Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You

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, [...]

TX Register Updates: Dual Eligibles, TANF, and SNAP

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 [...]

OIG Launches Compliance 101 Website

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 [...]

Medicare Cuts for Nursing Homes, Skilled Nursing

According to the Hill, nursing homes will see an 11 percent cut in reimbursements based on a “recapture” of extra payments. An excerpt: The American Health Care Association, which represents nursing homes, said the cut endangers thousands of jobs as well as the quality of nursing-home care. “This will threaten our ability to provide quality [...]

The True Impact of the “Never Events” Designation

Dr. Rich at the Covert Rationing Blog explains: The “never events” initiative – just as the Feds insist to us – is aimed at changing physicians’ behavior. But quite predictably, that behavioral change will not be in the arena of quality improvement (since no amount of quality improvement can stop “never events” that are inevitable). [...]