SNF PDPM Claims Issue: New Guidance from CMS
CMS’ MLN Connects offers new guidance for SNFs struggling with PDPM initial claims: “Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence …
A Deep Dive on SNF Oversight: Don’t Be Caught Off-Guard!
CMS has posted a new article about their new oversight initiatives for SNFs. Registered nurse staffing is being heavily scrutinized with CMS relying on a payroll-based journal reporting tool. It …
New PEPPER Retrieval Maps are Available Now
From the RELI Group: “PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data …
New DRAFT version of the MDS 3.0 Item Set Change for October 2020
A new DRAFT version of the MDS 3.0 Item Set Change History for October 2020 (v1.18.0) was posted. This document reflects the changes in the DRAFT version of the 2020 …
Medicaid Supplemental Payment Changes Target SNF Revenue
From Modern Healthcare: “A proposal to ramp up reporting requirements is threatening one of skilled nursing operators’ most significant revenue streams and could dent profitability, analysts said.” “CMS’ proposed new rule would …
Massachusetts CHIA Publishes Nursing Facility Industry Report
Massachusetts CHIA has released their first ever report on the Nursing Facility Industry in Massachusetts. CHIA’s initial report examines the Commonwealth’s nursing facilities at an industry level, as well as …
Always Be Vigilant: OIG Conducted Unannounced Site Visits at California Nursing Homes
OIG conducted unannounced site visits at select nursing homes in California from September to December 2018 to check for life safety violations and review the nursing homes’ emergency preparedness. OIG found …
Avoid Audits! Stay on Top of the SNF Three Day Billing Rule
In a recent report, the Office of Inspector General (OIG) determined that Medicare improperly paid for Skilled Nursing Facility (SNF) services when the Medicare 3-Day inpatient hospital stay requirement was not …
Proposed Medicaid Fiscal Accountability Rule Could Dramatically Lower Reimbursement for Providers
Today, CMS released their proposed Medicaid Fiscal Accountability Rule (MFAR), which works to ensure transparency in Medicaid payments and clamp down on impermissible financing arrangements. From CMS’ Press Release: “States …
Some SNF Claims Being Placed on Hold
CMS is holding a number of claims from SNFs as they continue to refine their payment systems for PDPM. See the following from CMS’ Medicare Learning Network (MLN): “CMS is …