The Senate Finance Committee recently passed the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S. 2368). The Act, intended to improve the Medicare audit and appeals process, would not, in fact, improve the … [Read more...] about Proposed Appeals Legislation Leaves Unanswered Questions
Weekly Alert
Office of Inspector General Authorizes Hospitals to Discount or Waive Certain Drug Charges for Patients Classified as “Outpatients”
The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) released a statement on October 30, 2015 that advises hospitals that it will not administratively sanction them if they discount or waive charges for an … [Read more...] about Office of Inspector General Authorizes Hospitals to Discount or Waive Certain Drug Charges for Patients Classified as “Outpatients”
Revisions to “Two-Midnight Rule” Do Not Help Hospitalized Medicare Patients in Observation Status
In 2013, the Centers for Medicare & Medicaid Services (CMS) promulgated the Two-Midnight Rule, which, for the first time in the Medicare program’s 50-year history, determined patient status in a hospital by reference to time.[1] … [Read more...] about Revisions to “Two-Midnight Rule” Do Not Help Hospitalized Medicare Patients in Observation Status
COBRA III: Cautions for Employees of Small Businesses
The Center for Medicare Advocacy has been hearing more often from persons nearing retirement who work in small businesses, many of which have fewer than 20 employees. Questions include whether COBRA benefits[1] will be available to them after … [Read more...] about COBRA III: Cautions for Employees of Small Businesses
COBRA and Medicare, Part II
Continued health care coverage authorized by the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly referred to as COBRA, provides a great step forwarded in reducing gaps in insurance for people between jobs or losing coverage due to … [Read more...] about COBRA and Medicare, Part II
People with Medicare Beware: COBRA Is Not Coverage as a “Current” Employee
CautionAdvocates have seen an increase in the number of Medicare beneficiaries who have delayed enrolling in Medicare Part B, thinking, erroneously, that because they are paying for and receiving continued health coverage under COBRA, they do not … [Read more...] about People with Medicare Beware: COBRA Is Not Coverage as a “Current” Employee
Department of Health and Human Services Forum on Drug Pricing and Innovation
On November 20, 2015, Center staff attended a one day symposium hosted by the federal Department of Health and Human Services (HHS) entitled “HHS Pharmaceutical Forum: Innovation, Access, Affordability & Better Health.” The … [Read more...] about Department of Health and Human Services Forum on Drug Pricing and Innovation
Budget Act of 2015 Increases Penalties for Programs under the Social Security Act, Including Nursing Facilities
For the first time in 20 years, there will be an increase in the amounts of federal fines that nursing facilities may be required to pay for violating the Nursing Home Reform Law. A little-noticed provision of the Bipartisan Budget Act of 2015, … [Read more...] about Budget Act of 2015 Increases Penalties for Programs under the Social Security Act, Including Nursing Facilities
Discharge Planning: Tips for Evaluating a Hospital’s Skilled Nursing Facility Placement Choices
Medicare beneficiaries often need care in a Medicare- participating skilled nursing facility (SNF) after an inpatient hospitalization. For these patients, hospitals are responsible for identifying skilled nursing facilities within the … [Read more...] about Discharge Planning: Tips for Evaluating a Hospital’s Skilled Nursing Facility Placement Choices
Update: Medicare Coverage for Ambulance Services
On Friday, October 23, 2015, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of the 3-year Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport in accordance with section 515(a) of … [Read more...] about Update: Medicare Coverage for Ambulance Services