Failure to provide the required support will result in cost reports being rejected for lack of supporting documentation. Going forward, if a hospital submits an amended cost report, whether that be the 12-month cost report or another amended cost report, supporting documentation must include either...
2018, each DSH-qualifying hospital must now include, as part of the cost report filing, a detailed listing of its Medicaid eligible days that corresponds to the Medicaid eligible days claimed in the cost report (and supports the DPP shown above) as supporting documentation...
Instructions on how to appoint a Representative Please note that only sections I, II, and III of the form apply to the Medicare Advantage program. Section I: Appointment of Representative section The name of the representative is required. In addition, the Medicare Beneficiary must sign and dat...
In the meantime, it is my job to assist my clients, and prospective clients, in identifying their lowest “total” cost Part D Drug plan for each calendar year. While people get fixated with monthly premium, one’s lowest total cost is the sum of their plan’s premium + any deductible ...
2.51 “Plan Factors” means factors used to adjust the PARTICIPATING MEDICAL GROUP’s Capitation to account for cost variations attributable to the mix of Member Benefit Agreements. 2.52 “Primary Care Physician” means the physician responsible for coordinating and controlling the delivery of Covered ...
Enhanced Focus on Billing for High-Cost Services Medicare audits in 2025 will likely place more emphasis on high-cost services, including surgeries, specialty procedures, and long-term care services. These areas are particularly vulnerable to billing errors or fraud due to their complexity and the ...
A claim must be filed with the appropriate intermediary or carrier on a form prescribed by CMS in accordance with CMS instructions. Continue Reading › Often overlooked in performance evaluations of the various contractors employed by the Medicare program to ensure program integrity, is the cost in...