NOVEMBER 2ND-4TH, 2022



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                   TAKE ACTION!

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)FIGHT for fair and equal transportation reimbursement for ALL states and PUSH for Fair inclusion in COVID waivers and provider relief funds. 


It is your voice that matters, your voice that changes opinions, and your voice that moves legislators to support our industry and profession. 

July 27, 2022 FRUSTRATED WITH ADVANTAGE PLANS? Well, Tell the Senate to Support the Improving Senior's Timely Access to Care Act of 2022
The House of Representatives passed the Improving Seniors' Access to Timely Care Act by a voice vote! Now it's time for the Senate to act! Senators Marshall, MD (R-KS) and Sinema (D-AZ) have introduced their companion legislation - The Improving Seniors' Timely Access to Care Act (S.3018). Like the House bill, this bipartisan legislation would require Medicare Advantage plans to adopt transparent prior authorization programs that adhere to evidence-based medical guidelines and hold plans accountable for making timely prior authorization determinations and providing rationales for denials. There are only a handful of days left this year for the Senate to get this over the finish line, Please click the button below to complete this quick form to contact your Senators today and urge them to co-sponsor the Improving Senior's Timely Access to Care Act

Are you looking for guidance on policies, billing issues & more? Sign on to this website & go to the Resources tab for information on polcies and procedures for Medicare, CMS, Advantage plan, Regulations & more. This resource is for Members Only.
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Join today and receive bi monthly newsletters, valuable resource materials and discounts on conference fees. 

Reminder Deadlines:
Deadlines for Reporting $10,000 in aggregate payments received 1/1/2021-6/30/2021 Period 3 is 7/1/2022-9/30/2022

OIG AUGUST 2022 WORK PLAN - includes plan to audit clinical laboratory payments for 2021

9/26/2022 More than 100 medical societies push congress to end destructive cycle of annual Medicare cuts
More than 120 medical societies have joined the American Medical Association (AMA) in a letter urging congressional leaders to work with the physician community to enact long-term solutions to the systemic problems in the Medicare physician payment system. The letter also called on Congress to take action to prevent scheduled Medicare payment cuts from going into effect in 2023

9/26/2022 CMS Releases Nursing Home Data on common Ownership in its latest Push for Transparency

Licensing officials, state and federal law enforcement, researchers and the public will, for the first time, be able to identify common owners of nursing homes across multiple locations.

9/26/2022 CDC: Some Nursing Homes can end indoor mask requirements
The CDC also made tweaks to other Covid-related guidance for health care providers in its latest batch of updates. Screening testing of asymptomatic health care personnel, including those in nursing homes, should be at the discretion of the facility. Separate guidance has been issued for residents admitted to nursing homes.

9/23/22 Industry Leaders split on Whether Skilled Nursing's future should seperate Long/Short term care

the big question is where long-term Medicaid beneficiaries would go if they’re not occupying beds in a nursing home.

9/20/2022‚Äč New CMS Data platform raises concerns about access, worker privacy
A technology change is raising concerns about data access and worker privacy as the Centers for Medicare & Medicaid Services transitions to a new, more secure data-reporting process.

9/20/2022 OIG partly blames CMS for Life Care Centers of America deficencies

A federal watchdog said a lack of communication by the Centers for Medicare & Medicaid Services may have caused infection control deficiency citations at Life Care Centers of America nursing homes between Jan. 2019 and May 2020.

9/14/2022 HRSA sends more PRF money, still reviewing Phase 4 applications
The Health Resources and Services Administration disbursed $60 million in Phase 4 PRF funds to 293 providers, leaving approximately $1.6 billion still to be given out.
There are still 1% of Phase 4 applicants to be reviewed, the agency noted.

9/8/2022 RBMA presses CMS to amend 2023 physician fee schedule

Warning that proposed new cuts in Medicare reimbursement could afflict U.S. healthcare with “severe and permanent damage,” the Radiology Business Management Association has presented CMS with detailed recommendations for stopping such a dire scenario from arising.

