Based on the OIG Audit Report: Financial Impact of Clustering Therapy Services During MDS Assessment Look-Back Periods for Texas Medicaid Residents of Long-Term Care Nursing Facilities, Texas HHS has issued a provider letter for Nursing facilities outlining best practices: ? Resident functional declines that do not warrant a significant change in status assessment (SCSA) should be clearly documented in the clinical record to support therapy evaluation and treatment orders. ? … [Read more...] about Nursing Facility Rehabilitation Services & Best Practices Provider Letter–Texas
OIG Finds Improper Payment for Skilled Nursing Facilities
The Office of Inspector General has this month, released a report entitled CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met. Under the law, post-hospital extended care is reimbursable when there is a 3-day consecutive inpatient hospital stay. According to the OIG, there was a lack of coordinated notification between hospitals, beneficiaries and SNF's. The OIG recommended additional … [Read more...] about OIG Finds Improper Payment for Skilled Nursing Facilities
CMS authorizes increase of $340 million in Hospice payments for FY 2019
Many families and health care providers are debating whether the Centers for Medicare and Medicaid Services, which runs Medicare (CMS) and Congress are doing enough to implement processes to protect patients and their families from hospice providers who may be exploiting the service. Recently, CMS finalized a $340 Million/ 1.8 percent increase in Hospice payments for Medicare Hospice providers. According to reports, the Office of Inspector General (OIG) at HHS synthesized 10 years of … [Read more...] about CMS authorizes increase of $340 million in Hospice payments for FY 2019
$434 Million in Financial Payments Improperly Issued by CMS to Insurers
In a new report by The HHS Office of Inspector General, the Centers for Medicare & Medicaid Services (CMS) was found to have wrongly funded $434.4 million in financial assistance payments to qualified health plan (QHPs) issuers for 461,127 policies. The audit revealed that the improperly authorized funding occurred in 2014, the first year the ACA law’s health insurance marketplaces went online. According to the report, CMS relied on insurers to verify that their enrollees were confirmed and … [Read more...] about $434 Million in Financial Payments Improperly Issued by CMS to Insurers
HHS Releases Report on Hospice Care Fraud in US
A report released recently released by the Office of Inspector General (OIG) at the US Department of Health titled: Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity has highlighted that hospice care fraud is a nationwide problem in the US. The report found that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care for Nursing home residents and other patients. When care is provided hospices’ inappropriate … [Read more...] about HHS Releases Report on Hospice Care Fraud in US
Three Federal Health Privacy Rules including HIPPA to be reformed by HHS
U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA) laws let providers share certain private information with patient family members and outside groups in emergencies; and now the U.S. Department of Health and Human Services (HHS) secretary Alex Azar confirmed that HHS will undertake an effort to reform federal health privacy rules, stating that "In the coming months, under the leadership of my deputy secretary, Eric Hargan, HHS will be releasing requests for information … [Read more...] about Three Federal Health Privacy Rules including HIPPA to be reformed by HHS
HHS OIG Releases Report Regarding Group Homes and Critical Incident Reporting
This January, the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) in conjunction with the Administration for Community Living (ACL) and the Office for Civil Rights (OCR) at HHS issued a report which detailed that "health and safety policies and procedures were not being followed. Failure to comply with these policies and procedures left group home beneficiaries at risk of serious harm. These are not isolated incidents but a systemic problem – 49 … [Read more...] about HHS OIG Releases Report Regarding Group Homes and Critical Incident Reporting
Provider Marketing Guidelines
Provider Marketing GuidelinesPurposeThe purpose of the Texas Provider Marketing Guidelines is to provide guidance to the State of Texas Medicaid fee-for-service, Medicaid Managed Care, Children's Health Insurance Program (CHIP), Children's Medicaid Dental, and CHIP Dental Providers, referred to as Medicaid, on permissible and prohibited provider marketing.The information provided is not intended to be comprehensive, or to identify all applicable state and federal laws and regulations. Providers … [Read more...] about Provider Marketing Guidelines
TEXAS STATE MEDICAID FRAUD CONTROL UNIT: 2013 ONSITE REVIEW
TEXAS STATE MEDICAID FRAUD CONTROL UNIT: 2013 ONSITE REVIEW OIG oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements. For fiscal years (FYs) 2010 through 2012, the Texas Unit reported recoveries of … [Read more...] about TEXAS STATE MEDICAID FRAUD CONTROL UNIT: 2013 ONSITE REVIEW
