Outsourcing is a common practice in all areas of business, including the healthcare sector. Although this is a major expense for a hospital, it can have an effect on the wage index factor impacting Medicare reimbursement. The wage index factor is determined through a hospital’s wage index average hourly wage which includes both employees on […]
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Beginning July 1, 2019, Medicare will reject hospital outpatient claims if the service location address on the claim does not exactly match the address on record in the Provider-Enrollment, Chain and Ownership System (“PECOS”). Any discrepancies, such as the difference between “Road” vs “Rd” or “Suite” vs “Ste”, may result in substantial payment delays. In MLN Matters […]
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On April 23, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Proposed Rule for the Hospital Inpatient Prospective Payment System (IPPS) for Acute Care Hospitals. The proposed rule includes several significant changes to the wage index calculation impacting the wage index factors and rural floor calculation. It is important to understand and […]
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On April 4, CMS announced that for cost reporting periods beginning on or after October 1, 2019, providers must comply with a “longstanding” rule to claim reimbursement for crossover bad debts from the Medicare program. After this point, providers will be denied reimbursement for their crossover bad debts unless the underlying balances are logged to […]
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Centers for Medicare & Medicaid Services (CMS) issued a memorandum, about changes to the Five-Star Rating system on Nursing Home Compare that will go into effect in April 2019. CMS has also revised and posted the Technical User’s Guide reflecting these changes. Important highlights of the changes are: CMS will end the survey freeze on […]
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As value-based healthcare becomes the norm, strong clinical documentation improvement (CDI) programs are becoming more important than ever. Value-based healthcare is a healthcare delivery model in which providers are paid based on patient outcomes. The Center for Medicare and Medicaid Services (CMS) is implementing a quality payment incentive program as required by law. Value-based reimbursement […]
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On March 5, CMS announced updates coming in April 2019 to Nursing Home Compare and the Five-Star Quality Rating System. Per CMS, these changes will strengthen the tool for consumers to compare quality between nursing homes. These updates are to advance CMS’s goal to improve accuracy and value and promote quality improvement in nursing homes. […]
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Attention 340B covered entities participating with Anthem Blue Cross and Blue Shield: Effective April 1, 2019, Anthem requires that a “JG,” “TB,” or another relevant modifier be added to claims involving 340B eligible outpatient drugs under the Medicare Outpatient Prospective Payment System (OPPS). This decision by Anthem resembles the January 1, 2018 decision by the […]
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On January 31, 2019, the Centers for Medicare and Medicaid Services (CMS) released the revised Federal Fiscal Year (FFY) 2020 Public Use File (PUF). If your hospital requested any changes to the wage index or occupational mix survey data prior to the September 4, 2018 deadline, this file should include revisions your Medicare Administrative Contractor […]
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Effective January 20, 2019, the process for calculating Indiana Medicaid reimbursement rates for home health services has been repealed. In addition, the requirement to file the Indiana Medicaid home health agency cost report is no longer effective. These changes were made to Indiana Administrative code 405 IAC 1-4.2. Therefore, no Indiana Medicaid home health cost reports […]
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By Greg Jackson, CPA, Principal at Blue & Co. Many not-for-profit organizations rely on public support (grants and contributions) to finance their mission. When that public support includes donor-restricted grants and contributions, those restricted amounts must be reported and accounted for in accordance with the related restrictions attached to the funds. When recording a donor-restricted […]
In the past several years, hospitals have continued to feel the impact on revenue from Clinical Validation Denials (CVD). The need for a robust CDI team to capture support for clinical indicators while the patient is still in house is more imperative than ever. The other overwhelming piece for revenue cycle teams to manage is […]
Ensuring the long-term financial viability of a health system requires constant attention to the operating statement. This involves assessing the current state of your healthcare organization and critically comparing the current condition to industry and/or internal benchmark standards. Ultimately, this assessment assists management implement an ongoing margin improvement process to increase the likelihood of achieving […]
