Tag Archives | review

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 pharmacy suppliers could conflict with the best interests of nursing home residents.

In response to overwhelming criticism, CMS has dropped the proposed regulation for now, which they acknowledged would be “highly disruptive to the industry.” Regulators “decided to further study the issue for future policy considerations,” Jonathan Blum, deputy director of the agency, said in a conference call with reporters.

CMS remains concerned about inappropriate medications for nursing home residents, and in a separate statement, encouraged nursing homes to voluntarily adjust how medications are prescribed or face stiffer regulations down the line.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

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 1, 2012.   Continue Reading →

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 →

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 billing under the new rules face denials and rejections for any errors or inconsistencies in the information submitted. 

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

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