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AHCA’s Revenue Cycle Management (RCM) Academy delivers strategies every SNF business office manager and accountant should use to secure earned dollars. This training program teaches...
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A recent $7.85 million settlement agreement between the US Department of Justice (DOJ) and a nursing facility company serves as a reminder about CMS guidance...
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In comments submitted to CMS, VHCA-VCAL urged CMS to consider a multi-year (no less than three years) phase-in of the Medicare parity adjustment. The association...
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We need your help submitting comments to CMS on the proposed payment rule. As you know, CMS issued the FY 2023 SNF Proposed Payment Rule last...
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CMS needs to hear from providers by June 10 about its proposed rule on Medicare payments and staffing minimums. The agency specifically asked for comments...
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This week, CMS published a proposed rule entitled, Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment...
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Last week, CMS issued a display copy of the agency’s final rule on payment policies for the calendar year (CY) 2022 under the Medicare Physician...
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AHCA/NCAL updated the guidance document titled 3-Day Stay and Benefit Period Waivers for Medicare Part A SNF PPS. The two specific updates include: Updating the extension of the...
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Effective September 20, 2021, CMS exercised enforcement discretion for skilled nursing facility (SNF) consolidated billing provisions related to flu and pneumococcal vaccines. This allows Medicare-enrolled...
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CMS has issued an MLN Matters MM12421 titled “Influenza Vaccine Payment Allowances – Annual Update for 2021-2022 Season.” It is intended for providers billing Medicare...
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Providers are encouraged to review the AHCA 3-Day Stay and Benefit-Period Waivers for Medicare Part A SNF PPS guidance and FAQs that were updated September 14,...
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CMS updated its MLN Matters article SE20011 titled Medicare FFS Response to the PHE on COVID-19. In the billing guidance CMS did not change the longstanding blanket 3-day qualifying stay...
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August is National Immunization Awareness Month (NIAM). Many Medicare patients missed vaccines during the pandemic. Keep in mind that Medicare covers the following vaccines: COVID-19,...
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In its August 12, 2021 edition of MLN Connects, CMS announced a resumption of the Targeted Probe & Educate (TPE) Program conducted by Medicare Administrative...
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CMS issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2022 update. AHCA has provided a summary...
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This week CMS issued a proposed rule on payment policies for the calendar year (CY) 2022 under the Medicare Physician Fee Schedule (PFS) Quality Payment...
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CMS has released minor updates to is Medicare Accelerated and Advance Payment FAQs (dated June 24, 2021). The FAQs offer links to Code of Federal...
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CMS has issued an updated list of the HCPCs codes subject to the consolidated billing provision of the Skilled Nursing Facility Prospective Payment System. Be...
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On May 7, 2021 CMS posted a web-based training series that provides an overview of the general and key clinical considerations important for conducting standardized...
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CMS issued guidance for nursing facilities regarding resident disenrollment from Medicare Advantage plans in 2015 and will soon be re-releasing this guidance. In anticipation of CMS’s...
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President Biden signed legislation that extends Medicare sequestration relief through the end of the year. CMS is expected to resume issuing claims shortly. Medicare Administrative Contractors...
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AHCA/NCAL will host a webinar on April 21 at 2:30 pm to review the fiscal year (FY) 2022 skilled nursing facility (SNF) proposed payment rule...
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In anticipation of possible Congressional action to continue the deferral the two percent across-the-board cut to all Medicare payments (commonly referred to as the sequester),...
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AHCA/NCAL recently updated the COVID-19-related 3-Day Stay and Benefit-Period Waivers for Medicare Part A SNF PPS fact sheet and FAQ. Key updates to the file...
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As Medicare Advance and Accelerated Payments (AAP) repayment begin soon, facilities should make note of the applicable terms. Information on establishing an extended repayment schedules...
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Medicare Accelerated and Advance Payment (AAP) repayments will begin for all Medicare providers, including skilled nursing facilities (SNFs), which received AAP payments one year from...
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Last week, CMS released an email update focused on Medicare fraud. The email states that “as the country begins to distribute COVID-19 vaccines, scammers are...
