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CMS/Medicare
The Centers for Medicare & Medicaid Services (CMS) is a department of Health and Human Services (HHS). The current administrator is Seema Verma, appointed by President Donald Trump.
CMS oversees the Medicare and Medicaid programs. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud, waste and abuse within the health care system.
What's ahead for the industry and how can you prepare?
On November 16, 2012 CMS issued a final rule titled “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013”.
WASHINGTON, D.C. (September 8, 2015)—Today, the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (CMS OMH), unveiled the first CMS plan to address health equity in Medicare. The CMS Equity Plan for Improving Quality in Medicare (CMS Equity Plan for Medicare) is an action-oriented plan that focuses on six priority areas and aims to reduce health disparities in four years.
States spend millions of dollars every year on fraudulent home care bills
WASHINGTON D.C. (September 2, 2015)—When the four DME MACs released draft local coverage determinations (LCDs) for lower limb prosthetics on July 16, they had no idea what they were in for.
WASHINGTON, D.C. (August 27, 2015)—From July 20 through 24, 2015, Medicare Fee-For-Service (FFS) health care providers, clearinghouses, and billing agencies participated in a third successful ICD-10 end-to-end testing week with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim, and submitter types.
Know the standards, and be prepared for site visits
Capitalize on industry innovation to achieve success for years to come
Recent government initiatives and changes from the Department of Labor may impact individuals and businesses employing home health caregivers
Lead the way through the changing regulatory landscape with new technology developments
As more baby boomers reach the geriatric age, there is a growing shift toward home care options in lieu of more traditional care facilities and nursing homes
These audits may seem inevitable, but denials do not have to be part of the equation
Look for these modifications to take effect in 2015 and 2016
Costs are directly impacted by Medicare fraud, and consumers are the ones who suffer
Policy discussions cement the move toward this trend
Providers be aware that insurers must follow certain statutes and regulations under ERISA
Stay aware of medical coverage changes and what written proof you need upon request.
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