What’s new: To promote and increase adult vaccinations, Health Quality Innovators (HQI) and the American Society of Consultant Pharmacists (ASCP) have teamed up to offer...
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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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On April 1, 2024, CMS updated the survey critical element pathways (CEPs) due to the enforcement of enhanced barrier precautions (EBP) outlined in QSO-24-08-NH. The...
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What’s happening: The CMS proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) for fiscal year (FY) 2025 would increase SNF PPS rates...
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What’s new: On March 25, the US Department of Health and Human Services (HHS), CMS, and the Administration for Strategic Preparedness and Response provided additional information...
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Download your March Quarterly Confidential Feedback Reports for the FY 2025 Skilled Nursing Facility Value-Based Purchasing Program from iQIES. Review data for upcoming measure and scoring...
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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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What’s new: CMS has taken steps to expand financial relief opportunities for providers impacted by the cybersecurity incident affecting UnitedHealth Group Inc.’s technology subsidiary Change Healthcare. Providers...
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What’s happening: The cybersecurity incident affecting Change Healthcare which began on February 21 is having a broad impact on claims submissions and month-end billing for...
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What’s happening: DMAS will hold separate meetings with specific managed care organizations (MCOs) to discuss lingering claims issues related to the initial roll-out of the...
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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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The deadline to respond to the DMAS wage survey is tomorrow, February 16, 2024. Participation in the survey is mandatory for all free-standing nursing facilities participating...
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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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Action needed: Responses for the annual DMAS nursing facility wage survey are due February 16, 2024. Participation is mandatory for all non-hospital based nursing facilities...
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CMS has posted the draft Minimum Data Set (MDS) 3.0 Item Sets version (v)1.19.1 and Item Matrix in the Downloads section on the Minimum Data Set...
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What’s happening: DMAS is finalizing the annual wage survey that will be the primary driver of the inflation calculation for rates effective on July 1,...
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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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CMS has shared guidance on vaccine billing. For flu, pneumococcal, and COVID-19 vaccines furnished on or after July 1, 2023, to patients in a Medicare...
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What’s new: The Veterans Administration (VA) posted updated Veterans Care Agreements (VCAs) rates for participating skilled nursing facility (SNF) providers. VCA SNF payment rates for...
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AHCA’s Revenue Cycle Management (RCM) Academy delivers concrete strategies for skilled nursing facilities to secure earned dollars, minimize unnecessary losses, and stay paid. RCM Academy teaches: RCM 101...
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What’s happening: A few weeks ago, VHCA-VCAL became aware of some issues with readiness to process Optional State Assessment (OSA)-based claims for both software vendors...
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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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CMS posted errata updates to the Minimum Data Set Resident Assessment Instrument (MDS-RAI) Manual, version 1.18.11 on the MDS 3.0 RAI Manual page effective October 1, 2023. The...
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CMS issued a Correction Notice that applies to the Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule published on August 7. Although the...
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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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AHCA/NCAL has unveiled a new resource to encourage and support vaccinations in long term care (LTC) facilities this season: #GetVaccinated Reimbursement Guide for Health Care Personnel:...
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In follow-up to the DMAS bulletin Minimum Data Set (MDS) changes effective October 1, 2023, we are sharing a brief Q&A document to help you...
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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 new: DMAS posted a new bulletin with information about using the Optional State Assessment (OSA) to generate a Virginia Medicaid RUG-IV billing code for...
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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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A July 26 Medicaid Bulletin explains that DMAS has issued a broadcast notice to local departments of social services that staff should immediately stop calculating...
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AHCA’s online training titled Revenue Cycle Management (RCM) Academy delivers concrete strategies for skilled nursing facilities to secure earned dollars, minimize unnecessary losses, and stay paid. RCM Academy teaches: ...
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What’s new: VHCA-VCAL previously reported that the Medicaid rates DMAS posted for the state fiscal year 2024, which began on July 1, included an error...
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What’s happening: Members alerted VHCA-VCAL with concerns about the calculation of patient pay amounts as part of the Medicaid redetermination process underway after the end...
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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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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 coming: Effective July 1, 2023, Optima Health Plan will assume agreements with Virginia Premier providers. As of the merger effective date, Optima Health will...
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What’s happening: CMS is moving to the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) submissions and providers should ensure they...
