GAO: New payment rates for Part B lab tests may lead to billions in overpayments

Source: The Bottom Line
This post originally appeared on December 10, 2018 in Revenue Cycle Advisor.
Medicare’s new method of calculating payment rates for laboratory tests, intended to reduce Medicare spending by $360 million in the first year, could cost the agency billions in overpayments, according to a recent report from the U.S. Government Accountability Office.
CMS established new payment rates for Medicare Part B laboratory services, effective in 2018. CMS was required under the Protecting Access to …

Civil monetary penalties to fund new CMS quality improvement initiative

Source: The Bottom Line
CMS announced a three-year quality improvement initiative in a press release on November 20, 2018. The Civil Money Penalty Reinvestment Program (CMPRP) aims to improve residents’ quality of life by equipping nursing home staff, administrators, and stakeholders with technical tools and assistance to enhance resident care. The CMPRP is funded by federal civil money penalties, which are fines nursing homes must pay CMS by law when they are noncompliant with certain regulations …

KX modifier amounts announced for CY19

Source: The Bottom Line
The annual per-beneficiary incurred expense amounts are now known as the KX modifier thresholds. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law. CMS recently posted a MLN Matters article with these amounts for CY2019, which were lowered by …

CMS works with states, facilities to identify and address potential cases of inadequate staffing

CMS released a memo today regarding staffing in nursing facilities:
Today, the Centers for Medicare & Medicaid Services (CMS) announced actions that will bolster nursing home oversight and improve transparency in order to ensure that facilities are staffed adequately to provide high-quality care. These actions include sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses; clarifying how facilities should report hours and deduct time for staff meal …