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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.
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HHS announces Immediate steps that the CMS is taking to assist providers affected by Change Health shut down
Optum Financial services has created a Temporary Funding Assistance Program for Change Health Providers
For provider organizations impacted by that payer system outage, ....established a temporary funding assistance support program to help with short-term cash flow needs.
March 12, 2024 CMS offers advance payment to providers affected by ChangeHealth cyber attack
March 8, 2024 UnitedHealth Group offers a timeline to restore ChangeHealth systems
Medical claims: We expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week. Many providers have had sucess filing claims by utilizing Optum Intelligent EDI (iEDI): A multi-payer web service and clearinghouse solution for all your EDI transactions. This service is free Learn more Here
March 6, 2024 Feds launch inquiry to assess private equity's impact on Healthcare
“When private equity firms buy out healthcare facilities only to slash staffing and cut quality, patients lose out,” FTC Chair Lina M. Khan said in a March 5 statement. “Through this inquiry the FTC will continue scrutinizing private equity roll-ups, strip-and-flip tactics, and other financial plays that can enrich executives but leave the American public worse off.”
March 5, 2024 Technologist files class action lawsuit claiming imaging provider violated labor laws
Plaintiff attorneys claim Digirad Imaging Solutions failed to pay minimum wages or overtime, along with shirking laws requiring regular meal and rest periods
March 5, 2024 Physicians urge HHS to tap emergency funds to help practices survive Change Health Cyber attack
Monday marked the 12th day providers have had to go without revenue due to disruptions at billing vendor Change Healthcare, the American Medical Association said March 4. This has placed an “enormous administrative burden” on medical groups, which have had to devise workarounds to submit claims, verify patient eligibility or obtain prior authorization.
March 5, 2024 Major data gaps persist as feds tackle Nursing Home Ownership transparency
Researchers continue to struggle to identify bad actors when approving changes in ownership or management,
March 1, 2024 DOJ collects $1.9B from Healthcare in 2023 with Imaging Provider making one of the biggest payout
February 29, 2024 ALERT! Change Healthcare cyberattack having an ‘alarming’ impact on physician practices, advocates warn HHS
Since the issue first arose on Feb. 21, providers in radiology and other specialties have experienced “substantial” billing and cash flow disruptions and limited electronic remittance advice from health plans. The Medical Group Management Association is imploring HHS to help mitigate these issues and prevent practices from having to take “drastic actions” to remain in operation.
February 21, 2024 Cyberattack temporarily shuts down United Health's ChangeHealthcare
A U.S. healthcare IT power player, Change Healthcare, announced Thursday that an outside cybersecurity threat has forced the company to disconnect systems, causing worldwide outages that the company said might linger.
February 16, 2024 RadNet launching career training to address Technologist shortage
The initiative comes as radiology providers face ongoing challenges hiring techs and other allied health professionals. Last year, the American Society of Radiologic Technologists reported that vacancy rates had hit record highs, including 18% among radiographers.
February 22, 2024 Nursing Home Mogul Phillip Estformes pleads Guilty to Medicare fraud, given no additional jail time or fines.
The Department of Justice agreed to drop five other counts against him.
February 16, 2024 California Hospice physician convicted of $2.8M Medicare fraud
As medical director of Hospice, Dr. Thropay of California fraudulently certified Medicare patients of Blue Sky Hospice as having terminal illnesses that the patients did not have so that Blue Sky Hospice could bill Medicare for hospice services.
February 14, 2024 Inside the Rash of Abrupt Nursing Home Closures
“Until a couple years ago, CMS was reluctant to terminate SNFs and generally only did so as a measure of last resort,” he said. “That seems to have changed.
February 13, 2024 Radiology errors rates unchanged in 75yrs - Can you see the Gorilla in the Image?
