Industry Notes:
CMS Takes One More Step Toward Appeals Reform
Published on Thu Oct 21, 2004
Eight Qualified Independent Contractors named - finally. If you thought the Medicare appeals reform changes mandated by BIPA would never come, you may be in for a pleasant surprise.
The Centers for Medicare & Medicaid Services has named eight Qualified Independent Contractors (QICs) - independent appeals entities required by the 2000 Medicare law. QICs will replace the "fair hearing" level of appeals for suppliers and will be part of a brand new, second level of appeals for home health agencies and hospices, CMS explains in a release.
Some observers believe QICs may give home care claims a more unbiased hearing than carriers or intermediaries (see Eli's HCW, Vol. XIII, No. 36, p. 284). The contractors named will be able to bid on HHA, supplier and other provider type workloads.
CMS aims to complete its overhaul of the Medicare appeals system by Oct. 1, 2005, it pledges. Changes will include a new system allowing parties to track their appeals online in real time, a 60-day decision deadline, and improved first-level appeal notices indicating the specific reasons for the determination.
The QICs are: Integriguard; Q Administrators; Island Peer Review Organization; Rivertrust Solutions Inc.; Computer Sciences Corp.; Maximus; First Coast Service Options Inc.; and Permedion. Authorities soon may be cracking down on flu vaccine price gouging. Department of Health and Human Services Secretary Tommy Thompson is urging state attorneys general to target the practice, which has surfaced after the flu vaccine shortage.
"It is extremely disturbing to learn of reports of price gouging by immoral individuals looking to make a quick buck off of a public health challenge," Thomp-son wrote in a letter to AGs. The Centers for Disease Control and Prevention is collecting reports on price gouging and sharing the information with the National Association of Attorneys General and state prosecutors, the letter says. Just to make your billing more confusing, a claims processing error at durable medical equipment regional carrier CIGNA HealthCare Medicare Administration is sending denials for duplicate claims when they've really been processed. "If your office submitted electronic claims beginning approximately 09/20/04 through 10/13/04, you may have inadvertently received denials for duplicates," CIGNA warns in a listserv message.
CIGNA processed the original claims correctly, but the error caused the electronic claims to stay in the mailbox and be processed again - and thus be denied as duplicates. You may be one of the lucky ones, however; the error didn't affect all suppliers. The Congressional Budget Office has shot down claims that disease management programs cut health care costs. "There is insufficient evidence to conclude that disease management programs can generally reduce overall health spending," CBO says in its study of peer-reviewed DM literature. "It is important to note that such programs could [...]
