Effective April 1, Medicare Advantage and Part D plans will reject or deny claims that are submitted for items prescribed or furnished by an individual or entity on the Preclusion List. The Preclusion List consists of individuals and entities that fall within either of the following categories.
The Department of Labor has published three Notices of Proposed Rulemaking (NPRM) regarding the minimum salary requirement for an employee to qualify for overtime, which forms of payment can be included and excluded in the “time and one-half” calculation when determining workers’ overtime rates, and clarifications of and revisions to the responsibilities of employers and joint employers to employees in joint employer arrangements.
Download the first issue of AMBR Journal! In this issue we discuss how to focus on new incentives under PDPM without scrapping therapy; how to get your compliance and ethics program into shape before November 1; ICD-10 training for your staff; a breakdown of consolidated billing, category I; and what billers can do to properly handle long-term care insurance policies.
by Deborah Collum, national director of revenue cycle management at Covenant Retirement Communities and AMBR Advisory Board member
Implementing a revenue cycle management (RCM) model in your facility will help you streamline your billing process to prepare for the Patient-Driven Payment Model (PDPM) to be implemented October 1, 2019. If your billing office still follows an accounts receivable (AR) model that only focuses on outstanding accounts, you’re not alone—but it may be time for a change.
In their annual report to Congress, the Medicare Payment Advisory Commission (MedPAC) made policy recommendations for nine provider sectors in fee-for-service (FFS) Medicare, including recommendations against raising payment rates for both skilled nursing facilities (SNFs) and home health agencies. MedPAC recommends that Congress not increase base payment rates for SNFs in 2020 and suggests that Congress reduce base payment rates for home health agencies by 5 percent for 2020.
In the final 2018 outpatient prospective payment system (OPPS) rule released by CMS, total knee arthroplasty, also known as total knee replacement (TKA/TKR), was removed from the Medicare inpatient-only (IPO) list. The IPO list includes procedures that are only paid under the hospital inpatient prospective payment system.
CMS announces that starting in March, the Quality Improvement and Evaluation System (QIES), Certification and Survey Provider Enhanced Reports (CASPER) and Automated Survey Processing Environment (ASPEN) will undergo a series of modernizing enhancements. The agency clarified that once updated, the new system, Internet Quality Improvement and Evaluation System (iQIES), will not change how providers currently submit data to CMS.
NAHRI is currently seeking speakers to present at the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16, 2019, at the Renaissance Orlando at SeaWorld in Orlando, Florida. We seek speakers to present on all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings. NAHRI will waive admission fees to the 2019 Revenue Integrity Symposium for all selected speakers and co-speakers. Click here to learn more and complete the call for speakers application. Contact NAHRI Director Jaclyn Fitzgerald at email@example.com with questions.
Between 2011 to 2016, Medicare fee-for-service drug spending increased from $17.6 billion to $28 billion under Medicare Part B. Medicare Part D total spending has almost doubled from 2010 to 2016, increasing from $77.5 billion to $146.1 billion, with costs projected to increase further, according to the Centers for Medicare & Medicaid Services (CMS). Drug prices for beneficiaries in the U.S. are also on the rise and can be found in places like Europe for up to 80% cheaper, according to NPR. The cause? A market full of hurdles and barriers to creating biosimilars (drugs with the same or similar active ingredients as the original and often available at a reduced price); current laws that prevent vendors from negotiating drug prices; and outrageous prices for essential drugs that treat ever-more-common chronic conditions, such as cancer, rheumatoid arthritis, and hepatitis C.