Medicare Compliance & Reimbursement

OCR Did Not Comply With HIPAA Requirements, Says OIG

One governmental agency — the HHS Office of the Inspector General (OIG) — is saying that another agency — the Office for Civil Rights (OCR) — failed to comply with “certain Federal requirements critical to the oversight and enforcement of the Health Insurance Portability and Accountability Act Security Rule (Security Rule),” in November 21 release.

“OCR had not assessed risks, established priorities, or implemented controls for its Federal requirements to provide for periodic audits of covered entities to ensure their compliance with Security Rule requirements,” the release said. It went on to add that the agency “had not fully complied with Federal cybersecurity requirements for its information systems used to process and store investigation data because it focused on system operability to the detriment of system and data security.”

To read the complete report see: oig.hhs.gov/oas/reports/region4/41105025.asp.

Medicare Issues Refunds For Erroneous Prison Takebacks

The Centers for Medicare & Medicaid Services (CMS) is finally correcting recoupments it made in error for supposedly incarcerated beneficiaries, but you’ll have to wait to reconcile your accounts receivable. CMS has begun making refunds of incorrect takebacks and expects “the majority” to be resolved by mid-December, it says in a new Frequently Asked Question document on the matter.

Exception: “Appealed claims will be handled separately and, where appropriate, refunds will be generated at a later date,” the FAQ says.

“If you have received a refund check and are in need of additional remittance details,” you’ll have to wait another week or so, says Home Health & Hospice Medicare Administrative Contractor National Government Services (NGS) in a Dec. 4 message to providers. “You are assured of receiving those details in a separate letter, postmarked by 12/12/13, and we are requesting your patience in awaiting that information,” the MAC continues.

Resource: See more details about the denials and refund process at www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/2013-Claim-Denials-Due-to-Beneficiary-Incarceration-Status.html. A link to the FAQs is in the “Downloads” section at the bottom of the page.

ZPICs Train Spotlight On Home Health, Hospice

It’s not just your imagination — if you’re a home health or hospice provider, you’ve gotten special attention from the ZPICs. One Zone Program Integrity Contractor “received almost $3 million for a completed project specifically examining potential fraud among home health providers,” reveals the Government Accountability Office in a new report.

In 2012, ZPICs closed 557 investigations of home health and hospice providers, the GAO says in the report. While 380 of those originated from “other” sources, 298 came from MAC complaint units, the GAO says. Seventeen of the 557 cases were accepted by law enforcement.

Dollars: In 2012, ZPICs referred more than $88 million in claims for overpayment collection. But, only $13.3 million was actually recovered. During that time period, ZPICs added 104 home health and hospice providers to prepay review and denied $7.3 million in claims. ZPIC-recommended auto-denials reached $8 million in the year, according to the report.

Other stats: In home health and hospice cases, ZPICs interviewed 1,455 beneficiaries, performed 126 onsite investigations, reviewed more than 8,300 claims in prepay review and more than 12,000 claims in post-pay, and received nearly 350 requests for law enforcement cases, says the report at www.gao.gov/assets/660/658565.pdf.