9/7/2022 Imaging referrers respond to government issued overutilization of musculoskeletal imaging notices
It was sent through the mail to practices with at least one practitioner in the top 20% of referrers in Australia for 11 imaging tests (lumbosacral or cervical spine, shoulder, hip, knee and ankle/hind foot).

8/25/2022 OIG adds investigation into SNF Medicare payments to related parties to the 2022 workplan

The agency will also look into whether Medicare reimbursement is sufficient to cover beneficiary care – particularly if overhead costs have increased while allocations for patient care decreased. see workplan

8/24/2022 Senate Finance Chair targets deceptive marketing tactics of Advantage Plans 
But the plans have come under rising scrutiny for fraud, false billing and misleading marketing tactics, sparking Wyden’s inquiry. Wyden last week sent letters to 15 states, including California, New York and Texas, requesting they provide information by mid-September on complaints from people enrolled in MA, so lawmakers can better understand any advertising or enrollment issues in the coverage when crafting legislation.

8/19/2022 CMS releases roadmap to the end of Public Health Emergency
The Centers for Medicare and Medicaid Services has released a roadmap to ending the COVID-19 public health emergency as health officials are expecting the Biden administration to extend the PHE for another 90 days after mid-October, according to Politico.
It is no surprise that the Biden administration will wait until after the November midterm elections to end the PHE.

8/18/2022 IDTF do's and don'ts when it comes to supervisory physician

So explained healthcare law specialist W. Kenneth Davis Jr., JD, in an online IDTF primer hosted by the Radiology Business Management Association (RBMA) Aug. 16.
Davis focused largely on regulatory compliance issues that can affect whether or not a site enrolled with Medicare as an IDTF will get paid for its services. Operational supervision was one of these, and it emerged as one of the topics to which he paid special attention.

8/16/2022 4% cut to Home Health Providers for 2023

“What is particularly disheartening about the proposed rule is home health is one of the least costly settings and is often the preferred settings for patients, and yet Medicare is choosing this moment [to] disinvest in it, when others are choosing to double in home-based care,” wrote the hospital system Mass General Brigham in comments

8/10/2022 AHCA/NCAL urges COVID emergency extension beyond October 13, 2022

“This pandemic is not over, but that does not mean our nation is dealing with the same situation as in 2020 nor even in 2021,” Parkinson (President & CEO of AHCA/NCAL) allowed in a letter to Secretary of Health and Human Services Xavier Becerra. Parkinson also observed “the virus continues to mutate into typically more contagious yet less severe variants.

8/8/2022 Scrutiny of Nursing Home corporation ownership fires up again on Multiple Fronts
Do you know who owns the nursing homes you service? Who do you go to for delinquent invoices? per Mcknights news, A chairman of a private equity firm defends the practice of chopping up nursing home ownership into separate companies as a “crucial legal maneuver that rehabilitated a struggling industry.”

8/5/2022 Introduction of the Linking Investors and Nursing Home Quality (LINHQ) Act. 

This legislation brings long-overdue transparency into nursing home ownership and financial activity. As private equity firms continue to move into the nursing home space, this legislation will shed light on whether Medicare and Medicaid funds are truly being directed to care for our nation’s seniors and individuals with disabilities. The bill requires nursing homes and parties with ownership interests to disclose ownership and financial information each year, down to the 5% ownership level, with penalties for non-reporting.

8/5/2022 New York queues up $3000 bonuses to hands on healthcare workers statewide
It offers bonuses to workers providing hands on healthcare (including technicians) at medicaid participating provider organizations. Qualified employees must be "front line health care and mental hygiene practitioners, technicians, assistants and aides that provide hands on health or care services to individuals". An employee is only qualified if they work for a qualified employer (as described above) and under an Eligible Worker Title . 

8/2/2022 Could CMS be listening to Provider complaints about Advantage Plans?
Until now, no one at CMS has publicly agreed to do more than monitor some of these issues. That could be changing. Maybe. 
Last week, in near lockstep with the CMS request for comment, a key House panel advanced legislation to reform the Medicare Advantage prior authorization process. The bill would force  MA plans to report to CMS how often they use prior authorization and their denial rates.

