Now viewing articles in the category Compliance.
Targeted Probe & Educate (TPE) AUDITS Where are we now?
June 7th, 2024
Targeted Probe & Educate (TPE) AUDITS Where are we now?
By: Barbara Blatt, PT
Director of Compliance and Appeals ManagementIn 2017, CMS announced expanding its Targeted Probe and Educate (TPE) program to include all Medicare Administrative Contractor (MAC) jurisdictions. This expansion aimed to identify potential Medicare fraud and improper payments. The focus was on claims with the highest financial risk to the Medicare fund and on providers with the highest claim error rates and irregular billing practices when compared to their peers. The TPE claim selection process was provider-specific, using data mining from Medicare claims.
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Kepro Rebranding: Kepro is becoming Acentra Health
April 24th, 2024
Kepro, the Medicare Quality Improvement Organization (QIO) responsible for Skilled Nursing Facility (SNF) termination appeals is rebranding. Kepro will soon be known as ACENTRA HEALTH. The target date for the rebrand “go live” is August 1, 2024.
1 minute readCMS ISSUES FINAL RULE
April 11th, 2024
WHAT YOU NEED TO KNOW
On April 4, 2024, CMS announced that Medicare Advantage (MA) appeals will parallel the same review process as traditional Medicare allowing MA plan enrollees to have access to the fast-track appeals process now.
Key elements include: Independent Review
1 minute readCMS Releases FY 2025 Proposed Rule
April 2nd, 2024
CMS Releases FY 2025 Proposed Rule: SNFs In Line to Receive 4.1% Reimbursement Increase
WHAT YOU NEED TO KNOW
On March 28th CMS issued Fiscal Year 2025 Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities proposed rule. This proposal contains many areas of importance and significance for SNF providers specifically as it relates to payment, quality, civil monetary penalties, and more. Key elements of the proposed rule include:
1 minute readPosted in: Compliance, NewsAETNA TO IMPLEMENT PTA & COTA REDUCTION
February 28th, 2024
AETNA TO IMPLEMENT PHYSICAL THERAPY ASSISTANT (PTA) AND CERTIFIED OCCUPATIONAL THERAPY ASSISTANT (COTA) REDUCTION EFFECTIVE MARCH 1, 2024: Aetna has announced they will implement a payment reduction when outpatient therapy services are provided in whole or in part by a physical therapy...1 minute readPosted in: Compliance, NewsCMS Releases FY 2024 Final Rule: SNFs In Line to Receive 4.0% Reimbursement Increase
August 1st, 2023
BACKGROUND The Centers for Medicare and Medicaid Services (CMS) are required to update the Medicare payment rates and quality programs on an annual basis. Prior to August 1 each year, CMS is required to publish the final rule for the upcoming fiscal year (FY).
WHAT YOU NEED TO KNOW: On July 31st, CMS issued the final rule CMS-1779-F for FY 2024. This final rule contains many areas of importance and significance for SNF providers specifically as it relates to payment, quality, PDPM, and more. Preferred Therapy Solutions is thoroughly reviewing the final rule and has planned an in-depth webinar for August 15th.
Key elements of the proposed rule include
2 minute read
CMS: SNF 5-CLAIM PROBE & EDUCATE REVIEW
May 9th, 2023
CMS: SNF 5-CLAIM PROBE & EDUCATE REVIEW
Attention: Implementation date - June 5, 2023
In an attempt to increase comprehension of correct billing practices under PDPM by all SNF providers that bill Medicare, and to prevent future improper payments, CMS is implementing a 5-claim Probe and Educate Medical Review Strategy1 minute readPosted in: Compliance, NewsCMS- PART B ABN Form R-131 RENEWAL
April 18th, 2023
The Advance Beneficiary Notice of Non-Coverage (ABN) Form CMS-R-131, and its instructions have been approved by the federal Office of Management and Budget (OMB) for renewal.
1 minute readPosted in: Compliance, News
Social Determinants of Health: LEVERAGING OCCUPATIONAL THERAPY TO ASSIST IN REDUCING HEALTH DISPARITIES
April 17th, 2023
Professionals in the skilled nursing arena are familiar with the Minimum Data Set or MDS. The MDS is a standardized assessment tool used to gather information about residents’ health status and needs. In 2023, we will see the MDS’s revision include
adding new social determinants of health (SDOH) to specifically have questions around ethnicity, race, language, transportation, health literacy, and social isolation1 minute readCMS Releases FY 2024 Proposed Rule: SNF’s In Line to Receive 3.7% Reimbursement Increase
April 5th, 2023
BACKGROUND
The Centers for Medicare and Medicaid Services (CMS) are required to update the Medicare payment rates and quality programs on an annual basis. Each April, CMS publishes a proposed rule for the upcoming fiscal year (FY) and opens a comment period for stakeholders to review and provide comments to CMS before releasing the final rule.
