Medicare Compliance & Reimbursement

Plus: Despite computer glitch, you don't need to resubmit NGS claims The Medicare Payment Advisory Commission (MedPAC) made two new recommendations last week that could put a stake through the heart of skilled nursing facility (SNF) and home health reimbursement. MedPAC voted to freeze SNF payment rates for 2009, which would mean that SNFs would see no pay increase next year. Although MedPAC made this recommendation to Congress, it is merely a recommendation, experts remind SNFs, and isn't yet set in stone. In addition, MedPAC recommended freezing home health agencies' rates for 2009 at current levels as well. The rationale for both rate freezes is that MedPAC projects an 11.4 percent profit margin by SNFs and home health agencies on Medicare this year. In Other News... • A National Government Services computer glitch may have you wondering whether you need to resubmit your claims. According to a news flash that NGS and Empire Medicare generated earlier this week, a "front end system problem" caused scores of claims that were electronically processed on Jan. 14 to be returned to providers in error. The carrier's Part B processing equipment for New York claims marked several claims with the error code, "M001 Duplicate File. Batch Status: Deleted -- Entire Batch Must Be Resubmitted." On the other hand, NGS says, you should not resubmit these claims. The carrier will automatically re-process the claims and generate accurate reports. For more information, visit http://www.empiremedicare.com/news/nynews08/ngs_011508cla.htm. • If you've been itching for an opportunity to get in on the Part B Competitive Acquisition Program (CAP) election period for 2008, now's your chance. CMS has extended the participation period for 2008, the agency announced on Jan. 14. The voluntary CAP program allows practices to get certain injectable and infused drugs from an approved CAP vendor, cutting down on the time and cost of buying and billing for the drugs, CMS said in its announcement. The additional CAP election period will run from Jan. 15 through Feb. 15, giving you a few more weeks to get in on the program, CMS noted. Practices that join the CAP during this extended period will be able to participate between April 1 and Dec. 31 of this year. For more information on the CAP program, visit the CMS Web site at http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp.