Healthcare, Senior Living, Economics
On November 1 the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year 2025 Home Health Prospective Payment System (HH PPS) final rule, which updates Medicare payment policies and rates for Home Health Agencies. Unlike other Medicare provider types that have PPS rule updates corresponding to the federal fiscal year (10/1), home health … Read more
When the 2025 Final SNF PPS Rule was released, the focus was on Medicare rate increases. This is typically known as the “headline”. But as readers and followers here know, there is always a regulatory tidbit or two that can be even more significant in terms of operations, particularly as more and more Medicare patient … Read more
The mandatory Transforming Episode Accountability Model (TEAM) will advance CMS prior work on value-based care models, including bundled care initiatives. The TEAM model (participation) will be mandatory for selected hospitals and participation “optional” for post-acute care providers. Transforming Episode Accountability Model (TEAM) | CMS The Transforming Episode Accountability Model (TEAM) is set to be a … Read more
Under the Final 2025 (PPS) rule released last Wednesday, nursing homes are set to receive a 4.2% pay increase in Medicare Part A. Additionally, the facilities will encounter a stricter fines system, with civil monetary penalties being applicable in more situations. The Final Rule is available here: SNF Final Rule 2025 In April I wrote … Read more
Happy Eclipse Monday! The post title is meant as a bit of fun but there is a bit of relevancy as well. Billing fraud occurs via a process of hiding what actually has transpired (or should have) with the care of a patient. The most typical fraud is overbilling or charging the government for care … Read more
It’s that time of year again where CMS begins to drop various rule proposals for updates to provider groups under PPS. From Hospitals, to SNFs, to Home Health and Hospice, each industry segment will see a proposed series of rate and programmatic (rule) updates from CMS. This is normal and it occurs at about the … Read more
Within the normal news cycle, legislation often gets ignored, especially in this hyper volatile election cycle we have begun. I’m expecting very little in terms of reform or new legislation on important healthcare issues to come forward, and, so far, I’m right. With near gridlock due to small opposing majorities in both houses of Congress, … Read more
Happy Hump Day! Long title for what is going to be, a rather brief post. As followers and regular readers know, my firm (I am the co-founder and part owner) H2 Healthcare, LLC has a practice area uniquely concentrated on clinical compliance and complex litigation support. The practice area is headed by Diane Hislop, RN (yes, … Read more
In 2023, regulators re-instituted audits of facilities for inappropriate diagnoses of schizophrenia (justification for anti-psychotic use), plus a five-claim audit of every nursing home. The purpose of the audit was to address a long-standing concern that inappropriate coding was driving higher Medicare reimbursement under PDPM, despite documentation in patient records, not substantiating the level of care … Read more
Yesterday I wrote about MedPAC’s rate recommendations for SNFs for FY 2025. Recall, MedPAC makes these recommendations annually, assuming the full commission votes (in January 2024) for the recommendations as released by draft. The final recommendations go to Congress. Yesterday’s post was the “draft” position for SNFs. Today, I’m including summaries for Home Health, Hospice, … Read more