Leslie Demaree Goldsmith

Leslie Demaree Goldsmith


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Upcoming PQRS Deadlines

If you are submitting PQRS data, please make note of the following upcoming deadlines this month: March 21, 2014: - Last day for groups to submit 2013 data through the GPRO Web Interface webpage...more

3/24/2014 - Deadlines PQRS

CMS Posts Guidance on Two-Midnight Rule and Related Audits

On February 24, 2014, CMS posted a list of updates to its guidance on the new Two-Midnight Rule and the Probe and Educate Audits. Several of the more major updates are discussed below....more

3/12/2014 - Audits CMS Healthcare MACs Medicaid Medicare

CMS Proposes Extensive Emergency Preparedness Rules

On December 26, 2013, CMS proposed emergency preparedness rules in the form of conditions of participation and conditions of coverage. These rules would apply to hospitals (including critical access hospitals), ambulatory...more

2/24/2014 - CMS Disaster Preparedness Emergency Response Healthcare Hospitals

PQRS Deadline: February 28, 2014

February 28, 2014 is the next PQRS deadline. It is the: - Last day that 2013 claims will be processed to be counted for the 2013 PQRS reporting; - Last day to submit 2013 PQRS data through the EHR reporting...more

2/21/2014 - Deadlines EHR PQRS

CMS Extends Time for Probe Audits of Inpatient Admissions, and Clarifies Inpatient Order and Certification Requirements

Probe and Educate Audits of Inpatient Admissions Extended - CMS announced on its Inpatient Hospital Review website on Friday that it was extending the probe and education audits of inpatient admissions for an...more

2/7/2014 - CMS Healthcare IPPS MACs

Two Midnight Rule Updates and How to Preserve Rights to Challenge Rule

Last month, CMS updated its FAQs related to the two midnight rule. In additional, CMS conducted two recent Open Door Forum Calls related to the new rule. Some of the highlights from the updated FAQs and calls are discussed...more

1/24/2014 - CMS Hospitals Inpatient Billing Medical Reimbursement Plans Medicare

OIG Calls for Increased Scrutiny on Hospital Outlier Payments

In a recent report [PDF], the Department of Health and Human Services Office of the Inspector General (OIG) highlighted hospital outlier payment trends it found troubling: Of the nearly 3,200 hospitals reviewed, approximately...more

11/27/2013 - Healthcare HHS Hospitals IPPS Medicare OIG Outlier Payments

CMS Releases Guidance for MACs on 100% Prepayment and Random Medical Reviews

On October 18th, CMS issued Transmittal 489 [PDF], providing Medicare Administrative Contractors (MACs) with instructions on 100 percent prepayment and random reviews. The guidance, effective November 19, 2013, provides MACs...more

11/14/2013 - CMS Compliance Healthcare MACs Medicare

CMS Issues Additional Guidance Related to 2-Midnight Rule

Earlier this month, CMS posted three new documents related to the 2-midnight rule for inpatient admissions on its webpage for inpatient hospital reviews: new FAQs, as well as CMS directions for selecting hospital claims for...more

11/14/2013 - Audits CMS Healthcare Hospitals Inpatient Billing MACs Medicare

CMS Issues FAQs for Inpatient "2 Midnight" Rule

CMS issued its first set of FAQs on the new 2 midnight inpatient admission standards [PDF] on September 26. In those FAQs, CMS stated: - Medicare Administrative Contractors (MACs) and Recovery Auditors are not to...more

10/7/2013 - Admissions CMS Healthcare Hospitals Medical Liability Medicare Recovery Audit

CMS Issues Inpatient Admission Order and Certification Guidance

On September 5th of this year, CMS issued guidance [PDF] addressing hospital inpatient admission orders and certifications. The regulations addressing certifications at 42 C.F.R. §§ 424.13 – 424.16 were revised as part of the...more

9/23/2013 - CMS Hospitals Medicare Patient Prospective Payment System

Earlier Deadlines for Wage Index Development Process

CMS has changed the timetable in the wage index development process for FY 2015. The FY 2015 Hospital Wage Index Development Timetable and the preliminary wage index files can be found here (see alert for link)....more

9/20/2013 - CMS Deadlines Indexing Wages

CMS Adopts Final Rules for Inpatient Admissions and Inpatient Part B Billing

In its final IPPS rule for FY 2014 CMS adopts its earlier proposals regarding its two-midnight policy related to inpatient admissions and hospital billing under Part B following a denial of an inpatient stay. CMS discusses...more

