Medicare Compliance & Reimbursement
DUAL-ELIGIBLE BLUNDERS COMPLICATE MCO PAYMENTS
Florida managed Medicare companies were the lucky beneficiaries of a costly error by the Florida Agency for Health Care Administration, according to recent audit report from the HHS Office of Inspector General. The state health department made improper fee-for-service payments that managed Medicare plans should have paid, the OIG asserts in "Medicaid Fee-for-Service Payments for Dually Eligible Medicare Managed Care Enrollees" (A-04-02-07007). The watchdog agency recommends that Florida should refund more than $2.2 million to the Centers for Medicare & Medicaid Services for the overpayments, which involved beneficiaries who were eligible for both Medicare and Medicaid. Some of the Florida managed Medicare companies won't keep the extra funds for long - AHCA says it will collect overpaid funds from them in cases where specific documentation of the overpayments is available. Lesson Learned: Managed care organizations should keep in mind that state health departments sometimes struggle with keeping payments straight for dually eligible enrollees. To see the report, go to http://oig.hhs.gov/oas/reports/region4/40207007.pdf.
Medicare Compliance & Reimbursement
- Budget:
SENATORS, PROVIDERS ARGUE AGAINST MEDICAID CUTS
Seventy-nine senators, led by Finance Committee chair Chuck Grassley (R-IA) and senior panel Democrat Max [...] - Reimbursement:
ROCKY REIMBURSEMENT ROAD AHEAD FOR PHYSICIANS, HOSPITALS
Physicians aren't getting much opportunity to celebrate this year's Medicare reimbursement increase. At a March [...] - HIPAA:
OCR OPENS DOOR TO PRIVACY COMPLAINTS
Health care organizations, take note: The HHS Office of Civil Rights March 20 laid out [...] - Home Health:
HOME HEALTH INDUSTRY GRAPPLES WITH SPENDING GROWTH FIGURES
Home care providers' efforts to secure reimbursement relief from Congress may have taken a hit [...] - DME:
FEDS MEAN BUSINESS ON TELEMARKETING RESTRICTIONS
Federal regulators are walking their talk when it comes to enforcing rules prohibiting durable medical [...] - Ambulances:
MEDICAL NECESSITY KEY IN AMBULANCE COMPLIANCE GUIDANCE
As health care fraud enforcement heats up for ambulance suppliers - especially at the state [...] - Hospitals:
WHISTLEBLOWER WINDFALL IN RECORD-BREAKING STARK CASE
A hospital employee who blew the whistle on alleged stark violations in a hospital-physician practice [...] - Hospitals:
CHARITABLE PROGRAMS CAN EVADE KICKBACK PERILS
Hospitals with a charitable mission have to take care that their efforts to help indigent [...] - DME:
DON'T BE TOO FORWARD WITH YOUR ADVANCES, OIG TELLS DMERCs
The check may be in the mail - but you might never see it anyway. [...] - Fraud & Abuse:
PAY A FINE, APPEAR ONLINE
Clash with the HHS Office of Inspector General and you could find yourself touted on [...] - Managed Care:
DUAL-ELIGIBLE BLUNDERS COMPLICATE MCO PAYMENTS
Florida managed Medicare companies were the lucky beneficiaries of a costly error by the Florida [...] - ASCs:
ASC RATESETTING STILL STALLED
Ambulatory surgical centers now have an updated list of the procedures Medicare has approved for [...] - Medicaid:
SUPREME COURT WILL HEAR TEXAS MEDICAID CASE
Did Texas waive its immunity under the federal constitution's 11th Amendment by entering into a [...] - BILL WATCH
The following House bill was introduced: H.R. 1422. A bill to amend title XVIII of [...] - REGISTER WATCH
Haven't been keeping up with the Federal Register? Missing a back issue? Here's your chance [...] - PROGRAM MEMO ROUNDUP
Medicare carriers will continue using existing policies on using statistical sampling to estimate provider overpayments, [...]
