Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You
April 30, 2012 by Jerri Lynn Ward, J.D.
Filed under Assisted Living, Hospitals, Licensed Health Providers, Medicaid, Medicare, Nursing Homes, Operational Issues, Other Posts, Patient Protection and Affordable Care Act, Quality Assurance
Since October 2008, the Centers for Medicare and Medicaid Services (“CMS”) have not paid hospitals for certain hospital-acquired conditions. That is, CMS will not pay for certain conditions that were not present in the patient upon admission. The conditions are, as designated by CMS, conditions that are: (a) high cost or high volume or both, [...]
Social Media and Your Health Care Organization
April 30, 2012 by Jerri Lynn Ward, J.D.
Filed under Business, Employment, General Counsel, Media, Privacy Issues, Social Media
A new study on social media and health care shows that more than 1, 200 hospitals participate on 4,200 social networking sites. Social media is changing the nature of healthcare interaction, and health care organizations that ignore this virtual environment may be missing opportunities to engage consumers. From a marketing perspective, health care organizations and small businesses should [...]
DADS News Alerts: Medicare Part A Clarification, Meetings
April 25, 2012 by Jerri Lynn Ward, J.D.
Filed under Medicaid, Medicare, Nursing Homes
– CMS posted a second errata for the MDS 3.0 RAI Manual. The two PDF files: MDS 3.0 RAI Manual (v1.08) Errata v3 MDS 3.0 RAI Manual (v1.08) Errata v4 – CMS staff clarification of a Medicare Part A stay — When such a resident is discharged: [T]he Assessment Reference Date (ARD) of a scheduled [...]
ILs: Medicaid Hospice
April 23, 2012 by Jerri Lynn Ward, J.D.
Filed under Hospice, Medicaid, Medicare, Nursing Homes
DADS released four information letters: CLASS: DADS has changed the monitoring review period in conjunction with implementing new contract and fiscal compliance monitoring tools for CLASS CMAs and DSAs. (Letter) Medicaid Hospice: DADS will begin identifying the overall aggregate payments made to hospice providers during each hospice cap period using claims paid in State fiscal [...]
TX Register Updates: Dual Eligibles, TANF, and SNAP
April 23, 2012 by Jerri Lynn Ward, J.D.
Filed under Hospitals, Licensed Health Providers, Medicaid, Medicare
The following information was obtained from the April 20 issue of the Texas Register. Proposed Rules HHSC proposes to amend §354.1143, Coordination of Medicaid with Medicare Parts A, B, and C, which would authorize HHSC to make higher cost-sharing payments for dual eligibles for certain services if HHSC determines it’s necessary to ensure adequate access [...]
DADS News Alerts: Upcoming Meetings/Webinar
April 17, 2012 by Jerri Lynn Ward, J.D.
Filed under Medicaid, Nursing Homes
DADS has issued several alerts since April 10. An excerpt: – A CLASS Stakeholder Quarterly Webinar is scheduled for April 24, 2012, from 1-2:30 p.m. Register here. – STAR program training in Wichita Falls has been rescheduled for April 25 for 1915 (c) Waiver Program providers. Please see the March 16 bulletin titled, “Training Schedule [...]
ILs/PLs: LTC Payment, DFPS Investigations
April 16, 2012 by Jerri Lynn Ward, J.D.
Filed under HCS, Hospice, Medicaid, Nursing Homes
DADS released three information and two provider letters: CBA and HCSSA (revised letter): DADS case managers will add a dental buffer up to a maximum of $400 to each CBA initial ISP and annual reassessment, unless the amount of the buffer will cause the ISP to exceed the cost limit, effective April 19. (Letter) AFC, [...]
TX Register Updates: Contract Awards, Medicare Billing Prohibition
April 16, 2012 by Jerri Lynn Ward, J.D.
Filed under Home Health, Hospice, Licensure Issues, Medicaid, Medicare, Nursing Homes
The following information was obtained from the April 13 Texas Register: Public Notices HHSC announced several contract awards. See the Texas Register for a listing of the companies. HHSC intends to submit transmittal number 12-010, which would convert the reimbursement methodology for non-emergency medical transportation services from fee-for-service to full risk capitation in the following [...]
OIG Launches Compliance 101 Website
April 14, 2012 by Jerri Lynn Ward, J.D.
Filed under Business, Fraud, General Counsel, Home Health, Hospice, Hospitals, Licensed Health Providers, Medicaid, Medicare, Nursing Homes, Operational Issues, Physicans
On March 5, 2005, the Office of the Inspector General (“OIG”) launched its Compliance 101 website. The website contains links to guidance and educational training materials for health care providers, practitioners and suppliers. The site contains segment-specific compliance guidance for nursing facilities, ambulance suppliers, physician practices, etc. Although the materials are from 1998-2008, the compliance program guidance [...]
Provider News Around the Web
April 10, 2012 by Jerri Lynn Ward, J.D.
Filed under Medicaid, Physicans
Kaiser Health News reports on an study with expected findings: when times are hard, hospitals expand into affluent areas. In other words, hospitals seek more private-injured individuals. They also buy private practices in those areas and build more emergency services. The Texas Tribune reports that lawmakers will include drug reimbursements in the expanding Medicaid managed [...]
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