Medicare Compliance & Reimbursement
OIG EYES EXCESSIVE CHARGES
Clarification may be in store on what could get providers excluded from Medicare. Providers 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 its usual charges. 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 services, including clinical laboratory services, durable medical equipment and supplies, and drugs. It could also play into outlier enforcement - a current OIG hot button. Physician services, however, are outside the scope of the rule. To see the rule, go to www.access.gpo.gov/su_docs/fedreg/a030915c.html.
Medicare Compliance & Reimbursement
- MEDICARE REFORM:
GOP, DEMS SUGGEST BIG MEDICARE REVAMP CAN WAIT
Thirteen conservative GOP representatives, all of whom voted "reluctantly" for the House Medicare bill, vowed [...] - LAB COPAY PROVISION STILL ON CONFEREES' TABLE
Meanwhile, labs recruit docs to help oppose copays.
Though it's been three months since the House [...] - HOME CARE PROVIDERS COULD BENEFIT FROM DELAY
House reps insist on home health copay.
Congressional leaders have returned to their Medicare and prescription [...] - Medicare+Choice:
AAHP EXPECTS FEWER PLANS TO WITHDRAW FROM M+C
Plans hopeful Congress will deliver on Medicare reform, funding increases. Things may be looking up [...] - HIPAA:
PROVIDERS GET RELIEF ON HIPAA TRANSACTIONS RULE
Medicare contingency plan will permit non-compliant claims.
Health care providers who feared the Oct. 16 compliance [...] - Fraud & Abuse:
OIG EYES EXCESSIVE CHARGES
Clarification may be in store on what could get providers excluded from Medicare. Providers confused [...] - DME:
WHEELCHAIRS FLYING OUT OF SHOW-ROOM, COURTESY OF MEDICARE
Feds vow to crack down on those who are riding away with Medicare's money. The [...] - Quality:
CMS GETS ORGANIZED ON TRACKING COMPLAINTS
New database to monitor complaints against providers.
If patients complains about the quality of service they [...] - Long-Term Care:
QUALITY OF CARE ISSUES CAN LEAD TO FALSE CLAIMS ACT PROBLEMS
Nursing homes can't afford to forget that perceived quality-of-care problems could leave them facing possible [...] - Home Care:
Trainee Services Don't Qualify For Medicare Payment
Home health aide trainees' skills don't have to be wasted, but they won't directly add [...] - Medicare+Choice:
MEDPAC: FOLD S/HMOs INTO M+C
The so-called social health maintenance organizations - with which Medicare has experimented for nearly two [...] - Coverage:
COVERAGE ON THE WAY FOR LVRS
After years of non-coverage, an emphysema treatment is about to get the green light.
Health care [...] - Home Care:
PRRB Decision Provides Ammo for some HHAs
Medicare beneficiaries are entitled to covered home health services no matter where they live, and [...] - LAB SCAM RINGLEADER WINS RECORD-BREAKING SENTENCE
High profile sentence casts spotlight on lab fraud.
A high-profile Sept. 8 fraud sentence could rile [...] - Enforcement:
FEDS HAVE FALSE CLAIMS ACT TARGETS IN HIGH PLACES
Bluegrass State's lieutenant govenor settles FCA suit. When it comes to health care fraud, the [...] - Rehab:
DOCTOR'S WORK IS DOCTOR'S WORK
PT clinic operators indicted for lying about physician evals. Two Texas physical therapy clinic operators [...] - Home Care:
BEWARE GIFTS TO REFERRING DOCTORS
Health care marketing practices remain in the cross-hairs - and not just for big pharma. [...] - BILL WATCH
The following bill was introduced in the House: H.R. 3090. A bill to amend title [...] - PROGRAM MEMO ROUNDUP
The Centers for Medicare & Medicaid Services advised Medicare fiscal intermediaries Sept. 5 that the [...]
