Durable medical equipment suppliers confused about how much is too much when it comes to charge-based Medicare payments could soon get some guidance from the HHS Office of Inspector General. In a Sept. 15 Federal Register notice, the OIG says it's planning to clarify the regulations that govern when it can exclude a provider from Medicare and other federal health care programs for billing for amounts that are substantially in excess of that provider's usual charges - even if the charges are based on a fee schedule. The proposal includes a formula that defines "usual charges" as well as a bright line for "substantially in excess" that's set at 120 percent of usual charges. The watchdog agency invites comments on the proposal, which are due Nov. 14. The exclusion rule would primarily affect providers of Part B items, including DME, supplies and drugs. It could also play into outlier enforcement - a current OIG hot button. The rule is at
www.access.gpo.gov/su_docs/fedreg/a030915c.html. If you've had a Joint Commission on Accreditation of Healthcare Organizations survey recently, you know that abbreviations are high on the accrediting body's list of no-nos. "Surveys conducted during the first six months of this year show that this goal has the highest level of non-compliance among all of the [National Patient Safety Goal] requirements," JCAHO says in a recent online newsletter. But many providers are in the dark on exactly which abbreviations are taboo. Now the Oakbrook Terrace, IL-based accreditor is developing "a list of commonly misunderstood abbreviations, acronyms and symbols and a corresponding list of preferred terms in order to provide additional guidance for organizational compliance with National Patient Safety Goal 2b," the Joint Commission says. The list will go on its Web site later this year. Kentucky is the latest state to jump on the AWP lawsuit bandwagon. Kentucky Attorney General Ben Chandler has filed a lawsuit against five pharmaceutical companies - Illinois-based Abbott Laboratories, California-based Dey and three related New Jersey-based companies, Schering-Plough, Schering and Warrick Pharmaceutical - for inflated average wholesale prices for drugs. Chandler expects to seek more than $100 million in the suit to recover Medicaid losses due to the allegedly fraudulent pricing, reports the Lexington Herald-Leader. Home care providers wondering what in the world Centers for Medicare & Medicaid Services chief Tom Scully is thinking may have an opportunity to find out. Scully is scheduled to speak at the Visiting Nurse Associations of America's Regulatory and Legislative Conference Sept. 24. VNAA has opened its conference, which will feature other CMS officials and will follow VNAA's Sept. 23 Lobby Day, to all comers. Registration and additional information are at
www.vnaa.org. New Mexico's Medicaid home care program soon may put utilization [...]
