This week in Medicare updates–04/27/2016

April 26, 2016

Medicare Insider

Quarterly announcement of interest rate change

On April 12, CMS released a recurring update notification regarding the interest rate effective April 19th. It applies to charging and payment of interest on overpayments and underpayments to Medicare providers. The rate increased from 9.75% to 10%.

Effective date: April 19, 2016

Implementation date: April 19, 2016

View Transmittal R266FM.

Medicare Compliance Review of DePaul Health Center for 2012 and 2013

On April 15, the OIG posted a report stating that DePaul Health Center in Bridgeton, Missouri complied with Medicare billing requirements for 190 of the 204 inpatient and outpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 14 claims (all of which were inpatient claims), resulting in overpayments of $81,000 for calendar years 2012 and 2013. These errors occurred primarily because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

View the report.

Medicare contractor payments to providers for hospital outpatient dental services in Jurisdiction H generally did not comply with Medicare requirements

On April 15, the OIG posted a report stating that Medicare contractor payments made to providers in Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in the stratified random sample, 91 did not comply with Medicare requirements. Using sample results, the OIG estimated that Medicare contractors improperly paid providers in Jurisdiction H at least $1.7 million from January 1, 2012, through August 31, 2014.

View the report.

Bundled Payments for Care Improvement Initiative (BPCI) fact sheet

On April 18, CMS posted an updated fact sheet regarding the BPCI. This initiative is comprised of four broadly defined models of care, which link payments for multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.

View the updated fact sheet.

OIG Advisory Opinion No. 16-04

On April 19, the OIG posted an advisory opinion regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance policies, whereby three insurance companies would indirectly contract with hospitals for discounts on the otherwise-applicable Medicare inpatient deductibles for their policyholders and, in turn, would provide a premium credit of $100 to policyholders who use a network hospital for an inpatient stay.

View the advisory opinion.

CMS releases Medicare Advantage quality data for racial and ethnic minorities

On April 19, CMS’ Office of Minority Health released data detailing the quality of care received by people with Medicare Advantage by racial or ethnic group. “This is the first time that CMS has released Medicare Advantage data stratified by race and ethnicity. Increasing understanding and awareness of disparities and their causes is the first step of our path to equity,” said Dr. Cara James, director of the CMS Office of Minority Health. “While these data do not tell us why differences exist, they show where we have problems and can help spur efforts to understand what can be done to reduce or eliminate these differences.”

View the data and summary report.

View the press release.

Long term care and IPPS reclassification interim final rule

On April 21, CMS posted an interim final rule with comment period in the Federal Register implementing section 231 of the Consolidated Appropriations Act of 2016, which provides for a temporary exception for certain wound care discharges from the application of the site neutral payment rate under the Long-Term Care Hospital PPS for certain long-term care hospitals. This interim final rule also amends the current regulations to allow hospitals nationwide to reclassify, for purposes of IPPS payment, based on their acquired rural status, effective with reclassifications beginning with FY 2018, as well as implement other changes related to the Geisinger Community Medical Center and Lawrence Memorial Hospital decisions. This rule is effective April 21. Comments are due by June 17.

View the rule in the Federal Register.