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Medicare Patients Win the Right to Appeal Gap in Nursing Home Coverage

Kaiser Health News

A three-judge federal appeals court panel in Connecticut has likely ended an 11-year fight against a frustrating and confusing rule that left hundreds of thousands of Medicare beneficiaries without coverage for nursing home care, and no way to challenge a denial. But it can have serious repercussions.

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CMS’s Final Rule on Medicare Advantage Risk Adjustment Data Validation

Health Law Advisor

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.

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The Doctor Won’t See You Now: The Unintended and Perhaps Inevitable Consequences of Medicare-for-All

Electronic Health Reporter

In the fall of 2013, when cancellation letters—notices of cancelled plans—went out to approximately four […]. The article The Doctor Won’t See You Now: The Unintended and Perhaps Inevitable Consequences of Medicare-for-All appeared first on electronichealthreporter.com. But the promise was impossible to keep.

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Medicare Advantage Plans Must Follow the Two-Midnight Rule

Hall Render

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. 1395w-22(a) ). d)(2) ).

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CMS Issues Final Rule for DSH Medicare Advantage Days Policy

Hall Render

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

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Biden Administration Extends Suspension of Mandatory 2% Medicare FFS Payment Sequestration

Health Law Attorney

The Act extends the temporary suspension of certain mandatory Medicare FFS claim payment reductions until December 31, 2021. President Obama issued a Sequestration Order in March 2013. Amongst other things, the CARES Act temporarily suspended sequestration of Medicare FFS claims from May 1, 2020 through December 31, 2020.

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What did the HIPAA Omnibus Rule Mandate?

HIPAA Journal

What was the HIPAA Omnibus Rule of January 2013? The HIPAA Omnibus Rule of January 2013 was comprised of four Final Rules which were combined into one Omnibus Rule to reduce the impact of the changes and the number of times covered entities and business associates would need to undertake compliance activities.

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