What you need to know
On April 4th CMS issued the proposed rule CMS-1779-P for FY 2024. This proposed rule contains many areas of importance and significance for SNF providers specifically as it relates to payment, quality, staffing, and more.
Preferred Therapy Solutions is thoroughly reviewing the proposed rule and has planned an in-depth webinar for April 19th.
Key elements of the proposed rule include:
2 minute readCMS Posts Draft MDS 3.0 RAI Manual Version SNF Transition to iQIES Starting Soon
April 4th, 2023
CMS Posts Draft MDS 3.0 RAI Manual Version SNF Transition to iQIES Starting Soon
WHAT YOU NEED TO KNOW
The Centers for Medicare & Medicaid Services (CMS) has posted the draft Minimum Data Set 3.0 (MDS 3.0) Resident Assessment Instrument (RAI) User’s Manual Version 1.18.11. The MDS 3.0 RAI User’s Manual v1.18.11 will take effect on October 1, 2023. CMS notes that this version of the RAI contains "substantial revisions related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which requires that standardized assessment items be collected across post-acute care
(PAC) settings."1 minute read
President Biden Releases Budget Proposal For Fiscal Year 2024
March 16th, 2023
On Thursday, March 9, President Biden released his budget proposal for FY 2024. While the President’s budget is largely a messaging document that is not voted on by Congress, it is an important document for communicating the Administration’s priorities. In the coming weeks, Administration officials will testify before key committees on the budget proposal.
The President’s Budget is comprised of numerous documents including the main budget summary as well as the HHS “Budget in Brief,” which outlines budget proposals for CMS and other entities within HHS (such as the CDC and FDA). These documents are available at the links at the bottom of this alert.
The budget document for CMS has a continuing focus on nursing facilities by the Biden Administration. President Biden had previously discussed nursing facility quality and safety in his State of the Union speech in 2022.
2 minute readConnecticut to Initiate CMI Audits
January 19th, 2023
Connecticut to Initiate CMI Audits
To our valued customers:
BACKGROUND
The State of Connecticut implemented a CMI program for Medicaid reimbursement in January of 2022. Connecticut has contracted with Myers & Stauffer to perform CMI auditing for the state.
WHAT YOU NEED TO KNOW
A recent webinar by Myers & Stauffer laid out the planned system for CMI auditing:
1 minute readPosted in: Compliance, News
KEPRO Quality Improvement
January 13th, 2023
KEPRO QUALITY IMPROVEMENT ORGANIZATION
UPDATE NOTIFICATION PROCESS FOR NEW APPEALSTo our valued customers:
WHAT YOU NEED TO KNOW
Starting on January 17, 2023, KEPRO will no longer notify post-acute facilities and Medicare health plans via telephone for appeal notifications when a new appeal has been filed.
1 minute readPosted in: Compliance, NewsCOVID-19 PUBLIC HEALTH EMERGENCY (PHE) EXTENSION
January 11th, 2023
To our valued customers:
WHAT YOU NEED TO KNOW
Xavier Becerra, United States Secretary of Health and Human Services has once again announced the COVID-19 Public Health Emergency (PHE) extension, which was due to expire today, Wednesday, January 11, 2023. The COVID-19 PHE has been renewed for an additional 90 days with the new extension due to expire on Tuesday, April 11, 2023.1 minute readPosted in: Compliance, NewsCMS Resumes Medicare A Post Pay Probes: ARE YOU READY
July 26th, 2022
The Center for Medicare and Medicaid Services (CMS) has resumed the Targeted Probe and Educate (TPE) program for performing medical reviews.
2 minute readPosted in: Compliance, NewsCMS to End Certain COVID-19 Waivers
May 6th, 2022
CMS TO END CERTAIN COVID-19 WAIVERS BACKGROUND The Center for Medicare and Medicaid Services released a memorandum on April 7th to state agencies announcing the ending of specific Public Health Emergency (PHE) waivers in two different time frames: May 7th and June 7th.
2 minute readCMS Releases FY 2023 Proposed Rule
April 14th, 2022
BACKGROUND The Centers for Medicare and Medicaid Services (CMS) are legally required to update the Medicare payment rates and quality programs on an annual basis.
3 minute readWHAT YOU NEED TO KNOW ABOUT OSHA INSPECTIONS
March 16th, 2022
BACKGROUND On March 7th, the Occupational Safety and Health Administration (OSHA) announced highly focused inspections directed at hospitals and skilled nursing care facilities that treat or handle COVID-19 patients.
