This week in Medicare–1/4/2017
Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy
On December 23, the OIG posted a Report on hospital stays in which the patients appeared to be unsuited for intensive therapy. The OIG found that patients who were not suited for intensive rehab therapy had physical limitations, lacked endurance, had unresolved health problems, or had altered mental status. Most remained in inpatient rehab hospitals for extended periods of time despite being unable to participate and benefit from intensive therapy.
End-Stage Renal Disease Quality Incentive Program; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure, and Appeals Process for Breach of Contract Actions; Correction
On December 23, CMS posted a Correction in the Federal Register to correct technical and typographical errors that appeared in the final rule published in the Federal Register on November 4, 2016, ‘‘Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model.’’
Renewal of the Advisory Panel on Hospital Outpatient Payment and Solicitation of Nominations to the Advisory Panel on Hospital Outpatient Payment
On December 23, CMS posted Notice in the Federal Register announcing the renewal of the Advisory Panel (the Panel) on Hospital Outpatient Payment (HOP) panel charter. The charter was approved on November 21, 2016 for a 2-year period effective through November 21, 2018. This notice also solicits nominations for up to two new members to the HOP Panel. There will be two vacancies on the Panel for 4-year terms that begin during Calendar Year (CY) 2017.
QIC Demonstration Evaluation Contractor (QDEC): Analyze Medicare Appeals To Conduct Formal Discussions and Reopenings With Suppliers
On December 28, CMS posted a Comment Request in the Federal Register regarding the Formal Telephone Discussions Demonstration, which is designed to improve the efficiency of Medicare’s backlogged five-level appeals system for fee-for-service (FFS) claims. CMS is interested in determining whether engagement between suppliers and the QIC will improve the understanding of the cause of Level 2 appeal denials, and over time, whether this results in increased submission of accurate and complete claims at the Medicare Administrative Contractor (MAC) level.
Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements; Corrections
On December 29, CMS posted a Correction Notice in the Federal Register regarding the 2017 Physician Fee Schedule Final Rule. The corrections address technical and typographical errors that appeared in the final rule published in the November 15, 2016, Federal Register.
Hospital Outpatient Prospective Payment System Final Rule Correction Notice
On December 29, CMS posted a Correction Notice to correct technical errors that appeared in the final rule with comment period published in the Federal Register November 14, 2016, “Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off‑Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital.”
Calendar Year (CY) 2017 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
On December 29, the CMS posted Transmittal 3687, which rescinds and replaces Transmittal 3682, dated December 22, 2016, to revise the inflation-index to be 1% in BR 9909.5 and in the policy section. It also adds that the reasonable charge codes P9070, P9071, P9072 and 89337 may be include in the next calendar year's reason charge update in the Policy section.
Effective date: January 1, 2017
Implementation date: January 3, 2017
Updates for the Shared System Maintainers to implement the Social Security Number Removal Initiative
On December 29, CMS posted Transmittal 1766, which rescinds and replaces Transmittal 1758, dated November 23, 2016, to update the implementation date to clarify Common Working File (CWF) will not implement code in April 2017, to add two additional requirements to BR 9858.24 for FISS to utilize extra hours, and to extend the due date for Shared System Maintainers to deliver July 2017 business requirements to December 22, 2016.
Effective date: April 1, 2017
Implementation date: April 3, 2017 for BRs 15-23.1, CWF development only
Medicare Compliance Review of University of Mississippi Medical Center for 2013 and 2014
On December 30, the OIG published a Report regarding the University of Mississippi Medical Center’s compliance with Medicare billing requirements. The OIG found the hospital did not fully comply with Medicare billing requirements for 80 claims, resulting in net overpayments of $68,000 for the audit period. On the basis of the OIG’s sample results, it estimates that the hospital received net overpayments of at least $356,000 for the audit period.
Clarification of Appeal Rights for Denials Stemming from Statutory Requirements
On December 30, CMS posted Transmittal 693 to update the language in the Chapter 5, section 5.5.2.3 of Pub. 100-08 related to appeal rights stemming from denials for failures to comply with statutory requirements. The updated language works to ensure that parties to an initial determination receive their statutorily-guaranteed due process rights to appeal their initial determinations and clarifies the relationship between the right to appeal and limitation on liability provisions.
Effective date: January 31, 2017
Implementation date: January 31, 2017