The recent CMS discharge planning rule that went into effect in November 2019 included several changes aimed at improving care transitions and encouraging patients’ involvement in their follow-up treatment and care protocols. (Click here to review the rule in the Federal Register.) With those rules in place, it is now imperative for organizations to familiarize […]
Tag: CMS
How Well Does Your Organization Provide Price Transparency?
HBI’s newly released 2019 Price Transparency Report seeks to help answer this question. It features two independent studies that show how organizations’ performance with price transparency is not yet where it should be. In one study, HBI examined the websites of 272 hospitals and found that approximately 49% are not fully compliant with CMS’ 2019 […]
Hospitals Must Post Standard Charges by 2021
In a Final Rule released Friday, November 15th, CMS implemented the majority of its price transparency proposals but gave hospitals an extra year to comply. By January 1st, 2021, hospitals must: Post standard charges for all items and services, which include: Gross chargemaster prices Payer-specific negotiated rates (which must also be labeled by plan) Discounted […]
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
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?
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
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 […]