Association blasts CMS' appeals inaction. The rules could change by the next time you take a squabble with your fiscal intermediary to the ProviderReimbursement and Review Board.
In a proposed rule published in the June 25 Federal Register, the Centers forMedicare & Medicaid Services revises, updates and clarifies various provisions of its reimbursement appeal rules. The current principal provisions are about 25 years old. CMS says extensive litigation over important regulations -- as well as a 10,000-case backlog before the PRRB -- prove that streamlining is long overdue. Some of the areas targeted for change include time periods and deadlines; hearing rights for providers and non-providers; "good cause" extensions; intermediary hearing officer jurisdiction; group appeals; board authority in hearing decisions; and reopened procedures. Meanwhile, the National Association for Home Care & Hospice blasts CMS for failing to implement new appeals processes for minor claims errors and omissions, as required by the Medicare Modernization Act passed last December. To date, CMS has only restated its current policy instead of implementing changes as required, NAHC criticizes. "CMS has failed in its responsibility to identify corrections and improve the appeals process intended by Congress," the trade association says. Home health agencies and hospices can accept a physician's rubberstamp for clinical record documentation, CMS tells surveyors in a new letter. As long as state and local laws, as well as the provider's own policy, allow the signature stamp, it's OK by Medicare, CMS says in a July 8 letter (S&C-04-35). However, to accept the stamp, the home care provider "must obtain a signed statement from the physician attesting that he/she is the only one who has the stamp and uses it," CMS tells surveyors in the letter at
www.cms.hhs.gov/medicaid/survey-cert/sc0435.pdf. The HHS Office of InspectorGeneral will have a new chief if Dan Levinson's White House nomination is approved. The July 13 announcement banishes any doubts about whether acting Inspector General Dara Corrigan would stay or would go. Levinson has served as Inspector General and Chief of Staff of the General Services Administration. Prior positions include chairman of the Merit Systems Protection Board. The Inspector General oversees more than 1,500 auditors, lawyers, investigators and support staff who target fraud and abuse in the HHS programs. Home Health Compare won't be the only online rating system your home care organization may be subject to. Now the Joint Commission on Accreditation of Healthcare Organizations is offering "Quality Check" at www.qualitycheck.org. The online system offers comparative ratings for hospitals in four areas of care -- heart attack, heart failure, pneumonia and pregnancy. But for home care providers such as HHAs, home medical equipment suppliers, hospices and infusion providers, the system indicates only whether National Patient Safety Goals have [...]