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What’s happening: CMS is preparing to move to iQIES for MDS submissions and it is important to create an account and establish credentials in the...
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The deadline to respond to the DMAS wage survey is tomorrow, February 17. Participation in the survey is mandatory for all free-standing nursing facilities participating...
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February 17 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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What’s happening: VHCA-VCAL submitted comments to DMAS in response to the agency’s request for comments on its intent to procure plan participants for the new...
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As SNFs continue to struggle with sluggish occupancy and workforce challenges, ensuring that every dollar earned for care delivery is retained is imperative. A solid Revenue...
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This summer, the Veterans Administration (VA) local contracting offices began sending letters to providers that were contracted to furnish services to veterans under Federal Basic...
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As SNFs continue to struggle with sluggish occupancy and workforce challenges, ensuring that every dollar earned for care delivery is retained is imperative. A solid...
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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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DMAS posted the state fiscal year (SFY) 2023 Medicaid rates on July 1 (scroll down to “Reimbursement Rates”). The rates reflect the 14.74 percent inflation adjustment....
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DMAS has posted a Medicaid Bulletin notifying providers that since the state budget was only signed by Gov. Glenn Youngkin on June 22, the 2023...
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In the coming months, federal aid will dwindle as the government and states move toward a post-pandemic normal order of business. As SNFs continue to struggle...
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CMS issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2023 update. AHCA/NCAL has developed a summary...
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DMAS has posted Medicaid Bulletins on the agency’s transition from its Virginia Medicaid Management Information System (MMIS) to the new Medicaid Enterprise System (MES) and...
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Are you ready for the new Electronic Medicaid LTSS Screening (eMLS) System? Mark your calendars for an important LTSS Screening Connection Webinar on March 8,...
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February 25 is the deadline for nursing facilities to complete and submit their Fair Rental Value (FRV) form and supporting documentation. The information is used...
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DMAS training courses are now available for fee-for-service Medicaid providers to help you get ready for the launch of the Medicaid Enterprise System (MES) on...
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February 18 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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February 18 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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DMAS has published Fair Rental Value (FRV) Reporting Form for Calendar Year (CY) 2021, which will be used to establish FRV rates for State Fiscal...
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Responses for the annual DMAS nursing facility wage survey are due February 18, 2022. Participation in the Wage Survey is mandatory for all free-standing nursing...
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DMAS has published the methodology for the nursing facility value-based purchasing program, which is designed to improve the quality of care furnished to Medicaid members....
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The recurring calls with CCC Plus managed care organizations (MCOs) to identify and troubleshoot claims processing issues will cease after this week. At this juncture,...
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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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Effective August 12, 2021, CMS will pay to administer additional doses of COVID-19 vaccines consistent with the FDA emergency use authorizations (EUAs) for immunocompromised individuals...
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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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As we previously reported, DMAS posted the Medicaid rates for the state fiscal year (SFY) that begins July 1, 2021. The agency has now posted...
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DMAS has posted the Medicaid rates for the state fiscal year that begins July 1, 2021. Inflation from the 2021 rates to the 2022 rates...
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On May 21, DMAS issued a notice to long term care providers about CARES Act funding and its review of eligible invoices. The message from...
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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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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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DMAS received updates on the CCC Plus managed care organization (MCO) directories contact lists by region. Please share this updated information with the appropriate staff...
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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 has a new four-module webinar series on ahcancalED to train staff about the delivery of person-centered care under the Patient Driven Payment Model (PDPM)....
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February 26 is the deadline for nursing facilities to complete and submit their Fair Rental Value (FRV) form and supporting documentation. The information is used...
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February 21 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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DMAS has published the calendar year (CY) 2020 Fair Rental Value (FRV) reporting form and instructions. Nursing facilities must complete and submit the form and...
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Responses for the annual DMAS nursing facility wage survey are due February 21, 2021. Participation in the Wage Survey is mandatory for all free-standing nursing...
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Nursing facilities have until Monday, February 15 to submit this spreadsheet to DMAS to reconcile the $20 per day nursing facility supplemental payments for utilization between...
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February 15 is the deadline for nursing facilities to submit this spreadsheet to DMAS to reconcile the $20 per day nursing facility supplemental payments for utilization...
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A workgroup DMAS representatives, managed care organizations (MCO), and the nursing care sector have worked together to find a way to reconcile the special $20...
