Final rules published in August 2013 by the Centers for Medicare & Medicaid Services (CMS) created time-based rules for determining inpatient status in an acute-care hospital.[1] Under the rules' two-midnight presumption, a physician … [Read more...] about New Study: CMS’s New 2-Midnight Rule Increases Hospital’s Use of Observation Status
Weekly Alert
MSP Reporting Threshold Change – 2/18/2014
On February 18, 2014, CMS’s Financial Services Group announced in an Alert an important change in the reporting threshold for certain liability settlements, judgments awards or other payments required by Section 202 of the Strengthening … [Read more...] about MSP Reporting Threshold Change – 2/18/2014
2014 Income and Resource Information for Medicare Low-Income Programs
Programs that help low-income people afford their Medicare, including the Medicare Savings Programs and the Part D Low Income Subsidy (also called LIS or Extra Help) have income and resource eligibility guidelines that change yearly.The Federal … [Read more...] about 2014 Income and Resource Information for Medicare Low-Income Programs
Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed
If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years. Please read carefully.In addition to revising Medicare manual … [Read more...] about Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed
CMA Report: Inappropriate Use of Antipsychotic Drugs in Nursing Homes, Part Three – Recommendations to Improve the Citing of Deficiencies
As required by the 1987 federal Nursing Home Reform Law,[1] CMS has developed, tested, and periodically revised a survey protocol that state surveyors, who are generally employed by the state health departments, must use to determine nursing … [Read more...] about CMA Report: Inappropriate Use of Antipsychotic Drugs in Nursing Homes, Part Three – Recommendations to Improve the Citing of Deficiencies
Medicare Therapy Caps: A Call for Repeal
Medicare-covered outpatient physical, speech and occupational therapy services are subject to an annual dollar-amount payment cap. As a result, many Medicare beneficiaries have their therapy terminate prematurely when they reach the cap. … [Read more...] about Medicare Therapy Caps: A Call for Repeal
Medicare Hospice Care: We Want Your Stories!
Hospice is a program of care and support for people who are terminally ill. To qualify for Medicare hospice coverage, a doctor certifies that a person is terminally ill, with an expectation of six months or less to live. Once a person … [Read more...] about Medicare Hospice Care: We Want Your Stories!
Medicare Policy Manuals Revised as Required by Jimmo Settlement
As of December 6, 2013, Centers for Medicare & Medicaid Services (CMS) Policy manuals have been updated to reflect the settlement in Jimmo vs. Sebelius, No.11-cv-17 (D.VT, January 24, 2013). The manuals now make it clear that improvement is … [Read more...] about Medicare Policy Manuals Revised as Required by Jimmo Settlement
CMA Report on Inappropriate Use of Antipsychotic Drugs in Nursing Homes – Part Two: What the Surveyors Say
The Center for Medicare Advocacy (the Center) has reported on the misuse of antipsychotic drugs by nursing homes for many years, discussing Congressional hearings and federal reports and the high personal and financial cost of the misuse of the … [Read more...] about CMA Report on Inappropriate Use of Antipsychotic Drugs in Nursing Homes – Part Two: What the Surveyors Say
Replacing the Broken Medicare Physician Payment Formula: At What Cost for People with Medicare?
OverviewThe current Medicare physician payment formula, known as the "Sustainable Growth Rate" (SGR), was designed to control the growth in aggregate Medicare expenditures for physicians' services.[1] If … [Read more...] about Replacing the Broken Medicare Physician Payment Formula: At What Cost for People with Medicare?