The Office of the Inspector General (OIG) is once again calling for a review of critical access hospital (CAH) criteria for hundreds of small rural hospitals across the nation. The OIG released another report this month revealing that Medicare beneficiaries pay more for outpatient services at critical access hospitals than they would at an acute care hospital for the same services. The OIG found the following: Because coinsurance amounts were based on charges, Medicare beneficiaries paid nearly half the costs for outpatient services at CAHs. In 2012, beneficiaries paid approximately $1.5 billion of the estimated $3.2 billion cost for CAH

Noridian Healthcare Solutions, Medicare Administrative Contractor in the state of Washington, has issued a notice they will perform service specific probe review of 100 IRF claims in the state of Washington. For additional information on the probe, click HERE.

The Centers for Medicare and Medicaid Services has announced the Part B Premiums and deductibles for calendar year 2015. For the nearly 49 million Americans enrolled in Medicare Part B, their Part B deductible for calendar year 2015 will be

The Centers for Medicare and Medicaid Services (CMS) has responded to an inquiry by the American Physical Therapy Association as to when and whether physical therapists should use a new subset of modifiers that CMS announced in August 2014. At this time, CMS states for providers of outpatient therapy services to

The Centers for Medicare and Medicaid Services has announced changes to the nursing home rating system beginning in 2015. Beginning in 2015, CMS will implement the following improvements to the Nursing Home Five Star Quality Rating System: Nationwide Focused Survey Inspections: Effective January 2015, CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System. In Fiscal Year (FY 2014), CMS piloted special surveys of nursing homes that focused on investigating the coding of the

On October 6, 2014, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule detailing revisions to the Conditions of Participation for Home Health Agencies. This proposed rule represents the first update to the Home Health Agency Conditions of Participation since 1989. According to the CMS website, the provisions of the proposed rule include: Includes revisions to the Outcomes and Assessment Information Set (OASIS) requirements to update applicable electronic data transmissions to meet current federal standards. Expands the current patient rights requirements to clarify the rights of each patient, the process for conducting patient rights violation investigations, and

The Centers for Medicare and Medicaid Services has revised the Medicare Appeals Process fact sheet. This fact sheet is designed to provide education on the five levels of claim appeals in Original Medicare (Medicare Part A and Part B). It includes details explaining how the Medicare appeals process applies to providers, participating physicians, and participating suppliers, in addition to including more information on available appeals-related resources. To access the fact sheet, click

The Centers for Medicare and Medicaid Services has issued revised instructions how to complete Form CMS-1500, Form Version 02/12. This is the form that is used by physical therapists, occupational therapists and speech-language pathologists who are in private practice to submit claims to Medicare for payment of outpatient therapy services. To access the revised instructions,