CMS Reverses Course on Requiring Independent Pharmacy Review

In a surprise reversal, the Centers for Medicare & Medicaid Services (CMS) has dropped a controversial proposed regulation that would require nursing homes to hire independent pharmacists to oversee residents’ medication regimens.  The proposed rule had been developed in response to the belief that relationships between long-term care providers and... Continue Reading →

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CMS Postpones Two Anti-Fraud Initiatives

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns.  Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January... Continue Reading →

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CMS Revises Initial Certification Process for HHAs

The Centers for Medicare & Medicaid Services (CMS) has issued revisions to the process Home Health Agencies (HHA) must undergo prior to initial certification.  The revised process adds an additional review of enrollment criteria performed by the Regional Home Health Intermediary (RHHI) or Medicare Administrative Contractor (MAC).  ... Continue Reading →

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Providers Face Greater Risk of Claim Denial Under New PPS Rules

Effective October 1, new PPS rules for fiscal year 2012 require nursing homes to diligently review claims prior to submission.  As previosly discussed, significant cuts in SNF reimbursement are aimed mostly at therapy services.   SNFs submitting claims under the previous rules can expect high rates of denials and rejections.  Even facilities... Continue Reading →

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