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CMS has provided updated clarifications to SNF Medicare Part A billing guidance when applying COVID-19 coverage waivers in MLN Matters SE20011. Since then, some providers...
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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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In an effort to further simplify access to the state’s allocation of CARES Act funding to nursing facilities and assisted living facilities, DMAS has announced...
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On November 18, AHCA/NCAL updated the 3-Day Stay and Benefit-Period Waivers for Medicare Part A SNF PPS Fact Sheet, as well as the accompanying webinar....
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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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The deadline for the Virginia Premier 2019 Claims Clean-Up project to reconcile any outstanding CCC Plus claims issues for calendar year (CY) 2019 is November...
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Make plans to attend the 2020 Financial Conference December 7, 8, and 10. The conference includes five interactive sessions over three days to help Virginia’s...
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For several weeks, DMAS has been engaged with three CCC Plus managed care organizations (MCOs), VHCA-VCAL, and LeadingAge Virginia to discuss how best to reconcile...
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Virginia’s MDS/OASIS Coordinator has issued an instructional memo on the new requirement for nursing facilities to complete and submit specific MDS item set field associated...
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VHCA-VCAL provided information from Virginia Premier in March on a project to “settle” all claims issues from calendar year 2019. Virginia Premier is now moving...
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Beginning October 1, 2020, DMAS will require providers to complete and submit specific MDS item set fields associated with the Patient Drive Payment Model (PDPM)...
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DMAS has notified VHCA-VCAL that beginning October 1, the agency will require the completion and submission of specific item set fields associated with all OBRA...
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CMS issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2021 update. The final rule includes a net market basket increase...
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The current COVID-19 Public Health Emergency (PHE) does not waive any requirements related to Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, CMS added CPT...
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Last week CMS announced that a new issue is affecting some inpatient hospital and skilled nursing facility (SNF) claims when an interrupted stay is billed...
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In the context of the roster billing for the Medicaid $20 add-on, we previously alerted you that some Virginia Premier emails were not operational due...
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A new issue is affecting some inpatient hospital and skilled nursing facility (SNF) claims when an interrupted stay is billed at the end of the...
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CMS recently updated the COVID-19 Provider Burden Relief Frequently Asked Questions (FAQs) related to claim audit waivers for multiple services. On March 30 CMS suspended most Medicare...
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Virginia Premier has notified VHCA-VCAL that it is still experiencing problems with its group email inboxes. For the final roster billing for the $20 COVID...
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Virginia Premier is experiencing technical difficulties with emails as it transfers to the Sentara network. Group email boxes are not working properly. To avoid delays...
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AHCA has partnered with the American Health Information Management Association (AHIMA) to offer two updated online in-depth ICD-10 trainings and two new 2.5-hour update trainings...
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DMAS has informed VHCA-VCAL that the agency will be changing the way the Medicaid $20 per day add-on is distributed. The now published 2021 operating...
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As a reminder, the fee-for-service (FFS) billing rosters for the May dates of service are due to DMAS tomorrow, June 5. While missing this deadline...
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DMAS has released the Medicaid rate memo for state fiscal year 2021, which begins July 1, 2020. The memo states that the rates are available...
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DMAS has asked VHCA-VCAL to relay a series of updates on the Medicaid $20 per day add-on. The updates address the May Fee-for-Service (FFS) rosters,...
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Virginia Premier is available to work on 2019 claims clean up and has provided instructions for providers. We have also been notified that HMS has...
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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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To receive the Medicaid $20 per day add-on, nursing facilities should submit their roster bills for April tomorrow, May 8, for payments expected by May...
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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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Earlier this week we communicated that DMAS finalized the guidance and templates and that the roster billing process for the per diem add-on had gone...
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This week, the General Assembly approved Gov. Ralph Northam’s $20 per day add-on to Medicaid nursing facility reimbursement during the COVID-19 emergency. DMAS has informed...
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The General Assembly met on Wednesday for its annual reconvened session to consider Gov. Ralph Northam’s action on bills and the budget passed during the...
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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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CMS issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2021 update. AHCA/NCAL reports that the proposed rule...
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In the last week there have been two developments related to nursing facility Medicaid funding. First, on April 10, Gov. Ralph Northam approved a $20...
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Providers may have recently received a letter stating that Optima Health will be retracting money paid for services rendered to Optima Health Community Care members....
