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We ask for your help in making noise on the Hill to EDUCATE our representatives and the healthcare industry on Portable Diagnostics and its value (avoiding unnecessary hospital visits by bringing x-rays & diagnostics to the elderly-saving lives & money), ADVOCATE for fair and equal transportation reimbursement for ALL states and PUSH for Fair inclusion in policies that matter to our patients & industry. 
  

OUR MISSION AND WHO WE ARE

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ARE YOU CODING THE PLACE OF SERVICE CORRECTLY? PAY ATTENTION! OIG has released a report on an audit they conducted on 5/30/23 finding that providers are not using the correct place of service code when filing for the professional component for a PartA patient. CMS has been instructed to create edits to track these overpayments and request recoupments. MEMBERS ONLY-sign in and go to the Resources tab/Medicare for full report. 

IMPORTANT DATES:
October 2023-Revisions to IDTF -Learn more about revisions to IDTF standards-Members Only-login and go to Resources Tab
855R Form is discontinued as of November 1, 2023 and is incorporated into 855I​
NEW ABN FORM CMS R-131 - START USING 6/30/23 read More for Members Only-login and go to Resources Tab
NEW PLACE OF SERVICE CODE effective 10/1/2023 new place of service code 27 for “Outreach Site/Street” - A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals.
ALJ Hearing Amount in Controversy remains the same for 2024 -The amount that must remain in controversy for reviews in Federal District Court requested on and after 1/1/24 has been reduced. For more info-MEMBERS ONLY-sign in and go to the Resources tab/Medicare CMS.

APDA'S WORK FOR ITS MEMBERS AND THE INDUSTRY CONTINUES TO PAY OFF!
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November 29, 2023 Medicare Advantage: A not so advantageous deal for Beneficiaries and Providers
The Centers for Medicare & Medicaid Services has been notoriously laissez-faire when it comes to Medicare Advantage, likely due to the revolving door between CMS and the insurance industry

November 30, 2023 Growing shortage of Radiologists and Technologist and overutilization of unnecssary exams was the biggest topic discussed at RSNA meeting this week
"The large volume of wasteful procedures is impacting patients in bad ways. We are exposing people to radiation, there is a greater fraction of false positives that then lead to over treatment and over diagnosis, the cost is staggering, and we are frankly running up against a limitation of our capacity. Especially after the great resignation, we simply don't have enough manpower to keep up with this," Bruno said. 

November 16, 2023 Visiting Nurse Health System partners with Dispatch Health

November 15, 2023 California SNFs owner and management agree to a $45.6M consent judgement to settle allegations of kick backs from Referring physicians
From 2009 to 2021, the SNF Defendants, under the direction and control of Thekkek and Paksn, systematically entered into medical directorship agreements with physicians that purported to provide compensation for administrative services, but in reality were vehicles for the payment of kickbacks to induce the physicians to refer patients to the six SNFs

November 15, 2023 CMS releases final rule for Transparency of Nursing Home Ownership
The final rule requires nursing homes enrolled in Medicare or Medicaid — the majority of this country’s nursing homes — to disclose additional information regarding their owners, operators, and management; for example, nursing homes will disclose individuals or entities that provide administrative services or clinical consulting services to the nursing homes. Nursing homes will also be required to disclose entities that exercise financial control over the facility, such as an organization the nursing home hires to manage all of its financial matters.

November 8, 2023 Kaiser Permanente Imaging Techs strike
More than 900 imaging technologists and pharmacy personnel with the Kaiser Permanente health system are on strike this week as their union seeks a new four-year contract.

November 7, 2023 CMS' Goal to Enroll all Medicare Beneficiaries in ACOs by 2030. 

November 6, 2023 Occupancy for SNF's increasing-Optimistic Economic Outlook
Occupancy for skilled nursing facilities (SNFs) increased nationally by 40 basis points month-over-month through October 22, 2023, following a prior increase of 15 basis points, according to BMO Capital Markets’ analysis on SNF REIT occupancy data for October.

October 31, 2023 By repeatedly denying claims, Medicare Advantage Plans threaten rural Hospitals and patients
Deny, Deny, Deny “They don’t want to reimburse for anything — deny, deny, deny,” Dr. Kenneth Williams, CEO of Alliance HealthCare, said of Medicare Advantage plans. “They are taking over Medicare and they are taking advantage of elderly patients.”

October 27, 2023 Feds pitch overhaul to lambasted out-of-network billing dispute resolution process
Unveiled Friday afternoon, the proposed rule (PDF) brings new requirements for payers, providers and the third-party arbitrators who settle out-of-network billing disputes under the No Surprises Act’s independent dispute resolution (IDR) process.

