CMS announces post-acute participants for bundled payment initiative

The Centers for Medicare & Medicaid Services (CMS) has announced the most recent participants in its Bundled Payments for Care Improvement (BPCI) Initiative.
Under the BPCI Initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare.
There are four different models. This most recent round of providers will be participating in Model 3. In Model …

CDC releases new report on the state of long-term care

The Centers for Disease Control and Prevention (CDC) has released a new report titled “National Study of Long-Term Care Providers”.
According to the CDC, the report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the CDC’s National Center for Health Statistics (NCHS).
This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, …

Overpayments resulting from improper claims for ambulance services

On November 6, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 1311, which offered guidance on the contractor claim data, identified by suppliers, which were billing ambulance claims for SNF to SNF transfer separately under Part B. This was resulting in overpayments.
As a result of overpayment for a transport between two SNFs when a beneficiary is in a Part A covered SNF stay, CMS will implement an Informational Unsolicited Response (IUR) and Reject …

OIG releases report on Medicare A and B redeterminations

Earlier this month, the Office of the Inspector General (OIG) released a report titled, “The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness”.
According to the OIG, the Medicare appeals process serves as an important protection for beneficiaries and providers. Their study represents the first examination of redetermination, i.e., the first level of the appeals process for Medicare Parts A and B. This study contributes to OIG’s body of work concerning the …