Jimmo: Opportunity to Focus on Quality of Life Issues for Our Most Vulnerable

Jimmo v. Sebelius – Medicare Lawsuit Summary

Jimmo V. Sebelius is a court case we have all been hearing about and reading about on the internet regarding quality of life. The case involved Medicare beneficiaries and The Center for Medicare Advocacy (non-for-profit) who filed a lawsuit regarding what they have termed the improvement standard by which Medicare beneficiaries who could benefit from services were denied services because they could not make enough progress. The Medicare regulations never held such language as the improvement standard; this was a general guideline that developed with increasing medical review of Medicare claims. Eventually, this standard was stated outright in claim denials for services such as therapy. The lack of progress was typically used to substantiate that the services were not medically necessary or worthwhile. Read more

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FDA Releases Recommendations Regarding Adult Portable Bed Rails

The U.S. Food and Drug Administration (FDA) released Consumer Guidance regarding portable bed rails safety and tips for caretakers on December 19, 2013. The recommendations were released because of the continuing injuries and deaths related to entrapment and falls associated with bed rail products. Overall, there is no standard definition for bed rails but they are typically divided into three distinct types: adult portable bed rails, child portable bed rails, and hospital bed rails. Adult portable bed rails are different from hospital beds, which feature a unified system of mattress, frame, and rails. Read more

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Change for Billing and Medical Review Notices

CMS has issued a memo, MM8268, stating that MACs are to redact the HICN number on all MRNs. MRNs are reconsideration request forms. The HICN will only show partial with asterisks in front, similar to what some credit card companies do when sending you a statement. This is to begin January 1, 2014.

See link below:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1296OTN.pdf

Skilled Nursing Facility (SNF) Alert Update – WPS Medicare eNews 5-23-13

This is an update to the issue identified where some SNF claims (type of bill 21x) were being cancelled erroneously for not meeting the three day qualifying hospital stay requirement when in fact the requirement was met. After further analysis by the Common Working File (CWF), it was determined that this only impacted SNF claims where the inpatient claim (type of bill 11x) posted on CWF contained dates of service less then four calendar days and the discharge date was equal to the SNF claim admission date. Read more

How can Therapy Services Impact your Five-Star Rating with CMS?

The Five Star rating system, upgraded in 2009, combined with increases in online rating systems that the consumer relies on to make decisions, has definitely made a splash in long term care. The Five-Star Rating system has somewhat changed the way we choose communities for our loved ones. Consumer behavior still supports word of mouth references, geographic proximity and appearances certainly are very important when choosing a community; however, many hospital case managers and area agencies are looking for those 5 little stars. Increased need for Five-Stars has also impacted who our hospitals choose to partner with for health services.  Let’s face it…even though this rating system doesn’t truly define you, it can make or break you. Read more

CRE: A newer and more persistent antibiotic resistant bacteria

The CDC has been tracking a resistant bacteria call carbapenem-resistant Enterobacteriaceae or CRE since 2001. This bacterium causes infections that are resistant to antibiotics and have affected people who are in or recently had inpatient medical care. CRE has affected 4% of short-stay hospitals and 18% of long-term acute care hospitals all having at least one case of CRE. Read more

Jimmo v. Sebelius – Medicare Lawsuit

Jimmo V. Sebelius is a court case we have all been hearing about and reading about on the internet. The case involved Medicare beneficiaries and The Center for Medicare Advocacy (non-for-profit) who filed a lawsuit regarding what they have termed the improvement standard by which Medicare beneficiaries who could benefit from services were denied services because they could not make enough progress. Read more

Medicare Change Alert

Multiple Procedures Payment Reduction [MPPR]:   What You Need to Know Read more

American Taxpayer Relief Act of 2012 Summary

While the last minute legislation is mostly known for the issue of the fiscal cliff and the arguments over taxes, the legislation is in large part a modified version of the Middle Class Tax Relief Act passed in April of 2012. Read more

Therapy Cap Fact Sheet

Medicare Part B Outpatient Therapy Cap and Exceptions Process

The Middle Class Tax Relief and Job Creation Act of 2012 (H.R. 3630) was signed into law on February 22, 2012. The law extends the Medicare Part B Outpatient Therapy Cap Exceptions Process through December 31, 2012. Read more