Alice Harris on Medicare

Federal Long Term Care Staffing Mandates: Impacts on Facilities Across the Country and in Alabama

On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published its controversial final rule imposing minimum staffing requirements for long term care facilities (the “Final Rule”). When it takes effect on June...more

5/21/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Long Term Care Facilities , Long-Term Care , Medicaid , Medicare , Nursing Homes

Changing Hospice Certifying Physician Enrollment: Starting in June, Physicians Must Be Enrolled or Opted-Out of Medicare for CMS...

On April 26, 2024, the Centers for Medicare and Medicaid Services (CMS) issued Questions and Answers concerning new hospice enrollment requirements for certifying physicians (CMS Q&As). In a nutshell, as of June 3, 2024, the...more

5/8/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physicians

CMS Allows for the Coverage of Marriage and Family Therapists and Mental Health Counselors Services

For the first time, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can enroll as Medicare providers under provisions established in the Consolidated Appropriations Act of 2023. MFTs and MHCs can...more

12/13/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Part B , Mental Health , Telehealth

Billing Medicare or Medicaid? Understanding Your Audit Risk

If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies constantly monitor and audit...more

7/12/2023 / Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Administrative Contractors (MAC) , OIG , Recovery Audit Contractors (RACs) , Skilled Nursing Facility , SMRC

CMS Announces New “SNF 5-Claim Probe & Educate Review”

On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new nationwide audit of all skilled nursing facilities (SNF) and Hospital swing bed providers that submit claims for reimbursement to Medicare...more

6/20/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Administrative Contractors (MAC) , Skilled Nursing Facility

The End of PHE Flexibilities – How to Navigate Upcoming Changes in Healthcare

On January 30, 2022, President Biden announced that the Covid-19 Public Health Emergency (PHE) will finally end on May 11, 2023.[1] Since the PHE was declared on January 31, 2020, emergency declarations and waivers were...more

2/17/2023 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Coronavirus/COVID-19 , Infectious Diseases , Medicaid , Medicare , Public Health Emergency , Skilled Nursing Facility , Telehealth

CMS Designates More Providers as “High Risk”

On November 23, 2022, the Department of Health and Human Services and the Center for Medicare and Medicaid Services (“CMS”) passed a final rule that drastically changed the risk categories for certain providers when they...more

12/7/2022 / Background Checks , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Skilled Nursing Facility

OIG to Audit Nursing Home Services Rendered Prior to Inpatient Hospitalizations – Four Steps to Take to Prepare for the Increase...

Efforts to reduce avoidable inpatient hospitalizations among nursing facility residents have been ongoing for years. As an example of these initiatives, CMS ran a program from 2012 to 2020 focusing on long-stay long-term...more

10/25/2022 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Nursing Homes , OIG

The Accelerating Movement Towards Hospital Care in the Home Setting

The next time you step into an emergency room, you may learn the hospital can provide you with hospital-level services to treat your illness in your home. Until recently, the idea of hospitals providing services to patients...more

7/29/2021 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Home Health Care , Hospitals , Medicare

SMRC Intensified Auditing in 2021: What is a Supplemental Medical Review Contractor and What Are They Auditing?

The year 2020 saw much less medical review auditing, including a CMS suspension of audits between March 30 and August 3 of 2020. However, with the lifting of the CMS suspension, the CMS Supplemental Medical Review Contractor...more

6/14/2021 / Centers for Medicare & Medicaid Services (CMS) , GAO , MACs , Medicare , SMRC

Health Care Reimbursement: Experience Matters. The Who, What, When, Where, and Why of Healthcare Reimbursement Coverage,...

The laws and policies surrounding the financial relationship between payors and healthcare providers is healthcare reimbursement law. Our attorneys and consultants have broad experience handling matters involving the full...more

9/22/2020 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Reimbursements , TRICARE

CMS Releases Extensive Updated FAQs on Medicare COVID-19 Billing and Documentation Issues and Cares Act Provisions

On August 26, 2020, the Centers for Medicare & Medicaid Services (CMS) released extensive COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service Billing and certain provisions of the Coronavirus Aid, Relief,...more

8/31/2020 / 1135 Waivers , CARES Act , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Medicare

Alice Harris

Maynard Nexsen

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