Tip: Audits and the False Claims Act’s far reach

If the results of an internal audit determine that Medicare was billed inappropriately, the provider is in potential violation of the False Claims Act, which describes a violator as any entity or person that causes the federal government to make payments for goods or services that are a) not provided, b) provided contrary to federal standards or law, or c) provided at a level or quality different than what the claim was submitted for.
In other …

CMS releases updates to billing for flu vaccine

by The Bottom Line
Flu season is August to April. Make sure you’re prepared to start billing for the influenza virus vaccine by staying up to date on the latest code and payment allowance updates. So far, CMS has released the following two notices:
1. Payment allowances for the influenza virus vaccine are updated on August 1 each year. This year’s annual update has been released, according to a CMS MLN Matters article. Click here for 2018-2019 …

Resources for a smooth transition to PDPM

Brought to you by Biller’s Association for Long-Term Care.
As SNF and nursing home providers familiarize themselves with CMS’ new Patient Driven Payment Model (PDPM), The Bottom Line is here to keep you educated and up to date on the latest resources, guidance, and best practices as they are made available. Here are this week’s helpful resources for you to add to your PDPM toolkit.

Attend HCPro’s free webinar, Ready or Not: PDPM is Here, led by …

Two strategic responses to bundled payment models

Source: HealthLeaders Media
Medicare’s bundled payment programs are profoundly impacting the way acute-care providers are working with their post-acute care partners.
Hospitals and health systems participating in federal hip and knee replacement bundles are adopting two post-acute care strategies: limiting referrals to skilled nursing facilities and integrating with SNFs.
For hospitals, establishing strong relationships with SNFs can drive positive clinical outcomes and financial gains, researchers say.
“Linkages between hospitals and SNFs may be associated with reductions in readmission rates, …