This week in Medicare updates–4/19/2017

April 18, 2017
Medicare Insider

Update to Common Working File (CWF) Blood Editing on Medicare Advantage (MA) Enrollees' Inpatient Claims for Indirect Medical Education (IME) Payment

On April 10, CMS published MLN Matters 10012 related to Transmittal 1819, which was published April 7 and instructs the CWF to bypass blood-services editing on MA enrollee inpatient claims submitted for IME payment.

Effective date: October 1, 2017

Implementation date: October 2, 2017


July 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

On April 10, CMS published MLN Matters 10016, which is associated with Transmittal 3746. This transmittal, released April 7, supplies contractors with the ASP and not otherwise classified (NOC) drug pricing files for Medicare Part B drugs on a quarterly basis.

Effective date: July 1, 2017

Implementation date: July 3, 2017


Ambulance Companies Settle False Claims Cases

On April 10, the OIG released information on False Claims Settlements with two Ambulance Companies:

  • Freedom Ambulance, LLC, of Beeville, Texas, entered into a $846,563.92 settlement agreement with the OIG to resolve allegations that it knowingly presented to Medicare and Texas Medicaid false or fraudulent claims for non-emergency repetitive ambulance services between beneficiaries' residences or skilled nursing facilities and non-hospital based dialysis facilities.
  • EasCare, LLC, of Dorchester, Massachusetts, entered into a $255,768.14 settlement agreement to resolve allegations that it submitted claims to Medicare for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate.


New Civil Monetary Penalties Settlements announced

On April 11, the OIG released information on multiple new Civil Monetary Penalties settlements, including those with the following providers:

  • Carroll Manor Nursing and Rehabilitation Center of Washington, DC, agreed to pay $1,962,227.92 for allegedly submitting claims to Medicare for therapy that lacked a physician certification for the plan of care and/or proper documentation for the number of therapy minutes billed.
  • Highland Medical, PC, of New York agreed to pay $403,151 for allegedly submitting claims to federal healthcare programs for Evaluation and Management Services purportedly provided by an employed physician but which were not rendered.
  • Crittenton Hospital Medical Center and Cancer Center in Michigan agreed to pay $3,274,153.90 for alleged physician self-referral and kickback violations. OIG alleged that the hospital and cancer center paid more than fair market value compensation for prohibited financial arrangements with a physician and entities owned by that physician and had associated compensation arrangements that not always documented or followed. OIG further alleged that the remuneration created an inappropriate financial relationship.
  • North Central Health Care Facilities of Wisconsin agreed to pay $50,612.28 for allegedly employing an individual who was not a licensed nurse, as she represented in certain employment-related documentation, to provide items or services for which payment may be made under a federal healthcare program; no federal healthcare program payments could be made for items or services furnished by the unlicensed individual.


Notice of New Interest Rate for Medicare Overpayments and Underpayments, 3rd Qtr Notification for FY 2017

On April 11, CMS released Transmittal 282 regarding the charging and payment of interest on overpayments and underpayments to Medicare providers. The Secretary of Treasury certifies an interest rate quarterly. The transmittal announces that Medicare contractors will implement an interest rate of 10.00% effective April 18, 2017 for Medicare overpayments and underpayments.

Effective date: April 18, 2017

Implementation date: April 18, 2017


New Email for Fee-For-Service Beneficiary Notice questions

On April 13, CMS announced a new email address for all questions related to the Beneficiary Notices Initiative (BNI). Effective April 13, 2017, questions regarding any of the Fee For Service BNI notices may be sent to CMS also specified that questions regarding Medicare Advantage notices should continue to go to and questions regarding the Medicare Outpatient Observation Notice (MOON) form can continue to go to


Office of Minority Health Reports released on racial, ethnic, and gender differences in Medicare Advantage

On April 13, CMS Office of Minority Health has released new Reports on racial, ethnic, and gender differences in healthcare for Medicare Advantage enrollees. One report compares quality of care for women and men while the other report looks at racial and ethnic differences in healthcare experiences and clinical care.


Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices

On April 14, CMS published a display copy of the 2018 IPPS proposed rule, which will appear in the Federal Register on April 28. The rule contains updates to quality initiatives and changes to the 2018 ICD-10-CM and ICD-10-PCS code sets, among other proposals. CMS is proposing an increase in operating payment rates of approximately 1.6% for general acute-care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are EHR users. The proposed rule also projected a hospital market basket update of 2.9% adjusted by negative 0.4% required for productivity.

Comments are due to CMS by June 13, and CMS expects to issue a final rule by August 1. Once finalized, changes will become effective October 1. CMS has also released an associated Fact Sheet and Press Release.

Related Topics: 
Compliance, IPPS, Medicare news