Jessie McGill, RN, RAC-MT, RAC-MTA Every spring, the Centers for Medicare & Medicaid Services (CMS) releases the notice of proposed rulemaking (NPRM) for the next fiscal year’s (FY’s) payment policies and rates. This provides an opportunity for stakeholders and providers to respond during the comment period. Each year, the American …
On June 3, 2021, CMS announced that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical reviews for dates of service after March 2020. Early in the COVID-19 public health emergency (PHE), CMS held all medical reviews. In August 2020, CMS resumed post-payment reviews of items and services with …
Question: If an OBRA or PPS assessment is completed late but the ARD was set timely in the appropriate window, is there a financial penalty or is it just a possible survey tag? Answer from Jeff Taylor, RN: For Medicare, there is no financial penalty for late completion. However, other …
Question: A resident on Medicare Part A admitted to the facility from the hospital on 5/26. He was sent to the emergency department (ED) on 5/27 and remained there on observation until 5/29. He readmitted on 5/29. Then, that same day, 3.5 hours after returning, he fell in the facility …
The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), is releasing revised reporting requirements for recipients of Provider Relief Fund (PRF) payments. This announcement includes expanding the amount of time providers will have to report information, aims to reduce burdens on smaller providers, …
Understanding the technical and skilled level care requirements for Medicare A is always a challenge. We’ve broken down the process with our Skilled or Not? tool . This tool was originally published in April 2017. It has been revised. For permission to use or reproduce this article in full or in part, please …
MACs Resume Medical Review on a Post-payment Basis: Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program (intensive education …
by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC ICD-10-CM coding is not a skill nursing school conveys to students, yet it is one that nurse assessment coordinators (NACs) must acquire to perform their diagnosis coding duties competently. Medicare’s transition to the Patient-Driven Payment Model (PDPM) on October 1, 2019, elevated the …
Question: A resident admitted for skilled care under a Medicare Advantage (MA) plan. The plan did not require a 3-day qualifying hospital stay (QHS) and the resident was hospitalized for observation only. The resident has elected to disenroll in the MA plan and revert back to Original Medicare. Is this …
The newest Five-Star data is to be released on the Care Compare website on May 26, 2021. AAPACN recommends reviewing this data on the website to ensure it is correct, especially if the Five-Star preview reports released on May 18, 2021, were not reviewed. If facility leadership has any discrepancies …
