OIG yanks controversial regulation.
You don't have to worry about a proposed rule from the HHS Office of Inspector General that would have punished Medicare providers for submitting excessive charges. The OIG withdrew the rule, which it proposed in 2003, in a June 18 Federal Register notice.
The OIG rule said charges greater than 120 percent of a usual charge would be excessive, notes the American Association for Homecare. Now the OIG says it does "not have sufficient information ... to establish a single, fixed numerical benchmark for 'substantially in excess' that could be applied equitably across health care sectors and across items and services," according to the notice.
AAHomecare cheers the withdrawal, noting that "the proposed rule incorrectly assumes that the benefit structure and payment methodology used by the Medicare program is directly comparable with that of the private sector."
Furthermore, the proposed rule was "arbitrary" and lacked "empirical basis," the trade group says. • A study analyzing the impact of OASIS data collection for private pay patients doesn't give any clear indicators of which way CMS may eventually rule on the matter. CMS suspended OASIS data collection for private pay patients in 2003 (see Eli's HCW, Vol. XII, No. 41). But the agency warned at that time that it could reinstate the practice at a moment's notice.
OASIS contractor Abt Associates completed the study in December 2005 but CMS posted the report on its OASIS Web site only recently. The report lists pros and cons for making the suspension permanent and reinstating the requirement. Mandating OASIS for all patients could improve patient outcomes, but would burden providers, patients and payors, the study says.
The study is at
www.cms.hhs.gov/OASIS/03_Regulations.asp under the "Downloads" section. • Don't be surprised if you encounter some senior clients who are having trouble disenrolling from private Medicare Advantage plans--a big problem for agencies in securing payment for home health services.
Seniors have the right to withdraw from the plans if they were misled or given incorrect information about benefits. But a recent report from the Lexington Herald-Leader suggests that problems persist as seniors try to get their benefits back on track.
"[H]undreds" of elderly residents have contacted the Medicare Rights Center because they cannot disenroll from a private MA plan purchased "as a result of misleading sales tactics," the paper reports. • Physicians who refer Medicare patients to home care will see a 9.9 percent cut to their home care-related payments next year. That's if Congress fails to provide more funding for Medicare physician payment rates. Some docs requested that CMS increase the work Relative Value Units for home visits (HCPCS codes 99343-99350). But CMS decided to keep the work RVUs the same for the services in 2008, according to [...]