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DMAS has advised that it has extended the Medicaid cost report filing deadlines to mirror the Medicare cost report filing extensions. We previously provided information...
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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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DMAS has requested all health plans suspend timely filing requirements for nursing facility crossover claims back to the beginning of the CCC Plus program until...
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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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On March 25, the US Senate approved a stimulus package including provisions that would financially assist nursing facilities. The House of Representatives is expected to...
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Late last week, VHCA-VCAL submitted a request to Gov. Ralph Northam to increase Medicaid funding to address cost increases associated with preparation for and response...
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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 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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Twelve senior legislators have been appointed to work out the differences between the House of Delegates and Senate of Virginia budget proposals. Today VHCA-VCAL communicated...
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Budget packages released on February 16 by the House of Delegates and the Senate of Virginia fully fund the Medicaid forecast and provide additional Medicaid...
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How are you defining what success looks like under the Patient-Driven Payment Model (PDPM)? At our March 4 program, Evolving Trends: Outcomes Success Under PDPM, clinical and...
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You can now register for the AHCA PDPM Academy 2020 Subscription – Building Optimal Operational Capacities©. This exclusive “SNF provider member only” subscription package includes...
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Virginia Premier has asked VHCA-VCAL remind members that it has set up a dedicated fax line to receive DMAS 80 forms and a dedicated phone...
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CMS has published the Calendar Year 2020 Physician Fee Schedule Payment Final Rule which implements several changes that are effective January 1, 2020. AHCA has...
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DMAS has shared additional clarification to nursing facilities to complete the Medicaid Managed Nursing Facility Managed Care Days Survey. The survey deadline is January 3,...
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Gov. Ralph Northam presented his final amendments to the current biennial budget and introduced his funding plan for the next two fiscal years (2021 and...
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To continue to help skilled nursing facility members with the Patient Driven Payment Model (PDPM) system, AHCA will soon launch its new 2020 PDPM Academy. AHCA...
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DMAS notified nursing facilities on December 10 that the agency is extending the deadline for providers to complete the DMAS Medicaid Nursing Facility Managed Care...
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CMS urges the use of Medicare Beneficiary Identifiers (MBIs) now to avoid claim and eligibility transaction rejects. Starting January 1, 2020, regardless of the date...
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VHCA-VCAL was copied on an email from DMAS that requests providers fill out a “Survey Monkey” designating the number of Virginia Medicaid Nursing Facility Managed...
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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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DMAS has announced a schedule change for the January LTC Portal and LTSS Screening call. The January call will be held on January 23, not...
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Medicare’s change to PDPM effective October 1, 2019 has necessitated a change in how the Medicaid program calculates its liability, if any, for dual eligibles’...
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Two CCC Plus health plans, Virginia Premier and Magellan, have recently indicated systemic nursing facility claims issues that both, while different, seem to be related...
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With the upcoming end of the end of the Medicare Beneficiary Identifier (MBI) transition period, CMS is reminding providers it will reject Medicare claims using...
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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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Due to unexpected scheduling conflicts DMAS has canceled the scheduled November 14 conference call related to the LTC Portal and LTSS Screening. The calls will...
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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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AHCA has posted numerous CMS updates and resources for PDPM. Updates include information on a work-around for MDS errors, and the potential elimination of MDS...
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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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VHCA-VCAL has been made aware of recent concerns over NF residents’ consent for the purchase of dental coverage. The cost associated with needed dental services is...
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On the most recent set of CCC Plus claims issues calls, DMAS asked if providers were experiencing any issues with CCC Plus billing for individuals...
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September 13, 2019 is the deadline to submit spreadsheets with any outstanding Virginia Premier CCC claims issues and any outstanding Virginia Premier CCC Plus claims...
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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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Virtual ICD-10 Coding training is available through AHCA and is important to PDPM success. Check out the online training options for coders and non-coders. AHCA/AHIMA ICD-10...
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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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For some time now, VHCA members, DMAS, and the six CCC Plus managed care organizations (MCOs) have been conducting periodic calls to identify and resolve...
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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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In an effort to provide more specific issue resolution for nursing facility (NF) claims under CCC Plus, Virginia Premier has established a specific inbox for NF...
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On August 27, DMAS provided an update that the DMAS-80 will be revised by September 1 to include a check box for individuals admitted prior...
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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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As we announced earlier this month, Virginia Premier is working to closeout any claims issues from the Dual Demonstration (CCC), which ran from August 2014...
