The following information was obtained from the January 6 issue of the Texas Register: Public Hearing HHSC will hold a public hearing on January 18, 2012, at 9 a.m. to receive comment on proposed payment rates for the Medicaid Biennial Calendar Fee Review - Therapy Services provided by CORF/ORF. The hearing will be held in the Brown Heatly Building Public Hearing Room at 4900 North Lamar Boulevard, Austin. For more information, see the Texas Register. Proposed Rules The Texas Medical … [Read more...] about TX Register Updates: Medical and Nursing Board Changes
Medicaid Cuts in Texas
If you treat a patient who receives both Medicare and Medicaid, your reimbursement will be limited. Earlier this year, lawmakers eliminated the Medicaid co-pay to save money in the state budget. As a result, providers might turn away more Medicaid and Medicare patients. An excerpt from the Dallas Morning News: "Doctors have to make the difficult decision whether to continue to treat these patients even though it doesn't make any financial sense,” said Steve Levine, a spokesman for the Texas … [Read more...] about Medicaid Cuts in Texas
ILs and PL: Cost Reporting, 1915(c) Waiver
DADS released eight information letters and one provider letter. CLASS CSAs, CLASS DSAs, and CDSAs: Effective January 1, 2012, a CMA and DSA can bill for pre-enrollment assessment activities on the same day. (Letter) ICF/MRs: DADS issued this letter to guide providers on using video surveillance cameras to monitor common areas. An excerpt: There is no state rule or federal requirement that specifically addresses the use of video surveillance cameras in ICFs/ID; however, 42 Code of … [Read more...] about ILs and PL: Cost Reporting, 1915(c) Waiver
TX Register Updates: Plan B, MRA Changes
The following information was obtained from the December 30 issue of the Texas Register: Proposed Rules HHSC proposed new §351.507, adverse licensing, listing, or registration decisions by HHS agencies, in Chapter 351, Coordinated Planning and Delivery of Health and Human Services. The changes would permit agencies that license or regulate certain specified entities to consider adverse licensing decisions made by other HHS licensing agencies when considering a license application or … [Read more...] about TX Register Updates: Plan B, MRA Changes
Medicaid Funding Deficits for Nursing Facilities
The American Health Care Association (AHCA) has released a report that announced not-so-good news regarding Medicaid reimbursement. Such a study is no surprise, given state budget shortfalls and a health care law that will add millions more Americans to the Medicaid rolls. Medicaid payments to nursing facilities are about to get lower. An excerpt from McKnight's: Eljay [which conducted the study on AHCA's behalf] on analysts and AHCA state affiliates attribute the shortfall to a … [Read more...] about Medicaid Funding Deficits for Nursing Facilities
Proposed Changes to Cost Reporting and Auditing in Chapter 355
On November 10, 2011, HHSC presented proposed amendments to cost reporting and auditing rules to the Medical Care Advisory Committee ("MCAC"). The proposed rules impact Title 1 of the Texas Administrative Code at Part 15, Chapter 355, Subchapter A, §§355.101 and 355.107 and apply to of Intermediate Care Facilities for Persons with Mental Retardation, Home and Community-based Services, Service Coordination/Targeted Case Management, Rehabilitative Services, School Health and Related Services, and … [Read more...] about Proposed Changes to Cost Reporting and Auditing in Chapter 355
Former Houston Physician Sentenced to Federal Prison for Mail Fraud Related to Private Insurance Billing
On November 14, 2011, the U.S. Attorney's Office for the Southern District of Texas announced that a physician was sentenced for fraud regarding private insurance, Medicare and Medicaid. Armando Chavez, a former physician and owner of the Chavez Medical Group in East Houston, was sentenced to 60 months for conspiracy and 70 months for each of three mail fraud charges, all to run concurrently. Chavez was also ordered to pay $3,821,082 in restitution. The charges stem from improper billing at the … [Read more...] about Former Houston Physician Sentenced to Federal Prison for Mail Fraud Related to Private Insurance Billing
Four Habits of High-Value Health Care Organizations
The New England Journal of Medicine recently published an article regarding four habits of effective hospitals. Although the article is geared towards, hospitals, the principles below are applicable to any health care organization. Specification and planning - Base choices, transitions, subgroups, and patient pathway on specific, meaningful criteria. Infrastructure design - Create microsystems to meet the needs of patient sub-populations. The author stresses that microsystems create "an … [Read more...] about Four Habits of High-Value Health Care Organizations
Fall 2011 OIG Semiannual Report to Congress
The Office of the Inspector General ("OIG") recently issued its semiannual report for the period ending September 30, 2011. The report provides an overview of the enforcement actions over the past year. Of particular interest is the report's section of hospice care. Hospice care for nursing facility residents has grown nearly 70% since 2005. The OIG recommends that CMS monitor hospices that depend heavily on nursing facility residents and modify the payment system for hospice care in nursing … [Read more...] about Fall 2011 OIG Semiannual Report to Congress
ILs/News Alerts: HIPAA, HSC Billing Training
DADS released two information letters and two news alerts: Most LTC providers: HIPAA rules mandate that all Electronic Data Interchange (EDI) transactions must use EDI Version 5010. CMS has extended the December 31, 2011, compliance deadline until April 1, 2012. (Letter) ICF/MR: DADS reminds providers of their responsibility to maintain current and accurate information in ICF/MR Provider Characteristics using Client Assignment and Registration Screen 683 and the instructions for … [Read more...] about ILs/News Alerts: HIPAA, HSC Billing Training
