With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% in 2021), the Centers for Medicare and Medicaid...more
In accordance with the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Center for Medicare and Medicaid Services (CMS) has expanded its current Accelerated and Advanced Payment Program for Medicare Part A...more
On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) released guidance expanding its Accelerated and Advanced Payment Program, which now allows most Medicare Part A and Part B providers and suppliers to...more
Report on Medicare Compliance 29, no. 7 (February 24, 2020) - Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more
Report on Medicare Compliance 29, no. 5 (February 10, 2020) - At least two Medicare administrative contractors (MACs) have set their sights on observation services, and there may be more to come. WPS is auditing...more
Report on Medicare Compliance 29, no. 2 (January 20, 2020) - CMS has agreed to pay a physical therapy practice $55,000 in a December settlement that’s at the intersection of claims and enrollment, and again runs into the...more
On October 26, 2018, CMS published Transmittal 839 (Change Request 10789) in the Medicare Program Integrity Manual (Pub. 100-08, Chapter 4/4.5 – 4/4.5.5). This Transmittal is meant to convey instructions to Medicare...more
In Banner Heart Hospital, et al. v. Burwell, the United States District Court for the District of Columbia (Court) held on August 19, 2016, that the Provider Reimbursement Review Board (PRRB) incorrectly declined to hear an...more
On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...more
Over the past decade, health care providers seeking to challenge Medicare claim denials have faced increasing delays in reaching what many consider the most important step in the Medicare appeals process - a hearing before an...more
Market Based Payment for Clinical Diagnostic Laboratory Tests - Summary - On June 17, 2016 the Centers of Medicare & Medicaid Services (CMS) issued the long awaited Medicare Clinical Diagnostic Laboratory Tests...more
Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) should not expand redeterminations and reconsiderations of claims denied on the basis of complex pre–or post–pay payments or automated...more