Healthcare, Senior Living, Economics
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
The Medicare Payment Advisory Commission is (likely) recommending to Congress a series of post-acute rate reductions (Medicare, Fee-for-Service) for federal fiscal year 2025 (beginning October 1, 2024, for most programs, January 1, 2025, for Home Health Agencies). Specifically, the MedPAC recommendations are as follows. Reduce the 2025 payment rate for home health agencies by 7%. … Read more
On November 1, CMS issued the final PPS rule for Home Health (2024). The majority of provisions within this rule, especially those related to payment, take effect on January 1, 2024. The Final Rule as published is available for download here: Home Health 2024 Final Rule In July I wrote a post on the proposed … Read more
Back a few weeks ago I did a post summarizing the 2024 Final PPS Rule for Skilled Nursing Facilities. Recall, these rules come out yearly, updating payment rates and other provisions impacting payment and some, impacting policy. Typically, the initial or proposed rule starts in spring and then after comments, etc., becomes final during the … Read more
As foretold in the SNF PPS Final Rule, CMS was going to fine tune the MDS/RAI manual prior to October 1 when the new 2024 Fiscal Year starts. Generally, data such as this update comes much closer, sometimes even after the October 1 implementation date. Providers get a break for a change. Initial proposed changes … Read more
Back in early June, I wrote a post on how Medicare/CMS was intending to audit 5 claims from every participating SNF in the country. The audits would be staggered and conducted by MACs (Medicare Audit Contractors). That post is available here: https://wp.me/ptUlY-AR As we are now three months into the audit process, details are emerging … Read more
SNFs got a little early Christmas present yesterday when CMS announced its Final Rule (PPS) for Fiscal Year 2024 (begins October 1, 2023). Instead of a 3.7% increase as proposed in the initial rule, CMS finalized a 4% increase (plus an additional 0.3%). Back in April, I wrote about the proposed rule. That post is … Read more