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Please provide updated census information through December 2020 to Steve Ford by January 8, 2021. This information will be used to support VHCA-VCAL’s advocacy efforts to obtain...
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Review Pfizer’s Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) regarding the limitations of the emergency use authorization approved last week. During the COVID-19...
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VHCA-VCAL is again completing census information to support our advocacy efforts to obtain continued COVID-19 assistance and permanent payment reforms to address historic Medicaid underfunding....
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On December 9, CMS posted updates to FAQs and an infographic about coverage and payment for monoclonal antibodies to treat COVID-19. The FDA has issued...
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CMS issued the calendar year (CY) 2021 Medicare Physician Fee Schedule (PFS) Final Rule and associated Fact Sheet which establishes payment rates and other provisions...
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As explained in July, CMS updated the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. This form is issued by SNFs and other providers submitting claims...
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On July 21, the US Department of Health and Human Services (HHS) released a framework for more detailed Provider Relief Fund (PRF) reporting guidance and...
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CMS recently updated the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, which is issued by SNF and other providers submitting claims for Medicare items...
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As a reminder, our COVID-19 Resources webpage includes links to all of our member updates sent from April Payne, as well as the AHCA/NCAL updates. Here are...
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As part of a recent COVID-19 related update to National Correct Coding Initiative (CCI) files, CMS announced the removal of many problematic claim coding edits...
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SNF PPS Part A claims were not being paid day-1 variable per diem rates when a beneficiary switched from Medicare Advantage (MA) to fee-for-service Medicare...
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In the past weeks, AHCA/NCAL has submitted an array of questions on the Provider Relief Fund. Of particular importance, health care providers have expressed concern...
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Two weeks ago, we learned that skilled nursing would be included as part of the stimulus bill’s (aka the CARES Act) $100 billion Provider Relief...
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Funding from the first disbursement of the CARES Act provider fund (about $30 billion of the $100 billion total) began to hit nursing facility bank...
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CMS has responded to member concerns that the ICD-10-CM diagnosis codes identified by the CDC as appropriate to code for COVID-19 were not compatible with...
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CMS indicates that providers should continue to code residents for the O0100M isolation item located in Chapter 3 of the MDS 3.0 RAI Manual v...
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AHCA prepared a set of Medicare Accelerated and Advance Payment FAQs to supplement the recent CMS Fact Sheet on this topic. The FAQs are based...
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CMS released a COVID-19 Provider Burden Relief FAQ document that states that the agency has suspended most Medicare Part A and Part B Fee-For-Service (FFS)...
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With the considerable burden posed by COVID-19, SNFs have been exploring as many possible ways to reduce administrative burden and free up staff. Palmetto GBA,...
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The CDC has posted a recorded version of its March 17 webinar Coronavirus Disease 2019 (COVID-19) Update and Information for Long-term Care Facilities. During the...
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In light of COVID-19, CMS issued a nationwide waiver of the 3-Day Stay requirement and expanded telehealth for Medicare. Three-Day Stay Waiver On March 14,...
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AHCA SNF provider members can now register for the AHCA PDPM Academy 2020 Subscription – Building Optimal Operational Capacities©. This exclusive “SNF provider member only” subscription...
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AHCA is aware that some claims submitted under PDPM to report information previously missed or that was entered incorrectly in the previous submission, have created...
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In a column in Provider, AHCA associate vice president for therapy advocacy Daniel Ciolek poses the six "W" questions to providers to assess decisions made...
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On November 25, 2019, DMAS will publish an Exempt Action Final Regulation to eliminate the hospital’s three-day exception post-discharge for providing the Medicaid long-term services...
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On November 25, 2019, DMAS will publish an Exempt Action Final Regulation to elminate the hospital’s three-day exception post-discharge for providing the Medicaid long-term services...
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In a recent report, the Office of Inspector General (OIG) determined that Medicare improperly paid for skilled nursing facility (SNF) services when the Medicare 3-Day...
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Now that the Patient Driven Payment Model (PDPM) system is in effect for skilled nursing facilities, AHCA is looking to 2020 and how the association...
