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CMS Proposes to Dramatically Increase Amount of Civil Monetary Penalties Imposed During Nursing Home Surveys

With Nursing Homes Still Struggling to Rebuild After the COVID-19 Pandemic, is This Advisable? When The Centers for Medicare and Medicaid Services (CMS) posted the PPS and Consolidated Billing Updates for Skilled Nursing...more

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

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

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

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

SMRC Targets for 2022: After Heavy Focus on Hospice, the SMRC Moves On to Home Health and Other Projects

The Supplemental Medical Review Contractor (“SMRC”) is a Centers for Medicare and Medicaid Services (“CMS”) contractor authorized to conduct nationwide medical reviews (Medicare Part A, Part B, and DME). As many in the...more

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