Per Radiology News, "We have to deal with this human factor. Good radiologists who are doing the right thing, who are knowledgeable, experienced, well trained, well rested, had their coffee, sitting the right chair, and their displays are bright enough, are still going to have a 3-4% error rate,"
February 6, 2024 Private equity-backed Premier Radiology inks long-term partnership with nation’s largest occupational health provider
“Handling thousands of patient scans daily requires a flexible system. Our advanced technological integrations ensure we always have the necessary resources, regardless of demand,” Drew Gaudet, co-founder and CEO of Premier Radiology, said Feb. 6. “This allows us to focus on providing targeted care to our occupational health patients quickly without being bogged down by technological concerns.”
February 2, 2024 Nursing Home Mogul Philip Estformes agrees to Plea Deal in Medicare Fraud Case
However, he is required to pay $5.5 million in restitution to the taxpayer-funded Medicare program. Additionally, he must pledge at least $14 million in assets towards his outstanding forfeiture penalty of $38.7 million
February 1, 2024 Radiology embracing the flexibility of Cloud Image Storage
Radiology is navigating towards cloud and enterprise imaging solutions to overcome IT challenges and unlock new possibilities for workflow efficiency, research, artificial intelligence and ultimately improve the quality of patient care.
February 1, 2024 CMS signals Medicare Advantage cuts in 2024
Medicare Advantage insurers could face an average 2.3% cut to baseline payments in 2024, the Biden administration said Wednesday. If the proposal stands, it would be a net cut of more than $3 billion to the industry.
January 31, 2024 Radiology at tipping point with limitations of RVUs and shortage of Radiologists
Is RVU still a good measure? How many reads in a day are too many? Can AI help?
January 30, 2024 Hospice Fraud back in the Spotlight with Home Health Agencies right behind
In one instance last year, 15 new hospices received Medicare certification, all operating from the same two-story building in Los Angeles, according to Pro Publica.The numbers point to something similar possibly happening in the home health industry.....
January 29, 2024 Layoffs Hit At-Home Care Innovator Dispatch Health
January 23 2024 OIG to audit CMS oversight of State contracted Nursing Home Surveyors
“It’s no secret that states are struggling to conduct surveys quickly and effectively,” Blackman and Muncy told McKnights in a written comment.
January 19, 2024 How the Chevron Case gives providers a chance to pick their poison - Federal agencies or Courts to have final say in interpretation of regulations.
In a nutshell, the High Court is going to let us know whether administrative agencies like CMS will continue to have the final say on what goes into legally binding regulations and how they’re enforced, or whether the courts should take more of that responsibility.
January 17, 2024 Billionaire Mike Bloomberg puts up $250 Million to open Healthcare High Schools for training Radiologic Technologists
Each location will offer robust academic programming, specialized healthcare classes, work-based learning at partner hospital systems, and a chance to earn necessary certification.
January 17, 2024 CMS to streamline prior authorization process that has plagued Radiology
Under the rule, CMS will require health plans to issue decisions on whether a service is covered within 72 hours for urgent requests and seven days for other standard claims. Beginning in 2026, the agency also will mandate that payers provide a specific reason for denying a prior authorization request. CMS additionally will require insurers to publicly report metrics on their denial of coverage for imaging and other services.
January 16, 2024 Medicare Advantage spending outstrips traditional Medicare by $88B
The federal government could pay Medicare Advantage plans $88 billion more this year than it would be spending if those seniors were in traditional Medicare, according to new data from congressional advisory group MedPAC.
January 11, 2024 New Jersey Lab pay $13M to settle kickbacks and unnecessary testing
RDx and Leykin allegedly paid commissions based on the volume and value of Medicare and Medicaid referrals to independent contractor marketers to arrange for and recommend that healthcare providers order RDx laboratory tests.
January 11, 2024 Portable X-ray provider sentanced to 15 years prison, $1,989.490 in restitution for Medicare fraud-appeal denied
The owner of a portable X-ray business has lost an appeal after arguing that his 2022 conviction should be tossed over the jury’s COVID-19 vaccination status
January 5, 2024 Errors in imaging orders - the burden of incorrect orders
“Combining tailored order options in the [electronic health record] with education and feedback on practice habits can improve the accuracy of imaging orders, thereby mitigating the overall order error rates,” Ariadne K. DeSimone, MD, a cardiothoracic radiologist with Brigham and Women’s, and co-authors wrote Jan. 2.
