Medicare Compliance & Reimbursement
WHAT'S MISSING FROM THE 2004 IRF PAYMENT UPDATE
Controversial 75 percent rule still unsettled. Inpatient rehabilitation facilities will get a 3.2-percent raise in 2004, the Centers for Medicare & Medicaid Services revealed in an Aug. 1 payment rule. But the fate of the much-maligned 75-percent rule still remains up in the air. The 75-percent rule requires rehab hospitals to show that at least three-quarters of their inpatient population over the most recent 12-month cost reporting period required "intensive rehabilitation services for 10 serious medical conditions," such as stroke, amputations and brain injuries. Providers have protested that the rule is so strict - not to mention outdated and inconsistent -that virtually no facilities would qualify for the IRF prospective payment system. A coalition of providers this summer called for the rule's repeal. CMS did not, as many hoped, offer a solution in its Aug. 1 payment rule. However, the agency promised to amend the 75-percent rule promptly -and stated that enforcement of the provision would be suspended until its new policy on the subject went into effect. To see the rule, go to http://www.access.gpo.gov/su_docs/fedreg/a030801c.html. Lesson Learned: Rehab facilities need to track the evolution of the 75-percent rule closely - how the cards fall will have a huge impact on their bottom line.
"After three months of discussion with the rehab community, we believe that we can articulate an appropriate compromise on the 75-percent rule," promises CMS Administrator Tom Scully.
Medicare Compliance & Reimbursement
- Long-Term Care:
BETTER PAY FOR HIGH-QUALITY CARE?
SNFs must prepare for a proposed link between payment and QI data. If a skilled [...] - HIPAA:
HIPAA, UNPREPARED PROVIDERS COULD CAUSE CLAIMS NIGHTMARES
Some provider groups are predicting a claims "train wreck." Three months before the Health Insurance [...] - Long-TermCare:
WHAT THE 2004 ADJUSTMENTS MEAN FOR NURSING HOMES
Industry braces for much-needed cash infusion. Skilled nursing facilities are in for a significant payment [...] - Medicare Reform:
DISCOUNT CARD AGREEMENT PUTS MOMENTUM BACK IN MEDICARE REFORM NEGOTIATIONS... BUT FOR HOW LONG?
House and Senate Medicare conferees have reached a "tentative agreement" on rules for prescription-drug discount [...] - HealthPlans:
WHY HEALTH PLANS HATE THE IDEA OF MEDICARE 'REGIONS'
The White House, House, and Senate all want to ensure health-plan choices for Medicare beneficiaries [...] - DME:
WHEN IS IT OK TO GIVE A FREE UPGRADE?
It's more often than you might think. Some suppliers might be scared off from furnishing [...] - Rehab:
WHAT'S MISSING FROM THE 2004 IRF PAYMENT UPDATE
Controversial 75 percent rule still unsettled. Inpatient rehabilitation facilities will get a 3.2-percent raise in [...] - Hospitals:
CMS PROPOSES 3.8-PERCENT OPPS UPDATE
Hospital payments under the outpatient prospective payment system would get a 3.8-percent increase under the [...] - Pharmaceuticals:
LOOKING INWARD ON MEDICAID PRICING, REBATES
Sparked by federal scrutiny, drugmakers examine compliance practices. Medicaid rebates and drug pricing issues are [...] - Rehab:
HOW RELATED PARTY ISSUES CAN LAND PROVIDERS IN PRISON
When a compensation package is too good to be true. A Missouri rehab operator capped [...] - Physicians:
PHYSICIAN FACES 'SHOCK' PROBATION
Upcoding leads to weekends behind bars Health care fraud enforcers are using the latest trends [...] - HomeCare:
LAWMAKERS COULD TARGET HOME CARE FOR CUTS
It just may have become more difficult to get negative home care provisions out of [...] - Medicare+Choice:
2 FLORIDA M+COS BUSTED FOR MARKETING VIOLATIONS
As the competition to enroll Florida seniors in Medicare+Choice plans heats up, more health plans [...] - PROGRAM MEMO ROUNDUP
Starting Jan. 1, 2004, patients will have a better sense of what's going on if [...]
