The Texas Nursing Home Upper Payment Limit (UPL) could result in significant financial benefits for nursing home operators and many Texas governmental hospitals. Here is an update on the program’s status and key action steps. In October 2012, the Centers for Medicare & Medicaid Services (CMS) approved a Texas State Plan Amendment allowing for a nursing home Intergovernmental Transfer (IGT)/UPL program
Although compliance programs for skilled nursing facilities (SNFs) are not a new concept, the Patient Protection and Affordable Care Act , enacted March 23, 2010, requires nursing facilities to have a compliance and ethics program in operation by March 23, 2013, that effectively prevents and detects criminal, civil and administrative violations under the Social Security Act of 1935 and promotes quality of health care.
On Monday, May 21, 2012, the Centers for Medicare & Medicaid (CMS) published a reminder that, effective for services provided on or after July 1, 2012, the statutory moratorium allowing certain pathologists and independent laboratories to bill for the technical component (TC) of pathology services expires. This means the TC for those surgical pathology services provided under arrangement to Medicare hospital patients only will be considered covered and payable by Medicare if billed by the hospital. The hospital will receive additional payment under the Outpatient Prospective Payment System (OPPS) for services provided to outpatients, but such services are considered included in the diagnosis-related group reimbursement for inpatients
The Patient Protection and Affordable Care Act (PPACA) introduced various ways to strengthen primary care by improving care coordination, making it easier for clinicians to work together and helping clinicians spend more time with their patients. One such program is the Comprehensive Primary Care (CPC) initiative.