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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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New Medicaid rates and new laws take effect on July 1, the start of a new state fiscal year. The new rates reflect a 2.9...
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Join us on August 14 for a day-long education program, Strategies for Success Under the Payment Driven Payment Model. Online registration is now available. To...
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Medicaid rates for state fiscal year 2020, which begins on July 1, 2019, have been posted to the Department of Medical Assistance Services (DMAS) website....
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Accurate ICD-10 coding and documentation are important to the success of your PDPM implementation. Have you taken steps to evaluate your team’s coding proficiency? AHCA...
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AHCA’s Virtual PDPM Training can help you prepare for the Patient Driven Payment Model (PDPM). If you missed the AHCA PDPM Academy Workshop in March, this...
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On May 20 the Centers for Medicare and Medicaid Services (CMS) issued an early release of several files associated with the MDS 3.0 RAI Manual v1.17...
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Daniel Ciolek, AHCA Associate Vice President of Therapy Advocacy, wrote in the May issue of Provider Magazine that upcoming changes to Medicare reimbursement under the...
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With thousands of codes and changes based on the new Patient Driven Payment Model (PDPM), accurate ICD-10 coding is essential. If you’ve been looking for...
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The Centers for Medicare and Medicaid Services (CMS) offer Resources for Integrated Care that supports providers integrating benefits for people receiving both Medicare and Medicaid....
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Medicaid reimbursement for hospice services provided in a nursing facility (NF) will change effective July 1, 2019. Legislation passed by the General Assembly will...
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Virginia Premier and Anthem, two of the managed care organizations which participated in the predecessor program to CCC Plus, known as Commonwealth Coordinated Care (CCC)...
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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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Effective July 1, 2019, the inflation increase for Medicaid rates for nursing facility services and specialized care for state fiscal year (SFY) 2020 will be...
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[caption id="attachment_105874" align="alignright" width="407"] Payment for Services Committee[/caption] VHCA-VCAL members and staff will again present their concerns about CCC Plus implementation to Department of Medical...
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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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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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The October 1 PDPM implementation date is rapidly approaching and training key staff now to be ICD-10 proficient is critical. The American Health Care Association...
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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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With thousands of codes and changes based on the new Patient Driven Payment Model (PDPM), accurate ICD-10 coding is critical. PDPM relies on accurate patient...
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Nursing facilities have until February 22, 2019 to complete the annual Nursing Facility Wage Survey. Your responses to this survey are critical as the data...
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On February 5, the Centers for Medicare and Medicaid Services (CMS) posted a new draft version (V3.00.0) of the MDS 3.0 Data Specifications on its...
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Space is limited to 250 attendees from member facilities and filling fast for the AHCA PDPM Academy. Sign up today to get access to the...
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Effective February 1, 2019, Virginia Premier will operate utilizing one Virginia Premier Payer ID: VAPRM or the Exchange Program ID: 251VA. This change is intended...
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Enroll in the members-only AHCA PDPM Academy to get the knowledge and support you need to successfully transition to the Patient Drive Payment Model (PDPM),...
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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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On December 18, Governor Ralph Northam presented his amendments to the current biennial budget to the General Assembly’s budget-writing committees. We are pleased to report...
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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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The Centers for Medicare and Medicaid Services (CMS) has launched a new webpage on the Patient Driven Payment Model (PDPM) with resources to help skilled nursing...
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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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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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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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The Centers for Medicare and Medicaid Services (CMS) has released the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Confidential Performance Score Reports, which contains each...
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The Centers for Medicare and Medicaid Services (CMS) finalized new rules for both the Prospective Payment System (PPS) and the Patient Driven Payment Model (PDPM)...
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You can now access a webinar recorded on July 16 on the Patient-Drive Payment Model– An Overview, AHCA Priority Comments, and Outlook for the Final...
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We have heard from many of you that you are receiving contracts or addendums to your CCC Plus contracts pertaining to the Medallion 4.0 program...
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In comments to the Centers for Medicare and Medicaid Services (CMS) on June 25, AHCA emphasized its key concerns with the proposed new Skilled Nursing...
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In the past weeks, several members have noted unusual outputs from the CMS Patient-Driven Payment Model (PDPM) tools. Since then, AHCA has been in contact...