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On November 1, 2019, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the...
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On November 5, CMS announced an update on claims payments under the Patient-Driven Payment Model (PDPM). As CMS has undertaken the implementation of PDPM, it...
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AHCA has issued a member update on PDPM claims processing. The update covers the latest information on the Medicare Administrative Contractors (MACs) ability to process...
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Sign up today to for the November 21 education program, A First Look at PDPM Claims. MDS expert Judy Willhide Brandt and rehab and therapy...
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With a few weeks of the new Medicare Patient Driven Payment Model (PDPM) behind you, you may be wondering how it’s all working. Register today...
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Over the last week CMS has issued three important manual updates for PDPM implementation. AHCA has conducted a preliminary review of these updates. AHCA is also...
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Since we shared the methodology for handling Part A claims under PDPM last week, DMAS has modified its guidance related to whether coinsurance days are...
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On October 7, CMS posted a revision to the PDPM DLL Package (V1.0003 FINAL). This revision replaces the previous version (V1.0002 FINAL). The new version...
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Judy Wilhide Brandt and Mark McDavid are analyzing actual Virginia claims data under the new Medicare Patient Driven Payment Model (PDPM). With input from their...
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On October 1 the Patient-Driven Payment Model (PDPM) became the Medicare Part A fee-for-service payment system for skilled nursing facilities (SNFs). Check out resources and...
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October 1 marks the start of the new Medicare Patient Driven Payment Model (PDPM). We’ve gathered together resources to help ensure your facility is correctly...
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AHCA offers last minute tips and resources to be successful implementing the new Medicare Patient Driven Payment Model (PDPM) to ensure your facility is correctly...
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On August 30, CMS updated a number of subregulatory PDPM materials including: PDPM FAQs – Changes in terminology such as 5-Day Assessment now called the...
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AHCA is hosting a 90-minute live webinar on September 17 covering the details related to unique challenges providers will face during the SNF PPS transition...
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SNFs that are not well versed in PDPM and ICD-10 coding are at a much higher risk of seeing their revenue negatively impacted and are...
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DMAS has indicated it will be providing its decision on the approach to Part A crossover claims under the Medicare PDPM. Under PDPM, effective for...
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AHCA will host a live webinar on August 27 at 3:00 pm to explain how providers can use a concise and downloadable 11th Hour PDPM...
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In the latest edition of Provider Magazine AHCA’s associate vice president, therapy advocacy Dan Ciolek explains that "providers that do not rely on dusty obsolete...
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CMS has issued a new fact sheet on the skilled nursing facility (SNF) 3-Day Rule Billing process and how it is currently intended to work. The fact...
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CMS issued a final rule outlining the proposed Fiscal Year (FY) 2020 Medicare prospective payment system rate update and quality reporting requirements for skilled nursing facilities (SNFs)....
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Are you still trying to wrap your head around what you need to do to get ready for the new Medicare payment methodology by October?...
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The new case-mix classification model, the Patient Driven Payment Model (PDPM), that will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS)...
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To help you prepare for the Patient Driven Payment Model (PDPM), Robin Hillier will review important topics to help you succeed. Bring your team to...
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Livanta, the new CMS Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) for CMS Region 3 has instituted a dedicated phone number for providers. If you...
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Livanta, the new CMS Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) for multiple Medicare Regions, including CMS Region 3 has asked VHCA-VCAL to share...
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On May 28, The Centers for Medicare & Medicaid Services (CMS) released the final rule for Programs of All-Inclusive Care for the Elderly (PACE), the...
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The Centers for Medicare and Medicaid Services (CMS) has named Livanta as the new Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) for multiple Medicare...
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The Centers for Medicare and Medicaid Services (CMS) 2020 Skilled Nursing Facility (SNF) proposed payment rule issued on April 19 is “good news” according to...
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The Centers for Medicare and Medicaid Services (CMS) issued a revised version of its 42-page “Patient-Driven Payment Model: Frequently Asked Questions (FAQs)” on April 4....
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On April 3, PBS NewsHour released a story by Philip Moeller titled, “How this Medicare loophole can lead to surprise medical bills,” which focused on the observation...