1 minute readPosted in: Compliance, NewsSolutions Syllabus: Quality Measures
February 24th, 2022
Preferred Therapy Solutions is hosting a monthly educational series based on the RAI Manual for coding the MDS to ensure accuracy with Quality Measures (QMs).
1 minute readINTERDISCIPLINARY PRACTICES DESIGNED FOR OPTIMAL PATIENT-CENTERED PERFORMANCE
July 7th, 2021
This past January, CMS released their updated Long-Term Care Survey Process Materials.
1 minute readCOVID-19 PUBLIC HEALTH EMERGENCY EXTENDED
April 19th, 2021
NEWS FROM U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES WHAT YOU NEED TO KNOWThis past week Xavier Becerra, United States Secretary of Health and Human Services, announced the COVID-19 Public…
1 minute readPosted in: Compliance, Blog Post(No Title)
April 6th, 2021
LOOK WHAT'S NEW IN TELEMEDICINECMS Expands Medicare Telehealth Coverage forSpeech-Language Pathology and Audiology Services BACKGROUNDSince March of 2020, the Centers for Medicare and Medicaid Services (CMS) has been expanding the…
1 minute readPosted in: Compliance, NewsCMS TO HOLD CLAIMS BEGINNING APRIL 1, 2021
March 31st, 2021
BREAKING NEWS FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES WHAT YOU NEED TO KNOWPer CMS - In anticipation of possible Congressional action to extend the 2% sequester reduction suspension,…
1 minute readKEPRO AND LIVANTA IMPORTANT REMINDER
March 18th, 2021
The Quality Improvement Organization (QIO) goal is to complete appeals and quality of care reviews with healthcare providers as quickly and efficiently as possible.
1 minute readPosted in: Compliance, NewsNEW INTERNATIONAL DYSPHAGIA DIET STANDARDIZATION (IDDSI)
March 10th, 2021
What’s your plan for rolling out the new IDDSI initiative? Preferred Therapy Solutions provides the necessary platforms in developing a crosswalk between IDDSI and Skilled Nursing Facility diets.
1 minute readFee Schedule Cuts Addressed by Year-End Spending Bill
December 23rd, 2020
To our valued customers:BACKGROUND Without legislative action by the end of 2020, skilled nursing providers were facing significant cuts to Medicare reimbursement in 2021.
1 minute readBREAKING NEWS Medicare Physician Fee Schedule (PFS) Final Rule
December 3rd, 2020
The Centers for Medicare and Medicaid Services (CMS) issued the CY 2021 Medicare Physician Fee Schedule (PFS) Final Rule on Dec 1st, 2020.
2 minute readPosted in: Compliance, NewsBREAKING NEWS
August 26th, 2020
CMS Mandates Strict Testing of COVID-19 for Nursing Home Staff. Fines up to $8,000 for Non-compliance. To our valued customers: Yesterday, The Centers for Medicare & Medicaid Services (CMS)…
1 minute readPosted in: Compliance, NewsCMS to Resume Fee for Service (FFS) Medical Reviews
July 27th, 2020
To our valued customers: CMS expects to resume Fee for Service (FFS) Medical Reviews on August 3, 2020, regardless of the status of the Public Health Emergency (PHE), which has…
1 minute readPosted in: Compliance, NewsSKILLED NURSING FACILITY ADVANCE BENEFICIARY NOTICE OF NON-COVERAGE
June 30th, 2020
SKILLED NURSING FACILITY ADVANCE BENEFICIARYNOTICE OF NON-COVERAGE To our valued customers:The ABN, Form CMS-R-131 notice is subject to comment and re-approval every 3 years. The ABN, Form CMS-R-131 has been approved…
1 minute readPosted in: Compliance, NewsBlack Lives Matter
June 11th, 2020
Black lives matter. My heart breaks for the families of Breonna Taylor, Ahmaud Arbery, and George Floyd and so, so many other black American families that have endured unimaginable pain…
1 minute readEDUCATIONAL WEBINAR SERIES
May 22nd, 2020
Preferred Therapy Solutions is dedicated to providing clinical education and support for the long term and post-acute care community. Due to overwhelming demand and many requests for training on how…
1 minute readJoin Preferred Therapy Solutions on this Informative COVID-19 Webinar.
