Mid-Atlantic Health Law TOPICS

Medicare Coverage of Nursing Services: Did you know that the federal government recently settled a lawsuit alleging that Medicare improperly denied coverage for skilled nursing care and rehabilitation therapy, such as home health or nursing home services? The lawsuit alleged that the federal government applied Medicare's medical necessity rules to permit coverage of only those skilled nursing services that can potentially improve a patient's health condition. Under the terms of the settlement, Medicare's policy manual will clarify that medically necessary skilled nursing services also include those skilled services that prevent the deterioration of a patient's condition by maintaining the status quo.

Durable Medical Equipment: Did you know that the federal government recently finalized rules implementing the Affordable Care Act's requirement that a physician have a face-to-face meeting with a patient when prescribing durable medical equipment (DME) for that patient? The new rule establishes a billing code for the face-to-face visit (HCPCS G0454), specifies that the required face-to-face visit must be performed within the six months prior to the DME order, limits the face-to-face requirement to new DME orders only (vs. DME orders already written), and delays the effective date of the face-to-face requirement to July 1, 2013.