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VCHA-VCAL associate member and frequent presenter Judy Wilhide Brandt participated in a panel discussion on the Patient Driven Payment Model (PDPM) focused on the roles...
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Dan Ciolek, AHCA Associate Vice President of Therapy Advocacy outlines some of the expectations skilled nursing facilities (SNFs) should have as the implementation of the...
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Work on CCC Plus logic for Part A crossover claims processing has unveiled an issue that the Department of Medical Assistance Services (DMAS) now believes...
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On March 13, over 250 members attended the AHCA PDPM Academy Workshop to learn what they need to do to get ready for the new...
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As KEPRO’s current contract with Centers for Medicare and Medicaid Services (CMS) is ending, the Patient Navigation program will be ending. KEPRO is not able...
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The Centers for Medicare and Medicaid Services (CMS) issued a MLN Matters article summarizing instructions to Medicare Administrative Contractors to put in place the changes to...
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The Centers for Medicare and Medicaid Services (CMS) finished mailing new Medicare cards to people with Medicare. Medicare patients are using their new cards in...
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An audio recording and transcript are available for the December 11, 2018 call on the Skilled Nursing Facility Prospective Payment System (SNF PPS). On October 1, 2019, the new Patient Driven...
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Register now for the December 11 CMS SNF PPS: New Patient Driven Payment Model (PDPM) Call. SNF PPS: New Patient Driven Payment Model Call December...
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Join us on November 15 for a day-long education program to learn about the new per-diem payment system, Patient-Driven Payment Model (PDPM), replacing the Medicare...
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Both Medicare beneficiaries and providers have certain rights and protections related to financial liability and appeals under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA)...
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Changes to the security settings for the Palmetto GBA eServices will take effect on September 9, 2018. Review the infographic for details on the changes...
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In the fall of 2017, Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) launched Healthcare Navigation programs that offer a good solution for Medicare...
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For the latest news and materials related to the Patient Drive Payment Model (PDPM), visit the members only AHCA PDPM webpage. Content on the page...
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CMS has finalized a proposal to replace the current Medicare RUGs-based payment model with a new per-diem payment system called the Patient-Driven Payment Model (PDPM)...
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CMS has finished mailing most cards to people with Medicare who live in Wave 1 states, which includes Virginia. All Medicare Administrative Contractor (MAC) secure...
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VHCA-VCAL has been made aware of multiple Medicare Targeted Probe and Educate (TPE) audits underway in Virginia. According to the Centers for Medicare and Medicaid...
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In a special White House Rose Garden ceremony on June 6, President Donald Trump signed into law the VA Mission Act of 2018, which offers veterans...
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On April 27, CMS issued a proposed rule outlining proposed Fiscal Year (FY) 2019 Medicare payment updates and proposed quality program changes for Skilled Nursing...
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On April 13, the Centers for Medicare and Medicaid Services (CMS) posted a Medicare Learning Network (MLN) Matters article and an associated program manual transmittal...
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Medicare beneficiaries in Virginia will be among the first individuals to receive the new Medicare cards with Medicare Beneficiary Identifiers (MBI). Providers should advise residents...
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As AHCA announced earlier this month, CMS had begun the process of reprocessing calendar year (CY) 2018 Medicare Part B claims, including those for outpatient...
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On March 16, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Medicare Learning Network (MLN) Matters article that announced several technical changes...
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Beginning in April, the Centers for Medicare & Medicaid Services (CMS) will be mailing all Medicare beneficiaries new Medicare cards that remove their social security numbers and...
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The current federal budget law requires that the President submit the budget between the first Monday in January and the first Monday in February. The...
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On February 9 both houses of Congress passed a budget deal enacted by the President that provides short-term funding to keep the government open through...
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The Centers for Medicare and Medicaid Services (CMS) is hosting a special Open Door Forum on January 23 at 2:00 pm about the change from...
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As we informed you earlier this month, Congress adjourned for 2017 without enacting legislation to address what is often referred to as Medicare "extender payment...
