Volume 26.01 National Government Services (“NGS”) will begin operating as Wellpoint Federal effective April 1, 2026. Beginning April 1, 2026, NGS will begin transitioning and there are no immediate changes to the provider portals, NGSConnex and NGSMedicare.com....
Volume 25.10 CMS has taken steps to increase program integrity of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) providers in the recently finalized “Calendar Year (CY) 2026 Home Health Prospective Payment System (HH PPS) Final Rule...
Volume 25.09 Skilled nursing facility (“SNF”) providers enrolled in the Medicare program or dually enrolled in the Medicare/Medicaid programs must submit a mandatory off-cycle provider enrollment revalidation or risk having their enrollment suspended or revoked. This...
Volume 25.08 Healthcare providers of all types pay certain employees who are eligible for overtime pay. The One Big Beautiful Bill Act (“OBBBA”) has been advertised as eliminating federal income tax on overtime pay; however, employers and employees must recognize the...
Volume 25.07 Skilled Nursing Facilities (“SNF”) that had an August 1, 2025, due date for submission of their CMS-855A revalidation has been pushed back to January 1, 2026. The Form CMS-855A was revised to collect the SNF data addressed in this guidance. Beginning...
Volume 25.06 The National Alliance for Care at Home (“Alliance”), in partnership with KNG Health, has published findings related to deteriorating access by Medicare program beneficiaries to home health care. Key findings include: “Since 2019, wait times for a first...
Volume 25.05 For many years, states have imposed broad-based taxes on healthcare providers. These taxes were used by the respective states to secure additional federal funding to support Medicaid payments to those healthcare providers. These taxes were acceptable to...
Volume 25.04 On Friday, April 11, 2025, the U.S. Centers for Medicare & Medicaid Services (“CMS”) released numerous proposed rules encompassing multiple types of providers. Fiscal year 2026 Hospice Wage Index and Payment Update - On April 11, 2025, the Centers for...
Volume 25.02 MEDICARE ADMINISTRATIVE CONTRACTORS NOT MEETING MEDICARE COST REPORT OVERSIGHT REQUIREMENTS The Office of Inspector General of the Department of Health and Human Services (“OIG”) Office of Audit Services has released “Medicare Administrative Contractors...
Volume 25.01 The Form CMS-855A was revised in September 2024. Effective October 1, 2024, all skilled nursing facility (“SNF”) providers must use the revised form for all enrollment applications and updates. Other Part A providers are required to use the new form for...
Volume 24.01 The Centers for Medicare & Medicaid Services (“CMS”) has continually been concerned regarding how to identify “bad actors”, their continued involvement with Medicare providers, and the appropriate response to inappropriate behavior by providers,...
Volume 23.08 CMS has announced a $709 calendar year application fee for providers that are: Initially enrolling in the Medicare program, Medicaid program, or the Children’s Health Insurance Program (“CHIP”), Revalidating their Medicare, Medicaid, or CHIP enrollment,...
Volume 23.07 On November 15, 2023, the Centers for Medicare & Medicaid Services (CMS) placed on display at the Federal Register a Final Rule that will implement portions of section 6101 of the Affordable Care Act, requiring the disclosure of certain ownership,...
Volume 23.06 The Centers for Medicare and Medicaid Services (“CMS”) has finalized the CY 2024 Medicare Physician Fee Schedule rule. Many enrollment-related provisions were included in the proposed rule. The Health Group, LLC discussed the proposed rule at its...
Volume 23.05 Many healthcare providers, for-profit and tax-exempt, submitted claims to secure the Employee Retention Credit based on lost revenues; however, many submitted claims based on other criteria related to the issuance of government orders. These claims,...
Volume 23.04 Many providers are dealing with significant delays in processing Medicare enrollment updates and new enrollment applications. It is not unusual to see approvals of CMS 855 filings taking four months to a year. Change of ownership and new enrollment...
