Carel Hedlund

Carel Hedlund


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CMS Issues CY 2016 Final Rule for Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes

On October 30, 2015, CMS issued its final policy changes, quality provisions and payment rates for the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for...more

11/16/2015 - Ambulatory Surgery Centers CMS Hospitals OPPS Outpatient Quality Reporting Outpatient Services Provider Payments Two-Midnight Rule

CMS Issues FY 2016 Final Inpatient and Long-Term Care Hospital Rule

On July 21, 2015, CMS issued a final rule updating the fiscal year (FY) 2016 Medicare payment polices and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment...more

8/24/2015 - Bundled Payments CMS Hospitals Inpatient Prospective Payment System (IPPS) Inpatient Quality Reporting Long Term Care Facilities Long-Term Care Medicare Patient Prospective Payment System Value-Based Purchasing

CMS Retracts Hospice Preauthorization Requirements for Part D Drugs

On July 18, CMS released new guidance retracting a major portion of its controversial preauthorization requirement for hospice beneficiaries. The new guidance supersedes portions of the March 10, 2014 guidance [PDF] that...more

8/8/2014 - CMS Healthcare Hospice Medicare Medicare Part D Prescription Drugs

CMS Proposes Relief for HH Face-to-Face and Therapy Reassessment Requirements

In the last issue, we reported on the difficulties faced by home health agencies (HHAs) in complying with the documentation requirements for the face-to-face (F2F) encounter between a patient and a physician before or shortly...more

7/14/2014 - CMS Face-to-Face Narrative Requirement Home Health Agencies Home Health Care Physician Payments Physicians Reporting Requirements

Home Health Face-to-Face: Continuing Deficiencies and Possible Relief

The Affordable Care Act mandates that a Medicare beneficiary have a “face-to-face” (F2F) encounter with a physician before the physician can certify that the patient is homebound and in need of skilled care and thus qualifies...more

6/27/2014 - Affordable Care Act Face-to-Face Narrative Requirement Healthcare Healthcare Reform Home Health Care Physicians

CMS Issues Cost Savings Reforms to Medicare Regulatory Requirements

On May 12, 2014, CMS issued a final rule, reforming certain Medicare regulatory requirements and eliminating those identified as unnecessary, obsolete, or excessively burdensome. Many of the streamlined provisions relate to...more

6/12/2014 - CMS Healthcare Healthcare Reform Hospitals Medicare Terms and Conditions

Highlights of Proposed Rules for Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Inpatient Psychiatric...

On May 1, 2014, CMS released proposed payment and policy changes for Medicare Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and Inpatient Psychiatric Facilities (IPFs). Some of the key changes...more

5/21/2014 - CMS Healthcare Inpatient Rehab Facilities IRF Claim Processing Payment Systems Proposed Regulation Public Comment SNF

Medicare to Deny Certain Hospital Inpatient Claims for Hospice Patients

Under new CMS guidance, hospitals may have certain claims denied for inpatient services to a hospice patient. On November 7, 2013, CMS issued Change Request 8273 announcing changes in Medicare’s claims processing systems that...more

1/9/2014 - Healthcare Hospice Inpatient Billing Medicare

Adult Failure to Thrive and Debility Can No Longer Be Principal Diagnoses on Hospice Claim Forms

Hospices will have until October 1, 2014, to ensure they conform their coding practices to comply with a “clarification” issued by the Centers for Medicare and Medicaid Services (CMS) in its final FY2014 Hospice Wage Index...more

12/2/2013 - CMS Compliance Elder Issues Healthcare Hospice

CMS Revises Part B Billing Policy for Unnecessary Inpatient Admissions

For many years, CMS policy has been that, if an inpatient admission was denied for medical necessity reasons, the hospital could bill under Part B for only a limited set of services that, significantly, did not include...more

3/29/2013 - Administrative Appeals ALJ CMS Hospitals Medicare Medicare Part B

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