8/27/2013 - CMS Hospitals Inpatient Billing Medicaid Medicare

CMS Accepts Court Ruling That Bad Debt Still at Collection is Allowable

As we reported in a recent Payment Matters article, the United States District Court for the District of Columbia ruled this spring, for a second time, that a Medicare contractor is not permitted to disallow Medicare bad debt...more

7/2/2013 - Bad Debt CMS Collection Agencies Debt Collection Medicare

CMS Provides More Information on New Medicare DSH Payment Calculations

In the proposed federal fiscal year (FY) 2014 inpatient prospective payment system (IPPS) rule, CMS provided added details on the new Medicare disproportionate share hospital (DSH) calculation methodology. The provisions of...more

5/30/2013 - CMS DSH Healthcare Hospitals Medicaid Medicare Physician Payments

CMS Proposes New Standard for Hospital Inpatient Admissions

As part of its proposed inpatient prospective payment systems (IPPS) rule for FY 2014, CMS introduced a new standard for determining whether an inpatient admission to an acute care hospital is appropriate. Specifically, CMS...more

5/17/2013 - CMS Healthcare Medicare Medicare Part B Physicians

The New DSH - Are You Supplying The Correct Data That Will Drive Your Payments?

Effective October 1, 2013, CMS will begin paying disproportionate share hospitals differently. Congress ordered the change to the disproportionate share hospital (DSH) adjustment payment methodology as part of the Patient...more

4/8/2013 - Affordable Care Act CMS DSH Healthcare Hospitals Payment Plans Uncompensated Care

D.C. District Court Again Rules That Bad Debt at a Collection Agency is Allowable

The United States District Court for the District of Columbia recently ruled, again, that a Medicare contractor is not permitted to disallow Medicare bad debts solely on the ground that the bad debt is still at an outside...more

4/4/2013 - Bad Debt Collection Agencies Debt Collection Healthcare Hospitals Medicare

CMS Proposes Rules to Promote Efficiency, Transparency and Burden Reduction

CMS recently proposed rules [PDF] in response to President Obama’s directive to government agencies, Executive Order 13563, to reduce outmoded or unnecessarily burdensome rules. CMS estimates that the changes in the rules...more

3/7/2013 - Barack Obama CMS Executive Orders Healthcare

Expect Increased Medicare Denials for Incarcerated Beneficiaries and Unlawful Aliens

The Department of Health and Human Services’ Office of Inspector General (OIG) recently published two reports finding Medicare improperly paid providers millions of dollars for incarcerated beneficiaries and unlawful aliens...more

2/22/2013 - HHS Incarcerated Beneficiaries Medicare Medicare Claims Processing Manual OIG Unlawful Aliens

Recent PRRB and CMS Administrator Decisions: A Summary for Providers

In recently released decisions, the PRRB and the CMS Administrator addressed a number of issues of interest to many providers. Short summaries of those decisions are provided below. The PRRB and CMS Administrator post their...more

2/8/2013 - Allocation Statistics Bad Debt CMS Disproportionate Share Adjustments GME Healthcare Professionals Hospitals IME Medicaid Fractions Physicians PRRB SNF Teaching Hospitals

Extension of Time for Overpayment Recoveries in Fiscal Cliff Law Not as Broad as it Sounds

The recently passed fiscal cliff legislation, i.e., the American Taxpayer Relief Act of 2012 (Act) [PDF], includes a number of provisions addressing Medicare and Medicaid. One of these provisions extends the recovery period...more

1/18/2013 - American Taxpayer Relief Act CMS Extensions Fiscal Cliff Medicaid Medicare OIG Overpayment Recovery Laws Reopening Laws Social Security Act

Recent PRRB and CMS Administrator Decisions: A Summary for Providers

In recently released decisions, the PRRB and the CMS Administrator addressed a number of issues of interest to many providers. Short summaries of those decisions are provided below. ...more

12/14/2012 - CMS FTEs GME IME Medicaid Medicare SNF

Court Again Rules Medicare’s “Must Bill” Policy for Medicare Dual Eligible Bad Debts Is Reasonable

The United States District Court for the District of Columbia once again upheld the decision of the Secretary of Health and Human Services (Secretary) to deny reimbursement for Medicare bad debts associated with copayments...more

12/5/2012 - HHS Medicaid Medicare

AHA and Hospitals Sue HHS Over Claims Denials Involving Patient Status

In a suit recently filed in the United States District Court for the District of Columbia, the American Hospital Association (AHA) and several hospitals, assert that the Medicare Program improperly denied payment to hospitals...more


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