January 4, 2024 Effective January 1, 2024 Lab speciman fee gets an increase
January 3, 2024 New Federal Initiatives increase criminal enforcement concerns for SNFs & Providers
The White House announced in December it would be launching a cross-government public inquiry “into corporate greed in healthcare.” It includes the addition of new, high-ranking healthcare attorneys at three federal agencies with healthcare oversight.
December 21, 2023 Study: Hospital at Home May Relieve Caregiver stress
DispatchHealth has published findings from a case study assessing caregiver fatigue within the hospital-at-home model, and they suggest that in-home hospital alternative care may alleviate, not exacerbate, caregiver stress.
December 28, 2023 Medicare Advantage growth raises critical financial concerns
While MA plans cost the government 6% more per enrollee as opposed to traditional Medicare, MA continues to underpay providers
December 14, 2023 Congress adjourns for 2023 without a Radiologist pay fix
Key congressional committees had recently advanced legislation to offset a nearly 3.4% cut to the conversion factor next year. However, it appears the full House and Senate will not vote on a doc Medicare pay fix before the year’s end.
December 14, 2023 Radiologists lose market share of Medicare ultrasound billings to cardiologists in some settings
Radiologists have lost a substantial share of the ultrasound billing market in certain sites of service over the last decade while cardiologists have gained ground, according to new research.
December 13, 2023 White House announces plan to scrutinize private equity ownership in healthcare
Officials highlighted “roll-up” acquisitions, which “currently evade antitrust review,” as one area of concern. Businesses such as private equity firms and health insurers often use this strategy, which involves making a series of small acquisitions that can eventually lead to the consolidation of a market.
Nursing home operator Philip Estformes – convicted of one of the biggest Medicare frauds in history....was denied an appeal hearing by the U.S. Supreme Court on Monday to throw out his conviction altogether.
December 8, 2023 House lawmakers pass bill to blunt Radiology cuts
On Thursday, House Energy & Commerce announced it has advanced a package of healthcare-related bills out of committee. The list included H.R. 6545, the “Physician Fee Schedule Update and Improvements Act,” which incorporates a 3% increase to the conversion factor to offset the 3.4% planned cut.
December 7, 2023 Platform allowing patients to second guess their Radiologist reading expands to 12 states
MDView first launched in its home state of Florida over the summer and is now ramping up its roll out. As part of the announcement, the Cooper City-based tech company has inked a new partnership with Modern Teleradiology to provide second opinion reports and video consultations to its users.
December 5, 2023 New Ultrasound system facilitates catheter and IV placement
The BD Prevue™ II Peripheral Vascular Access System reportedly offers real-time needle depth markers that may reduce multiple needlestick attempts and allow easier placement of intravenous (IV) access in high-risk patients. Learn More
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 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.
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2024 Capital Hill Fly-In
May 7th - 9th, 2024
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APDA 2024 Conference Fly-In
5/7/2024 to 5/9/2024 EDT
Important Dates for Reporting
Reporting Period 5 Is Closed
Recipients who received one or more PRF and or ARP payments exceeding $10,000, in the aggregate, during a Payment Received Period are required to report in each applicable Reporting Period as outlined below.
Payment Received Period (Payments Exceeding $10,000 in Aggregate Received) | Period of Availability for Expenses | Period of Availability for Lost Revenues | Reporting Time Period |
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Period 6 | July 1, 2022 – December 31, 2022 | January 1, 2020 – December 31, 2023 | January 1, 2020 – June 30, 2023 | January 1, 2024 – March 31, 2024 |
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Period 7 | January 1, 2023 – June 30, 2023 | January 1, 2020 – June 30, 2024 | January 1, 2020 – June 30, 2023 | July 1, 2024 – September 30, 2024 |
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Period 8 | July 1, 2023 – December 31, 2023 | January 1, 2020 – December 31, 2024 | January 1, 2020 – June 30, 2023 | January 1, 2025 – March 31, 2025 |
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