Volume 23.03 CMS’s increasing focus on provider integrity continues as they have proposed numerous Medicare enrollment changes impacting healthcare providers of all types. The proposed rule includes, but is not limited to, the following: Reporting Changes in Practice...
Volume 23.01 On March 7, 2023, the IRS issued a warning to Employee Retention Credit claims. False claims generate compliance risk for people and businesses claiming improper credits. According to the warning, “The IRS and tax professionals continue to see third...
Volume 22.12 Effective December 5, 2022, certain modifications have been made to Chapter 10 of the Medicare Program Integrity Manual dealing primarily with “Ownership Disclosures”, “Electronic Funds Transfers”, and “Special Payment Addresses”. MM12880 - Provider...
Volume 22.11 In September 2022, the Department of Health and Human Services Office of Inspector General (“OIG”) released a report entitled “HHS’s and HRSA’s Controls Related to Selected Provider Relief Fund Program Requirements Could Be Improved” (“Report”). The...
Volume 22.10 The U.S. Centers for Medicare & Medicaid Services has released Home Office Cost Statement, Form CMS-287-22 (“Home Office Cost Report”). R1P248i | CMS The new Home Office Cost Report (CMS-287-22) is effective for cost reporting periods beginning on or...
Volume 22.09 In March 2021, CMS began recovering COVID-19 Accelerated and Advance Payment (“CAAP”) balances. After one year, the recovery of the advanced monies was made at twenty-five percent (25%) over eleven months, followed by fifty percent (50%) over the...
Volume 22.08 The Office of Inspector General (“OIG”) has the authority to exclude individuals and entities from Federally funded health care programs pursuant to section 1128 of the Social Security Act ("Act") (and from Medicare and State health care programs under...
Volume 22.07 Medicare providers are required to revalidate information contained in the Medicare enrollment records on a periodic basis to ensure all information on file is accurate and compliant with Medicare regulations. Revalidation was paused because of the...
Volume 22.06 For several years we have cautioned health care providers that Medicare billing privileges could be deactivated if the provider did not submit any Medicare claims for twelve (12) consecutive months. This deactivation is provided for at 42 CFR...
Volume 22.05 The Department of Health and Human Services and the Department of Justice have released the Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2021. During FY 2021, the federal government won or negotiated more than $5 billion in...
Volume 22.04 The Biden administration on Wednesday extended the COVID-19 public health emergency that had been due to expire on April 16. The 90-day extension, announced by the Department of Health and Human Services (HHS), will allow millions of Americans covered...
Volume 22.03 Many providers are confused regarding the required reporting for the use of Provider Relief Funds (“PRF”). Reporting timelines are based on when the funds were received by the provider. The following summarizes when funds must be used and reported to...
Volume 22.02 Many healthcare providers, consultants to the healthcare industry, and other observers have been attempting to gain an understanding of the changes to the healthcare delivery systems and the changes in costs incurred by healthcare providers, which may...
Volume 22.01 On Thursday, the Supreme Court issued mixed rulings, allowing vaccine mandates for certain health care workers (Vote was 5-4), but blocking enforcement of a mandate for businesses with 100 or more employers (Vote was 6-3). The Court ruled that OSHA lacked...
Volume 21.15 The U.S. Senate is expected to pass legislation (already passed in the House of Representatives) that would: Implement an additional three (3) month suspension of the two percent (2%) Medicare sequestration payment reductions that were scheduled to begin...
Volume 21.14 CMS is issuing an Interim Final Rule requiring most Medicare and Medicaid certified providers and suppliers to establish a policy ensuring that all eligible staff have received the first dose of a two-dose vaccine or a one-dose vaccine prior to providing...
Volume 21.13 Over the weekend, the Health Resources and Services Administration (“HRSA”) modified certain details regarding the Phase 4 PRF application. Information provided by HRSA now requires Phase 4 applicants to submit their Taxpayer Identification Number...
