NEWS YOU CAN USE: Don't Violate Corporate Integrity Agreement Unless You Want to Face Harsh Repercussions

• Department of Health and Human Services drops hospital from federal programs
If you’ve ever questioned what the consequences of violating the Corporate Integrity Agreement (CIA) are, the Department of Health and Human Services has just answered your question. In an unprecedented move, HHS has excluded South Beach Community Hospital in Miami Beach from federal health insurance programs because, according to HHS, the private for-profit hospital did not comply with the CIA.
This is the first exclusion due to CIA violations in the 30-year history of the HHS, and it is only the second exclusion of any type during those 30 years.
HHS notified South Beach Community Hospital in December 2005, informing the hospital of the pending exclusion. South Beach indicated it would make the changes HHS requested. The hospital can appeal HHS’ decision, but since South Beach filed for bankruptcy in February and transferred all of its patients, that seems unlikely.
• AMA publishes minor corrections to CPT book
The American Medical Association corrected some minor errors in the 2006 CPT book. You can read the corrections online at http://www.ama-assn.org/ama/pub/category/print/3896.html.
• Take note of how CMS wants you to report emergency department services
CMS Transmittal R881CP clearly states how OPPS hospitals should properly bill emergency department services that exceed 24 hours. The transmittal specifies that you need to ensure that when you report emergency department services you have to meet the following criteria:
• Identify the emergency department with revenue code 045X.
• Make sure the service date you use is the date that the physician provided the service in the emergency department.
• If the patient was in the emergency department after midnight, you should only enter one service date--the date the patient entered the emergency department.
• List only one service unit.
To read the entire transmittal, visit www.cms.hhs.gov/Transmittals/downloads/R881CP.pdf.
• HHS Inspector General subpoenas Universal Health Services
As part of an ongoing investigation into Medicare and Medicaid fraud, the Department of Health and Human Services Inspector General subpoenaed Universal Health Services Inc. The hospital chain, based in Pennsylvania, owns several acute care and behavioral health facilities throughout the United States. The investigation is related to physician hiring and patient referral.
• Massive decreases in drug payments may be heading your way
The HHS Office of Inspector General claims that you may be getting paid too much for many Part B drugs. Inconsistent accounting practices have led to CMS overestimating many drug costs, according to the OIG. (See “Calculation of Volume-Weighted Average Sales Price For Medicare Part B Prescription Drugs,” OEI-03-05-00310 for full details.)
Some 46 percent of drug codes had more [...]

- Published on 2006-04-17