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, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been … [Read more...] about Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You
DADS News Alerts: Medicare Part A Clarification, Meetings
-- 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 Medicare Prospective Payment System (PPS) assessment may be adjusted to the day the resident is discharged only when the ARD for the scheduled PPS assessment was set prior to the day of … [Read more...] about DADS News Alerts: Medicare Part A Clarification, Meetings
ILs: Medicaid Hospice
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
DADS News Alerts: Upcoming Meetings/Webinar
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 for Providers of DADS 1915(c) Waiver Programs concerning the STAR program in the Medicaid Rural Service Area" for the updated information. -- Region … [Read more...] about DADS News Alerts: Upcoming Meetings/Webinar
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
TX Register Updates: Employee Vaccines, SSLC Staff Training
The following information was obtained from the April 6 issue of the Texas Register: Public Notices HHSC intends to submit to CMS a request for MDCP and CBA waiver program renewals. HHSC also intends to submit transmittal number 12-007, which would add tobacco cessation counseling services for pregnant women, and transmittal number 12-001, which would update the Medicaid State Plan section titled "Section One - Single State Agency Organization" to include current information on agency … [Read more...] about TX Register Updates: Employee Vaccines, SSLC Staff Training
Primary Care, Medicaid News
The shortage of primary care physicians and primary care in general has been widely reported. According to the Texas Tribune, for example, the federal government has declared Harris County a primary care physician shortage zone. The health care reform law will result in millions more Texans on the Medicaid rolls. Who will treat them? CMS announced a program to alleviate some of the pressure. The initiative will provide funds to hospitals to increase training for advanced practice registered … [Read more...] about Primary Care, Medicaid News
ILs/PL: Rule Reminders for HCS and TxHmL
DADS released three information letters and one provider letter: NFs: DADS notified NFs that the compliance date for the Automated External Defibrillator Requirement has been extended to September 1, 2014. (Letter) HCS and TxHmL: DADS rules require these providers to include in an individual's implementation plan a list outcomes and to document the progress or lack of progress toward the outcomes. Completing sample logs in the billing guidelines might not fulfill this requirement. … [Read more...] about ILs/PL: Rule Reminders for HCS and TxHmL