Volume 21.12 If you are going to apply for Phase 4 funding of Provider Relief Funds and have not yet applied for IRS validation, you should immediately submit required, but limited, information for IRS validation. This process must be completed before you can upload...
Volume 21.11 Providers can apply for the new, Phase 4, Provider Relief Funds beginning September 29, 2021. The application period will run through October 26, 2021. The application will be made in the Provider Relief Application and Attestation Portal. Providers...
Volume 21.10 Three methods are available to healthcare providers for determining lost revenues eligible to be applied as a qualified use of Provider Relief Funds. These are: Option 1: Actual 2020 and 2021 revenues compared against 2019 revenues, Option 2: Actual 2020...
Volume 21.06 HHS Press Release: “The Biden-Harris Administration announced today that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health...
Volume 21.05 It is reported that the U.S. Centers for Medicare & Medicaid Services (“CMS”) and the Centers for Disease Control and Prevention (“CDC”) are jointly involved in the development of changes in Conditions of Participation that would require all staff of...
Volume 21.09 The Department of Health and Human Services (“HHS”) has updated the rules relating to the reporting of Provider Relief Funds (“PRF”) use by nonfederal entities as part of the single audit requirements. Recipients that expend a total of $750,000 or more in...
Volume 21.08 CMS has temporarily ceased revalidations for Medicare providers and suppliers because of the COVID-19 PHE. CMS is not issuing any revalidation notices, deactivating providers for any failure to respond to revalidation requests and is not updating...
Volume 21.07 The U.S. Department of Health and Human Services (“HHS”) has released updated reporting requirements for the use of Provider Relief Funds (“PRF”). The period of availability of funds is based on the date the payment is received (rather than requiring all...
Volume 21.06 In 2020, the U.S. Centers for Medicare & Medicaid Services (“CMS”) expanded the availability of Accelerated and Advance Payments to Medicare providers to provide assistance with cash flow during the COVID-19 Public Health Emergency (“PHE”). CMS has...
Volume 21.05 We previously reported regarding the impact of the COVID-19 PHE and Medicare cost reports; however, based on numerous inquiries, we are pleased to provide the following information. Filing Deadlines – For cost reports covering periods through December 31,...
Volume 21.04 The financial assistance received by many healthcare organizations in 2020 was not free of compliance requirements. As most of you know by now, The Department of Health and Human Services (HHS) is requiring the recipients of payments in excess of $10,000...
Volume 21.03 On October 8, 2020, CMS issued a Press Release announcing that COVID-19 Provider Relief Funds (“PRF”) could be used to repay obligations incurred because of the Accelerated and Advance Payment program. We have received numerous inquiries regarding this...
Volume 21.02 As you probably know, earlier today the Health Resources & Services Administration (“HRSA”) has opened the Provider Relief Fund Reporting Portal for registration, but not for reporting the use of Provider Relief Funds (“PRF”). Reporting has again...
Volume 21.01 On January 5, 2021, CMS has updated the list of cost report filing extensions as follows: For all cost reports with cost reporting periods ended on March 1, 2020 through December 31, 2020, providers are granted an additional sixty (60) days from the...
Volume 20.40 The Omnibus and Coronavirus Relief Bill was passed by Congress on December 21, 2020. The Bill, over 5,000 pages, titled The Consolidated Appropriations Act, 2021 (Omnibus and Coronavirus Relief Bill) will directly or indirectly impact every part of the...
Volume 20.39 There has been substantial confusion throughout the healthcare industry regarding expenses and lost revenues which will be eligible for justification of Provider Relief Funds. With every update from the U.S. Department of Health and Human Services...
Volume 20.38 Health Financial Systems (“HFS”) will be holding its virtual 2020 User Meeting on December 7-10, 2020. Ted Cuppett will be presenting on Wednesday, December 9, 2020 on “Preparing for Reporting the Use of Provider Relief Funds”. The summary of program...