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Since Congress adjourned for 2017 without enacting legislation to address the Medicare "extender payment policies," including the Part B therapy cap exception process, these policies...
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The Centers for Medicare & Medicaid Services (CMS) recently announced that the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport is being extended...
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As part of the nationwide initiative to eliminate the use of Social Security numbers on all Medicare cards by 2019, the Centers for Medicare and...
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On October 2, the Centers for Medicare and Medicaid Services (CMS) made a number of problematic changes to billing programming, remittance advice and related guidance...
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Looking for information about the Jimmo Settlement Agreement? Visit the new Jimmo Settlement Agreement webpage for background on the settlement, links to resources, and FAQs....
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The Centers for Medicare and Medicaid Services (CMS) has notified healthcare providers that it is taking steps to remove Social Security numbers from Medicare cards...
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On April 27, CMS issued a notice of proposed rulemaking (NPRM) for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year 2018 update. ...
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CMS has announced that effective today, April 13, 2017, questions regarding any of the Fee For Service Beneficiary Notice Initiative (BNI) notices may be sent...
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CMS has issued instructions regarding implementation of the Medicare Outpatient Observation Notice (MOON), The new instructions provide more specific detail on notice delivery for hospitals...
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Facilities that have been Medicare-certified for at least one year are eligible to participate in a pilot study on two Transfer of Health Information and...
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AHCA has developed a summary of the Medicare Physician Fee Schedule (PFS) final rule for 2017 issued in November. The final rule updated Medicare Part...
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The Medicare Learning Network (MLN) has published a document, Provider Compliance Tips for Skilled Nursing Facility (SNF) Inpatient Services, that clarifies the distinction between skilled...
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The annual Medicare Open Enrollment period runs from October 15 through December 7, 2016. The Virginia Insurance Counseling and Assistance Program (VICAP) has developed a...
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On September 21, 2016 the Department of Medical Assistance Services (DMAS) announced it had narrowed the field of prospective managed care plans for the newly...
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CMS has published the updated Skilled Nursing Facility (SNF) 30-Day Potentially Preventable Readmission (PPR) Measure. It estimates the risk-standardized rate of unexpected PPRs within 30 days for...
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AHCA has shared guidance and resources and resources from the U.S. Department of Health and Human Services' (HHS) Office for Civil Rights (OCR) to assist...
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VHCA has recently learned of instances when two nursing facilities that underwent Minimum Data Set (MDS) focus surveys were cited for D-level deficiencies and were...
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Cil Bullard, RN,CPC, RAC-CT, State RAI/OASIS Coordinator at the Virginia Department of Health, shared the following information from CMS related to a new MedLearn Matters...
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This week the Centers for Medicare and Medicaid Services (CMS) released a public data set on utilization, payments and submitted changes organized by provider, state...
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Providers face an increasingly complex audit process as federal regulators and lawmakers push to eliminate fraud, waste and abuse in the Medicare system. It is...
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The Centers for Medicare and Medicaid Services (CMS) released the final version of a 2012 proposed rule that requires Medicare Parts A and B health...
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The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enacted last April contained provisions to replace the problematic Part B therapy Manual Medical Review...
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The Centers for Medicare and Medicaid Services (CMS) has issued new guidance, Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries, offering actionable...
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The U.S. Department of Health and Human Services, Office of Inspector General (OIG) has released its 2016 work plan, which describes new and on-going audits,...
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Now is the time to test how your payroll system interfaces with the new Centers for Medicare and Medicaid Services (CMS) Payroll-Based Journal (PBJ). CMS...
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The Centers for Medicare and Medicaid Services (CMS) has finalized a new rule establishing the Comprehensive Care for Joint Replacement (CJR) program, a mandatory bundled...
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American Health Care Association’s Provider reports that the bipartisan budget passed by Congress and signed by President Obama turns out to have had its own...
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Last week Congress passed and President Barack Obama signed a two-year budget deal, the Bipartisan Budget Act of 2015, which will increase spending limits and...
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Beginning on January 1, 2016, Virginia will be included in a Centers for Medicare and Medicaid Services (CMS) demonstration program aimed at testing a process...
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