Home Health & Hospice Week
Statistical Sampling Rules On Deck
MMA changes may have less effect that providers hoped.
The Centers for Medicare & Medicaid Services expects to finalize its rules on the use of extrapolation shortly, agency staff reported during a recent Open Door Forum.
Providers have long challenged the use of extrapolation - also known as statistical sampling for overpayments - by Medicare contractors.
Under the Medicare Modernization Act, contractors are not permitted to use statistical sampling or extrapolation to calculate an overpayment unless there is a finding of a "sustained or high level of payment error." A similar finding is also required for a contractor to initiate a nonrandom prepayment review based on a provider's or a supplier's identification of an improper billing practice.
However, the exact effect of these MMA provisions will not be clear until CMS decides how it will define "sustained or high level of payment error." In response to a question from Eric Sokol of the Power Mobility Coalition regarding the allowable use of extrapolation, a CMS staffer reported that the agency is updating the Program Integrity Manual instructions on the use of extrapolation.
The House committee proposes cutting $20 billion over five years from mandatory spending programs under the Energy and Commerce Committee. The Senate committee proposes cutting $15 billion from mandatory spending programs under the Senate Finance Committee.
Most of those cuts are expected to come from Medicaid's budget. And when lawmakers are searching to meet their goals, Medicare may become an irresistible target for cuts as well.
The new code takes effect April 1. Details are at www.cms.hhs.gov/manuals/pm_trans/R451CP.pdf.
Amedisys credited the increase to its 13 new locations in 2004, its acquisition of eight companies and its admission growth rate of 27 percent, notes The (Baton Rouge) Advocate.
The company expects to open 20 new locations in 2005 and see an internal admission growth of 15 to 20 percent, CEO William Borne says in a release. The chain also has plenty of cash on hand to make more strategic acquisitions.
VITAS saw average daily census grow 14 percent over the same period in 2003, to 9,134 for the quarter. Length of stay averaged 64.1 days for the quarter. VITAS is planning 11 "new starts," it says.
The civil suit seeks to force Fleming to forfeit $1.8 million seized during a probe into alleged health care fraud, wire fraud and money laundering. At the time of the seizure, Fleming was already serving a term of supervised release following a conviction for access device fraud in Arkansas.
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Statistical Sampling Rules On Deck
MMA changes may have less effect that providers hoped.
The Centers for Medicare & Medicaid Services [...]
