Manual Medical Review Process Update from CMS [02-22-13]

Filed under: Industry Updates — Editor @ 12:26 pm

cmslog4colCMS has posted an update regarding the Manual Medical Review (MMR) process to the Medical Review and Education page on the Therapy Cap (click here to be redirected to the page). Here is a portion of the update:  CMS is developing a long term strategy to deal with manual medical review. However, in the interim, Medicare Administrative Contractors (MACs) will conduct prepayment review on the claims reaching the $3700 threshold. CMS requested MACs conduct these manual medical reviews within 10 days. At this time, there is no advance request for an exception process. Additional information will be provided on the MAC websites. Section 603 (b) of the American Tax Relief Act counts outpatient therapy services furnished in a Critical Access Hospital (CAH) toward a beneficiary’s annual cap and threshold amount using the Medicare Physician Fee Schedule rate. CAHs are not subject to the therapy cap, the manual medical review process, or the use of the KX modifier. (more…)

Court Approves Settlement with HHS Requiring Coverage For Maintenance Therapy Services [02-07-13]

Filed under: Industry Updates — Editor @ 9:58 am

Glenda JimmoA previous Marden Industry Update Post on November 12, 2012 reported on a proposed settlement with the U.S. Department of Health and Human Services (“HHS”) in a class-action lawsuit concerning Medicare coverage for medical rehabilitation services. The proposed settlement of the case, Jimmo et. al. v. Health and Human Services Secretary, was given final approval by Chief Judge Christina C. Reiss in the U.S. District Court in Vermont on January 24, 2013. Under the settlement HHS will be required to apply a revised standard when determining coverage for rehabilitation services.  This impacts all services settings including SNFs, outpatient clinics and home health. (more…)

Early Signs of Progress on A Permanent Fix for Physician Fee Schedule [02-06-13]

Filed under: Industry Updates — Editor @ 1:52 pm

House Speaker Boehner Presides Over Opening Session Of CongressThe very early days of the 113th Congress have witnessed several developments which may augur that Congress will finally make a concerted effort to enact a permanent solution to the nearly decade-long problems created by the Sustainable Growth Rate (“SGR”) formula for the physician fee schedule. Under current law, providers reimbursed under the fee schedule face a nearly 30 percent reduction in payments on January 1, 2014 unless Congress takes action to prevent it. The recent developments of significance are described below. (more…)

The Cost of Long Term Care [02-06-13]

Filed under: Industry Updates — Editor @ 12:34 pm

mapSquared Away used data from Genworth, one of the nation’s largest insurers in the long term care insurance market, to generate a U.S. map with the median cost in each state of a semi-private room in a nursing care facility in October of 2012.  Click on the map for a larger view.

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