May 22nd, 2020
Register at: https://bit.ly/3bVApkX
1 minute readPreferred Therapy Solutions and Celtic Consulting Partner on COVID-19 Webinars
May 21st, 2020
Preferred Therapy Solutions and Celtic Consulting will be hosting a series of collaborative webinars. The next webinar will be on May 28, 2020. Register at: https://bit.ly/2zaqqef
1 minute readCMS Updates PDPM-ICD-10 Mappings for COVID-19
April 1st, 2020
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) has the authority to update the list of ICD-10-CM codes used for capturing various payment components under PDPM. CMS has exercised…
1 minute readPosted in: Compliance, NewsCMS to Delay MDS 3.0 Draft Changes
March 19th, 2020
Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for…
1 minute readPosted in: Compliance, NewsCMS Publishes FY 2022 SNF Annual Payment Update (APU) Overview Table
February 18th, 2020
Background Skilled Nursing Facility (SNF) Quality Reporting Program Measures The Impact Act of 2014 required implementation of clinical assessment areas using standardized data elements in each of the instruments used…1 minute readCMS FINAL RULE
August 6th, 2019
Changes with CMS' FINAL RULE: FISCAL YEAR 2020 Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with…1 minute readClarification to the Anthem Blue Cross Blue Shield Implementation of Pre-Authorization for Outpatient Therapy
July 16th, 2019
Preferred Therapy Solutions continues to provide its partners with information that may impact rehabilitation services, compliance or regulatory requirements. The below information clarifies the significant change in pre-authorized outpatient therapy as defined by Anthem…1 minute readNursing Home Compare Quarterly Refresh with SNF QRP Data Now Available
April 25th, 2019
Nursing Home Compare QuarterlyRefresh with SNF QRP Data Now Available BackgroundCMS announced that the April 2019 Nursing Home Compare Refresh, including quality measures results based on SNF Quality Reporting Program…1 minute readPosted in: Compliance, News*TIME SENSITIVE* CMS HOSTING NATIONAL PROVIDER CALL Learn CMS’ Review and Corrections Process for VBP before it’s too late!
March 5th, 2019
Phase One Review and Corrections Call — March 20th BackgroundThe SNF Value Based Program measure, Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) estimates the risk-standardized rate of all-cause, unplanned…1 minute readPosted in: Compliance, NewsNursing Home Compare Quarterly Refresh with SNF QRP Data Now Available
February 4th, 2019
Nursing Home Compare Quarterly Refresh withSNF QRP Data Now Available Background CMS announced that the January 2019 Nursing Home Compare Refresh, including quality measures results based on SNF Quality Reporting Program…1 minute readPosted in: Compliance, News*TIME SENSITIVE* SNF Provider Preview Reports Now Available
February 2nd, 2019
REVIEW BEFORE DATA MADE PUBLIC Background Prior to the release of SNF QRP data on Nursing Home Compare, SNFs have the opportunity to review their quality measure results during a…1 minute readPosted in: Compliance, NewsBilling Reminder! CMS 2019 Physician Fee Schedule Final Rule Is Now In Effect!
January 16th, 2019
Physician Fee Schedule Effective January 1, 2019 Background CMS released the Physician Fee Schedule Final Rule in November 2018 with an effective date of January 1, 2019. What you need…1 minute readPosted in: Compliance, NewsSNF QRP Submission Deadline Approaching
October 10th, 2018
Background The Skilled Nursing Facility Quality Reporting Program (SNF QRP) requires facilities to report assessment data in a timely manner. Providers must submit all data necessary to calculate the SNF…1 minute readPosted in: Compliance, NewsNew York MDS Case Mix Picture Date Update
September 18th, 2018
Yesterday, September 17, 2018 the NY DOH held a monthly briefing and announced they will release final details today with regard to the NY MDS case mix picture updates which…1 minute readPosted in: Compliance, NewsCMS Releases FY 2019 SNF PPS Final Rule: PDPM Finalized
August 1st, 2018
CMS Releases FY 2019 SNF PPS Final Rule: PDPM Finalized Background Late yesterday afternoon, the Centers for Medicare and Medicaid (CMS) released the Final Rule for FY 2019 SNF Prospective Payment…2 minute readPosted in: Compliance, NewsSkilled Nursing Facility (SNF) Provider Preview
June 7th, 2018
Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. Providers have until June 30, 2018 to review their performance data prior to public display on…1 minute readPosted in: Compliance, NewsCMS Releases FY 2019 Proposed Rule
May 2nd, 2018
Background On Friday April 27th, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the Prospective Payment System & Consolidated Billing for Skilled Nursing Facilities (SNF-PPS)…2 minute readMedPAC Holds March 2018 Public Meetings
March 20th, 2018
Background On Thursday, March 1, 2018, the Medicare Payment Advisory Commission (MedPAC) met as scheduled for their March public meeting in Washington, DC. The purpose of this and other public meetings…1 minute readCMS discusses timeline for RCS-I Implementation on ODF
March 9th, 2018
The Centers for Medicare and Medicaid Services (CMS) stated there is no timeline for the implementation of the proposed Resident Classification System-I (RCS-I) on their Open Door Forum (ODF) held on…1 minute read
