This week in Medicare updates–3/14/2017
New Provider Self-Disclosure Settlements
On March 8, the OIG posted information on multiple self-disclosure settlements, including several for facilities that employed an individual that it knew or should have known was excluded from participation in Federal healthcare programs, including:
- Ridgeview Institute, Inc., of Georgia
- Health Sciences, Inc., of Alabama
- OhioHealth Corporation of Ohio
- Athena Orchard View, LLC, of Rhode Island
Further, the OIG posted information on Metro Health Corporation and its subsidiary, Metropolitan Hospital, of Michigan, which agreed to pay $2,305,743.39 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Metro Health entered into professional services agreements with two independent contractor physician groups for the provision of neurosurgical and general surgery services and paid the physician groups in excess of fair market value.
The OIG also posted information on Quest Diagnostics, Inc., of New Jersey, which agreed to pay $1,151,053.07 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that:
- Phlebotomists employed by Quest performed services at multiple locations in Texas, Maryland, Ohio and New Jersey that were outside the scope of their employment
- Quest failed to meet documentation requirements supporting its donation of valuable electronic health records software or information technology and services through donation agreements with individuals or entities from which Quest received referrals of clinical laboratory business
- Quest failed to collect timely second-year payments from physician clients as required in electronic health record donation agreements
New Medicare Outpatient Observation Notice (MOON) FAQs
On March 8, CMS published a series of FAQs related to the MOON form, the same day as the requirement for its use went into effect.
Revision to State Operations Manual (SOM) Appendix PP - Incorporate revised Requirements of Participation for Medicare and Medicaid certified nursing facilities
On March 8, CMS published Transmittal 168, rescinding and replacing Transmittal 167, dated February 10, 2017, to correct specific tags. In addition, the Effective and Implementation dates were also changed to reflect the current re-issue date.
Effective date: March 8, 2017
Implementation date: March 8, 2017
Medicare Compliance Review of Mayo Clinic Florida for 2013 and 2014
On March 8, the OIG published a Report regarding its compliance review of Mayo Clinic Florida, which complied with Medicare billing requirements for 185 of the 199 inpatient and outpatient claims that the OIG reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 14 claims, resulting in net overpayments totaling $71,000.
Medicare Contractors' Payments to Providers for Hospital Outpatient Dental Services Generally Did Not Comply With Medicare Requirements
On March 9, the OIG published a Report regarding audits of six Medicare contractors, during with the OIG found that payments made to providers for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 600 dental services in our 6 stratified random samples, Medicare contractors properly paid providers for 27 dental services. The OIG recommended that CMS implement national edits for hospital outpatient dental services and work with the Medicare contractors to develop or strengthen their local edits to ensure that payments made to providers for dental services comply with Medicare requirements.
Federally Qualified Health Centers (FQHC) Prospective Payment System (PPS) - Recurring File Updates
On March 10, CMS published Transmittal 3734 to update the grandfathered tribal FQHC PPS payment rate for the FQHC Pricer.
Effective date: July 1, 2017
Implementation date: July 3, 2017
Indian Health Services (IHS) Hospital Payment Rates for Calendar Year 2017
On March 10, CMS published Transmittal 3732 regarding the annual update of IHS payment rates for calendar year 2017.
Effective date: January 1, 2017
Implementation date: April 10, 2017
Clarification of Admission Order and Medical Review Requirements
On March 10, CMS published Transmittal 234 to clarify CMS rulemaking language as it relates to Admission and Medical Review Criteria for Hospital Inpatient Services Under Medicare Part A; Requirements for Physician Orders.
Effective date: January 1, 2016
Implementation date: June 12, 2017
April 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.1
On March 10, CMS published Transmittal 3735 to provide the I/OCE instructions and specifications for the I/OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness.
Effective date: April 1, 2017
Implementation date: April 3, 2017
OIG Advisory Opinion No. 17-01
On March 10, the OIG published an Advisory Opinion on a hospital system’s proposal to provide free or reduced-cost lodging and meals to certain financially needy patients. The OIG concluded that the proposed arrangement would not constitute grounds for the imposition of civil monetary penalties under section 1128A(a)(5) of the Act.