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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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Virginia Premier CEO Linda Hines has provided VHCA-VCAL with a letter outlining the steps it is taking to resolve the remaining nursing facility payment issues...
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The Department of Medical Assistance Services (DMAS) has released the 2019 Medicaid nursing and specialized care rates, which take effect on July 1, 2018. The...
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Gov. Ralph Northam has signed the fiscal year (FY) 2019-2020 budget, setting the stage for the inflationary adjustments for nursing center and specialized care services...
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Health and Human Services (HHS) Secretary Alex Azar on June 5 said long term and post-acute care (LT/PAC) providers will play a “key role” in...
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VHCA-VCAL is aware that at least one CCC Plus managed care organization (MCO) has issued an addendum to its provider agreement and appears to have...
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After protracted debate that largely centered on whether the Commonwealth should extend Medicaid coverage to adults aged 19-64 who meet certain income limits under the...
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In response to feedback from VHCA members during the biweekly claims processing conference calls about paper claims being rejected on the front end and not...
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VHCA-VCAL submitted comments to the Department of Medical Assistance Services (DMAS) as the agency requested comments in advance of potential revisions to the CCC Plus...
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Although the managed care organizations (MCOs) in the CCC Plus program paid over $120 million in April to catch-up on the backlog of unpaid claims...
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This week Humana provided initial information regarding its final reconciliation process for CCC (Dual Demo) claim issues. Humana reports that 22 entities have outstanding claims...
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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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Humana has provided instructions on how nursing centers can submit their final reconciliation/claim issues under the CCC (Dual Demo) program. Nursing centers should submit the...
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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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As the starting point for the April 11 special session on the state budget, Gov. Ralph Northam introduced the same budget proposed in December by...
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On Thursday, the House of Delegates and Senate approved their respective budget bills setting the stage for them to head to a conference committee to...
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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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VHCA-VCAL continues to hear from members that claims adjudication under CCC Plus has been inconsistent and slow, in varying degrees among the six managed care...
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Each year the Department of Medical Assistance Services (DMAS) collects wage data from nursing centers, which is used in the calculation of annual inflation factors...
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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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On November 30, the Centers for Medicare and Medicaid Services (CMS) finalized major changes to the mandatory post-acute bundling programs. These large-scale demonstrations were created...
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We are continuing to work through claims issues with the six managed care organizations (MCOs) under CCC Plus since the program went live in August. ...
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AHCA/NCAL President and CEO Mark Parkinson shares, “There is significant, positive news from D.C. this week. Our efforts to get the new Administration to reduce...
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In an MLN Matters message issued on July 14, 2017, CMS reminds skilled nursing facilities (SNFs) that failing to submit required quality data to Medicare...
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This week we are featuring Discharge to Community: Creating Seamless Transitions, part two of a 10-part resource series designed by AHCA to support members in...
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Ascend Project Support Services requested that we notify you that it will now be offering providers in Virginia another option for resolving their assessment questions...
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On June 6, the Department of Medical Assistance Services (DMAS) posted an updated Medicaid rate file for fiscal year 2018. As we have reported in...
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Coming out of the 2017 General Assembly Session, VHCA-VCAL estimated that SFY 2018 nursing center Medicaid reimbursement would increase, relative to SFY 2017, by approximately...
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This week the House of Delegates and Virginia Senate passed their respective amendments to the biennial budgets. At this juncture, it appears that nursing centers...
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On December 20, 2016, CMS issued the final rule implementing the Advancing Care Coordination through Episode Payment Models mandatory bundled payment program. This rule implements...
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Next month Humana will change its billing procedures under the Commonwealth Coordinated Care (CCC) Program for dates of service on and after January 1, 2017. ...
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Effective for dates of service beginning January 1, 2017, Humana will process all Commonwealth Coordinated Care (CCC) claims on the Humana claims processing platform. Current...
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CMS has declared that all ICD-10 flexibilities in place over the last year will expire on October 1, 2016. Providers should be coding to the...
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Governor Terry McAuliffe has announced that Virginia is facing a $1.5 billion state budget shortfall due largely to lower-than-expected income and sales tax collections. The...
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According to the Department of Medical Assistance Services (DMAS), the fix to the patient pay calculation/communication issue in the new eligibility system was implemented over...
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VHCA staff has been fielding a number of calls and e-mails regarding issues with patient pay corrections not being done timely or not at all...
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