| Total Medicaid spending is expected to grow 4.5% in FY17, according to a report published by the Henry J. Kaiser Family Foundation. To cut costs, almost all states have made or executed plans to move some long-term care services from skilled nursing facilities to community-based settings. | | An additional development request (ADR) may be triggered by a specific edit, the MAC will review all documentation submitted in response for compliance. Untimely, insufficient, or otherwise inappropriate ADR submissions can result in claim denials. Although providers may appeal such decisions, preventing denials in the first place can save valuable resources and promote prompt receipt of deserved reimbursement. For this reason, every hospice should have a written process in place for identifying and responding to ADRs effectively and should keep tabs on the care and billing areas currently under the MAC microscope. Read tips and advice on ADRs. | | The final report from the Alliance for Home Health Quality and Innovation (AHHQI)’s Future of Home Health Project was published online this month in the peer-reviewed journal Home Health Care Management and Practice. The article, “The Future of Home Health Care: A Strategic Framework for Optimizing Value,” outlines a plan for home health and home-based care and recommends a framework for the Medicare-certified home health agency of the future. | | Medicare health plans are being rated on a five-star scale due to a system implemented and published once a year by CMS. As a result of this quality-control technique, services provided by Medicare Advantage programs have improved, and enrollees are expected to reach 18.5 million in 2017, a 60 percent increase from 2010. | Recent CMS Events Tuesday, 10/25 - CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum | Product Spotlight Building solid operational and clinical processes is key for skilled nursing facilities (SNF) to stay compliant under the numerous Centers for Medicare & Medicaid Services (CMS) regulatory changes effective October 1. The evolving “volume to value” industry landscape brings with it more accountability, higher outcome standards, and incentivized payment systems. |
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