MAC Palmetto GBA releases many claims that were ‘incorrectly suspended’

Brought to you by Home Health Line.
Many home health agencies were taken aback in early June after receiving what appeared to be additional documentation requests (ADRs) from SafeGuard Services LLC, a Unified Program Integrity Contractor (UPIC).
But it appears some claims were “incorrectly suspended,” according to a post on Medicare Administrative Contractor (MAC) Palmetto GBA’s website.
UPICs help address fraud, waste and abuse by performing regional Medicare and Medicaid data analysis, complaint resolution and investigative activities, according …

AMA calls for funding of long-term care and support

The American Medical Association (AMA) announced during its 2018 annual meeting that it recognized the growing importance of long-term services and supports (LTSS). In 2015, national spending for LTSS exceeded $331 billion, more than half of which was funded by Medicaid.
According to AMA Board Member Stephen R. Permut, MD, JD, “Rising costs of everything from home ownership to higher education are making it harder than ever for Americans to save for retirement and the long-services …

CMS offers guidance for treating and funding better care for opioid addicts

On June 11, CMS released guidance aimed at partnering with states to ensure they have the necessary tools to address the opioid crisis. According to CMS:
This new guidance provides information to states on the tools available to them, describes the types of approaches they can use to combat this crisis, ensures states know what resources are available, and articulates promising practices for addressing the needs of beneficiaries facing opioid addiction. Notably, CMS released an Informational …

Reimbursement increased by 77% for brand-name Part D drugs

Brought to you by BALTC.
According to a report published by the OIG this month, total reimbursement for all brand-name drugs in Part D increased 77% from 2011 to 2015, despite a 17% decrease in the number of prescriptions for these drugs. After accounting for manufacturer rebates, reimbursement for brand-name drugs in Part D was found to have still increased 62% from 2011 to 2015.
The OIG conducted their review following concerns about the increase in …