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 year 2010. (Letter) Medicaid Hospice and NF: DADS clarified which provider is responsible for billing … [Read more...] about ILs: Medicaid Hospice
ILs/PLs: LTC Payment, DFPS Investigations
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, ALF, CBA, CLASS, CMPAS, DBMD, HDM, MDCP, PACE, TAS, and other providers: An excerpt on how to check for LTC claim payment information: Personal Needs Allowance … [Read more...] about ILs/PLs: LTC Payment, DFPS Investigations
TX Register Updates: Contract Awards, Medicare Billing Prohibition
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 designated counties: Collin, Dallas, Denton, Ellis, Hood, Hunt, Johnson, Kaufman, Navarro, … [Read more...] about TX Register Updates: Contract Awards, Medicare Billing Prohibition
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 is still relevant and details the high-risk areas for each health … [Read more...] about OIG Launches Compliance 101 Website
ILs/PL: LTC Claim Errors, Criminal History Checks
DADS released two information letters and one provider letter: AFC, ALF, CBA, CLASS, DAHS, HDM, Hospice, ICF/ID, NF, PACE, and other providers: Last year, LTC CMS processed over 15 million claims, which included 423,185 rejected claims and 456,967 denied claims. DADS provided guidelines to deal with the most common errors that delay LTC provider claim processing and payment An excerpt: Rejected Claims A rejected claim fails initial system edits, and is returned to the provider for … [Read more...] about ILs/PL: LTC Claim Errors, Criminal History Checks
ILs: Revised MDS 3.0, Hospice Forms
DADS released four information letters: All contracted NFs: CMS revised the MDS 3.0 Assessments, effective April 1, 2012. Details and revisions to the RAI Manual may be found on this CMS webpage. (Letter) ADC, ADF, CAS, CLASS, DBMD, MDCP, PACE, and other providers: CMS has mandated an April 1 deadline for all transactions to be compliant with EDI Version 5010. (Letter) CBA HCSSA, MDCP, HCS, and PACE: DADS is releasing a new version of the MN/LOC 3.0 assessment, effective April … [Read more...] about ILs: Revised MDS 3.0, Hospice Forms
IL and PLs: Adverse Licensing, Crime Reporting
DADS released one information and two provider letters. CLASS CSA, CLASS, DSA, HCS, TxHmL, CDA, and Local Authorities: DADS is expanding utilization management and review activities for its Medicaid community entitlement and waiver programs, effective January 1, 2012. (Letter) ADC, ALF, HCSSA, ICF/ID, and NF: Beginning March 1, 2012, if the name of an applicant or associated person is listed in a health and human services agency record of adverse licensing, DADS may deny the person's … [Read more...] about IL and PLs: Adverse Licensing, Crime Reporting
ILs and PLs: COLA Delay, ICF/ID Changes
DADS released three information and three provider letters: Community Care for the Aged and Disabled RC providers, CBA, AL/RC, and AFC: CMS recently announced a 3.6 percent COLA increase in federal benefits. Because of late receipt of this news, HHSC will not implement the increase until February 1, 2012. (Letter) NF, ICF, HCS, and TxHmL: HHSC will delay the COLA increase in Retirement, Survivors and Disability Insurance, Supplemental Security Income, and Medicare Part A and B … [Read more...] about ILs and PLs: COLA Delay, ICF/ID Changes
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
IL and News Alerts: Hospice, MDS Conference
Medicaid Hospice: HHSC approved rate changes for the Medicaid Hospice program FY2012. You'll find the new rates at the HHSC Rate Analysis site. (Letter) A sample of recently released DADS news alerts: -- DADS revised Appendix XIV in the CBA provider manual, which updates ISP cost limits. -- DADS hosted a webinar on Oct. 25, 2011, to discuss the Dining Experience. The webinar audience submitted questions, and the answers are provided here. -- The 2012 MDS National Conference … [Read more...] about IL and News Alerts: Hospice, MDS Conference