July 29, 2022 Fiscal Year 2023 SNF PPS Final Rule
CMS estimates that the aggregate impact of the payment policies in this final rule would result in an increase of 2.7%, or approximately $904 million, in Medicare Part A payments to SNFs in FY 2023 compared to FY 2022. 

July 27, 2022 CMS final rule gives Hospice 3.8% raise for 2023

The reimbursement hike is larger than the 2.7% the agency initially proposed for next year, which many providers and industry groups contended was too small in light of rising expenses

July 25, 2022 An Update on President Biden's Initiatives for Long Term Care
President Biden focused on four main objectives in reference to long-term care facilities and providers: 
Establish a new minimum staffing ratio to protect resident, Reduce room overcrowding, Strengthen value-based payment (“VBP”) to ensure taxpayers pay for quality care, Reinforce safeguards against unnecessary medications and treatments 

July 25, 2022 Most patient's aren't getting access to their medical records 
Other findings included 33% of patients receiving incorrect test results or erroneous medical reports—and close to half, 46%, saying they’ve experienced a misdiagnosis.

July 22, 2022 Employer faces ADA lawsuit even though it has no proof that employee has medical condition
A Pennsylvania long-term care provider is facing a lawsuit under the Americans with Disabilities Act even though the plaintiff, a fired employee, may not have a qualifying medical condition

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Upcoming Events

November 2-4, 2022
MGM Grand Hotel in Las Vegas

Save & Register Today! 

Key Speakers & Topics include:
  • Alec Alexander, J.D. & Robert Zinc, J.D., Healthcare enforcement, All about CMS 
  • Sue McNamee, APDA Board Member, the Future of Ultrasound Transport Reimbursement
  • Dawson Halliday, Owner of a Chick-Fil-A franchise, Creating a Successful Workplace Culture
  • Jeffery Baird, J.D., When the Part A Buck Stops
  • Scott Grinley, APDA Board Member, Growing your services
  • Jennifer Mora, Senior Counsel, Medical Marijuana in the workplace
  • Open Forum/Panel Discussion 

APDA encourages members to stay vigilant and monitor this Website Daily along with these sites:

CDC NEWS AND UPDATES, CMS NEWS AND UPDATES HHS News Releases, and Cares Act Provider Relief Fund updates

Click HERE for FAQs, updates & links to helpful resources.

Important Dates for Reporting

Recipients who received one or more payments exceeding $10,000, in the aggregate, during a Payment Received Period are required to report in each applicable Reporting Time Period as outlined in the table below. LEARN MORE

Reporting Period 2 Is Open

Providers who are required to report in Reporting Period 2:

  • The PRF Reporting Portal opened for Reporting Period 2 on January 1, 2022 & will remain open through March 31, 2022 11:59PM ET
  • Providers who received one or more General and/or Targeted PRF payments exceeding $10,000, in the aggregate, from July 1, 2020 to December 31, 2020 must report on their use of funds in Reporting Period 2.
  • The deadline to use funds for Payment Received Period 2 was December 31, 2021.
Upcoming Reporting Periods
  • Reporting Period 3 opens July 1, 2022
  • Reporting Period 4 opens January 1, 2023


    APDA Announces 2021 Tom Wuerstle Award

    • Monday, October 25, 2021
    • Admin


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    APDA Announces 2020 Tom Wuerstle Founders Award

    • Tuesday, October 27, 2020
    • Admin

    Congratulations Will Irwin! Will Irwin received an unexpected visit during Day 3 of the APDA Virtual Conference Member Business meeting. Michael Straecke, APDA Emeritus, Sharon Reilley, APDA Administrator and Ken Andrews APDA member from K & A X-ray showed up at Will's office (while he was on Live during the Virtual meeting) to present him with the engraved Waterford Crystal Decanter Tom Wuerstle Founders Award, commemorating Will's years of dedicated service. Michael gave a very warm and well deserved speech thanking Will for his years of dedication and tireless service to APDA. Congratulations WILL, Well Deserved!

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    APDA COVID-19 Information, Updates and Resources

    • Saturday, March 7, 2020
    • Admin

    Stay informed with APDA Covid 19 Updates Read More and Leave a Comment  

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