Insights by Engage

Medicare expects providers to exercise care when billing and accepting payment.  Medicare also expects that providers will promptly bring incorrect payments to the Medicare Administrative Contractor’s (MAC) attention.

Earlier this week, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the distribution of approximately $9 billion in Provider Relief Fund (PRF) Phase 4 payments, from a pool of $17 billion, to health care providers who have experienced revenue losses and expenses related to the COVID-19 pandemic. (Provider Relief Fund Payments ) Phase 4 funding is being distributed based on expenses and decreased revenues from July 1, 2020, to March 31, 2021. The average payment for small providers is $58,000, for medium providers is $289,000, and for large providers is $1.7 million. HRSA is reimbursing a higher percentage of losses and expenses for smaller providers, who typically care for vulnerable populations and historically operate on smaller financial margins.

Published on the RAC Monitor Site on December 14^th  2020, written by Steven Greenspan JD, LLM.

In the 34^th Edition of the User’s Guide for Short-Term Acute Care Program for Evaluating Payment Patterns Electronic Report (PEPPER)(ST PEPPER User’s Guide), the Centers for Medicare and Medicaid Services (CMS) has included a new target area – Severe Malnutrition. Also effective with the Q3FY21 release, CMS is discontinuing the Transient Ischemic Attack target area.

Published on the RAC Monitor Site on December 8^th  2020, written by Steven Greenspan JD, LLM.