Tag: Reimbursement
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MedPAC Report to Congress: A Wrap with Monday?
Yesterday I wrote a post on President Biden’s healthcare budget. Today, I thought a quick visit back to March and MedPAC’s Annual Report to Congress on payment and program adequacy would be a good “wrapper” – for now. Every year, MedPAC (the Medicare Payment Advisory Commission) reports to the Congress in March on the Medicare…
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Medicare, DOJ, Fraud and the Eclipse?
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…
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Wednesday Feature: Hospice Proposed Rule for 2025
Happy Hump Day! As I wrote in a post on Monday regarding CMS’ Proposed Rule for SNFs, ’tis the season. This time of year, is when CMS drops proposed changes to reimbursement and other programmatic elements for all provider types, save Home Health which comes a little later (Home Health rate year is calendar year…
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CMS Releases 2025 PPS Proposed Rule for SNFs
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…
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Analyzing the 2023 Cost of Care Survey: Trends in Long-Term Care Rate Increases
On Tuesday, the Genworth 2023 Cost of Care Survey was released. Year-over-year rate increases in long-term care/senior living ranged from 1% to 10%, depending on the setting (SNF, Assisted Living, etc.). The report is available here: Genworth Cost of Care 2023 The report is interesting though in some ways, a bit misleading as data is…
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Record-breaking $2.7 Billion Paid by Healthcare Providers in False Claims Act Cases
A couple of weeks ago, on February 22nd. the Department of Justice issued its annual statement regarding False Claims Act activity in FY 2023 (federal fiscal years run 10/1 to 9/30). “Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023. The government and whistleblowers were…
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Wednesday Feature: Navigating the Evolving Landscape – Enhancing Ethics and Compliance Programs for Risk Mitigation
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,…
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The Financial Struggle of Rural Hospitals: A Growing Concern for Healthcare Access
Among the many healthcare sectors I follow, rural healthcare has become my favorite. Oddly enough, it’s not because of the policy issues that exist, though it should be. It is because it is an overlooked sector and one that has a real risk of collapse. Last summer (2023) I wrote a post about the plight…
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Rising Tide of Audits: Brace Yourself for Increased Scrutiny on Skilled Nursing Providers in 2024
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…