October 27, 2023 ACHA Signs Coalition Letter Urging Congress to halt Medicare Part B policy that would harm resident access to care
In response to this controversy in 2021, Congress delayed implementation of the code until at least 2024. In the 2024 Medicare Physician Fee Schedule (MPFS) proposed rule, CMS proposes moving forward with implementation of G2211 and estimates that it is responsible for 90% of the overall budget neutrality cuts to providers such as physicians, therapists, portable-ray and other suppliers of services to AHCA/NCAL member residents that CMS proposes for 2024. 

October 25, 2023 ACR study projects 5 fold growth in FDA approvals of AI imaging products by 2035
Assuming that future funding follows the same linear trend it has previously, the study projects funding will be $30.8 billion in 2029, which would lead to FDA-approved products in 2035.

October 25, 2023 Advocates warn of slower sales as Nursing Home ownership law begins
The new law, which took effect Oct. 1, comes amid a push by state attorneys generals and federal lawmakers to increase transparency around facility ownership structures.

October 19, 2023 OCR posted a detailed Cybersecurity Newsletter which outlines both the HIPAA Privacy and Security Rule requirements. The Newsletter provides an outline of what your organization’s sanction policy should contain, along with a list of hyperlinked resources. Click Here to read OCR’s newsletter!

October 11, 2023 Mobile Imaging Provider pays $85M for false claims stemming from alleged referral scheme

October 10, 2023 ACR adds 9 new topics to its influential imaging appropriateness criteria
“These updates to the ACR Appropriateness Criteria will assist referring physicians and other providers make the most appropriate imaging or treatment decisions for specific clinical conditions,” Mark E. Lockhart, MD, chair of the college committee dedicated to this topic, said in an Oct. 10 announcement.

October 6, 2023 Aetna may have received $25.5M in MA overpayments for 2015-2016 audit finds

October 6, 2023 Radiology impacted by tens of thousands of Kaiser Permanente Healthcare workers on strike
Radiology is among the specialties impacted by tens of thousands of health workers across five states and D.C. who recently went on strike at Kaiser Permanente. October 10, 2023-update- Strike ends for Now READ MORE

October 3, 2023 Owners of a California Mobile Phlebotomy company each sentenced to 15 months in prison for Medicare Fraud
According to court documents, between Dec, 1, 2015, and Dec, 1, 2020, Santibanez and Hazard ran a mobile phlebotomy company, PhlebXpress Inc. that provided phlebotomy and other medical collection services at patients’ homes and long-term care facilities in Sacramento and elsewhere. Santibanez and Hazard agreed to bill Medicare for services provided that were not reimbursable by Medicare. Santibanez and Hazard also agreed to bill Medicare for overstated mileage that PhlebXpress phlebotomists traveled.

October 3, 2023 Inside the I-SNP Journey: Nursing Homes unlock promise of Medicare Advantage with 3 different models
Medicare Advantage Institutional Special Needs Plans (I-SNPs) are undergoing rapid growth, with operators pursuing distinct strategies meant to realize financial and operational gains.

October 2, 2023 Cigna will pay $172M for allegedly filing false claims lacking necessary imaging to back diagnosis
 “The reported diagnoses of serious and complex conditions were based solely on cursory in-home assessments by providers who did not perform necessary diagnostic testing and imaging. Cigna knew that these diagnoses would increase its Medicare Advantage payments by making its plan members appear sicker.”

October 1, 2023 CMS surprise: 4% SNF pay raise 
Nursing homes will see a higher-than-expected 4.0% increase in their Medicare Part A payments starting Oct. 1, thanks to a finalized Centers for Medicare & Medicaid Services rule published in August.

September 28, 2023 FDA clears mobile 1.5T MRI system
The machine is designed to be transported to an off-site location, effectively providing access to MRI scans from anywhere.In the statement announcing the FDA clearance, the vice president of magnetic resonance at Siemens said the company is dedicated to mobile imaging and providing people, regardless of location, access to the latest technology.

September 28, 2023 SNFist practice General Medicine driven out of business by False Claims Allegations must face trial
GM’s model relied on physicians and nurse practitioners to provide care exclusively for patients in client skilled nursing, rehabilitation, assisted living and other long-term care facilities, all of it overseen by Prose as senior medical director.

September 27, 2023 Gaming keyboards could revolutionize Radiologist engagement with pacs 
Specialty keyboards designed for video games, however, could be a solution, allowing users to personalize the use of each button to “simplify complex tasks into single-touch actions.”

September 22, 2023 These 10 Largest Nonprofit Nursing Home providers own 30% of Facilities Nationwide
Over the past decade, the nonprofit nursing home sector has experienced steady growth, with an average annual growth rate of 2.2%, while mergers and acquisitions activity has resulted in the ten largest providers representing nearly 30% of all facilities in the industry.

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