Effective for Federal District Court requests filed on or after 1/1/2015, the amount in controversy will increase to $1,460. The amount that must remain in controversy for review in Federal District Court requested before 12/31/2014 is $1,430. The amount that must remain in controversy for ALJ hearing requests filed before 12/31/2014 is $140. This amount will increase to $150 for ALJ hearing requests filed on or after 1/1/2015.

The Centers for Medicare and Medicaid Services has published 2 booklets; Reading a Professional Remittance Advice and Reading the Institutional Remittance Advice. Each booklet is designed to provide education to the provider or institution in how to read the remittance advice and includes actual screen shots with an explanation of what you will find on each screen. Private practices will want to read the “Reading a Professional Remittance Advice” booklet and non-private practices (i.e. institutional providers) will want to read “Reading the Institutional Remittance Advice” booklet. To access the booklets, click

CMS has updated the Inpatient Rehabilitation Facility- Patient Assessment Instrument (IRF-PAI) Training Manual with an effective date of October 1, 2014. Providers are encouraged to review the manual for any changes.  In particular, changes in signature requirements have been identified. The following signature guidelines should be utilized when completing the IRF-PAI:

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