Tag: CMS

Reimbursement & Regulations: SNF ABNs, Terminated Providers, More

By: Andrew Minten JD
Date: February 1, 2019
Category: Custom Services
Filed under: ABN, ABNs, CMS, OIG, Reimbursement & Regulations, Skilled Nursing Facilities, SNFs, Terminated Medicaid Providers, Tracheostomy

After April 30, 2018 it will be mandatory that all skilled nursing facilities use the new advance beneficiary notice of non-coverage form created by the CMS. The new form can be accessed here, and there is nothing stopping organizations from using it right away. This form is to be used in instances when it is […]

Pulse Check: Price Transparency

By: Andrew Minten JD
Date: January 2, 2019
Category: Custom Services
Filed under: CMS, financial assistance, Patient Experience, Payers, Price Transparency, Pulse Check

Now that the CMS has stated that prices for all items and procedures must be posted online, it is important to ensure patients understand what these prices mean to them. We’ve seen healthcare organizations be effective creating a financial assistance committee that can partner with the community to determine the most efficient way to communicate […]

Reimbursement & Regulations: E&M, Social Determinants of Health, Kickbacks

By: Andrew Minten JD
Date: December 7, 2018
Category: Custom Services
Filed under: 2019 MPFS, CMS, E/M, E&M, HHS, Inpatient Billing, Kickbacks, Medicaid, Medicare, OIG Work Plan, Reimbursement & Regulations, Social determinants of health

Return readers will be happy to hear that the CMS is delaying its changes to E&M payments. In the 2019 Medicare Physician Fee Schedule Final Rule, the CMS stated it will not be reducing E&M payments from five levels to two, but to three levels, and that it will not be doing it until 2021. […]

What Do the Midterms Mean for the Future of Medicaid Work Requirements?

By: Courtney Zott and Anna Miller
Date: November 20, 2018
Category: Market Events
Filed under: CMS, medicaid work requirements, midterm elections

A federal policy guidance document released by CMS in January 2018 showed states how to implement Medicaid work requirements, sparking a wave of proposals from Republican-led state legislatures to require certain enrollees to complete work or community engagement activities. Some states have already garnered federal approval, while others are waiting for authorization, though the results […]

Reimbursement & Regulations: Sepsis, Medicare Part C, MBIs

By: Andrew Minten JD
Date: November 2, 2018
Category: Custom Services
Filed under: Anthem, CMS, DSH, HHS, MBI, Medicare, Medicare ID Cards, Medicare IDs, Medicare Part C, Reimbursement & Regulations, Sepsis, Sepsis-3, United Healthcare

Starting January 1, United Healthcare will use sepsis-3 criteria for the medical necessity of claims. Experts believe this could lead to higher denials in the near future. This change is for all of United Healthcare’s plans. Sepsis-3 defines sepsis as “life-threatening organ dysfunction caused by dysregulated host response to infection [suspected or confirmed].” Two standards […]

Reimbursement & Regulations: Emergency Plan, H&P, & Transplant Centers

By: Andrew Minten JD
Date: October 12, 2018
Category: Custom Services
Filed under: CMS, Emergency Plans, Emergency Preparedness, Medical History and Physical Examination, Reimbursement & Regulations, Transplant Centers

Since the OIG only has two new Work Plan focuses this month, and because neither deal with hospital reimbursement on a broad level, this month I will only focus on a new Rule proposed by the CMS. On September 20, 2018 the CMS released a new proposed rule with the purpose of reducing more of […]

Three Lessons You’ll Learn During HBI’s Price Transparency Roundtable

By: Courtney Zott
Date: October 8, 2018
Category: Revenue Cycle
Filed under: CMS, price estimation, Price Transparency

Hospital prices have been coming under increased scrutiny amid rising patient consumerism and regulatory attention. Most recently, CMS issued a new regulation requiring providers to publicize standard charges online on January 1, 2019. In this climate of transparency, organizations’ strategies for informing patients of their care costs are more important than ever. Leaders from University […]

Reimbursement & Regulations: Price Transparency, IMRT planning, E&M

By: Andrew Minten JD
Date: September 7, 2018
Category: Custom Services
Filed under: charges, CMS, E&M, IMRT, Medicare, OIG, OIG Work Plan, Price Transparency, Radiation Therapy, Reimbursement & Regulations

The CMS has made final their rule to require all hospitals to publish a list of standard charges in a machine-readable format online at least once a year. This requirement will be in place as of January 1, 2019, so it is important to get your organization moving. The CMS created this rule in order […]

Helping Patients During the Transition to New Medicare Cards

By: Kelli Jenkins
Date: August 3, 2018
Category: Revenue Cycle
Filed under: CMS, Medicare, Medicare Beneficiary Identifier, Medicare Cards, Patient Identification

Since April 2017, CMS has been rolling out its new Medicare beneficiary cards in phases to a variety of states and territories of the U.S., and many are still awaiting their arrival. As some healthcare organizations begin to encounter patients with new cards and many more prepare to, leaders may be wondering what impact—if any—this […]