This week in Medicare updates – 1/10/2018

January 10, 2018
Medicare Insider

CMS Launches Data Submission System for Clinicians in the Quality Payment Program

On January 2, CMS issued a Press Release regarding a new data submission system for eligible clinicians in the Quality Payment Program (QPP) to use when submitting data for the 2017 performance period. The system will allow eligible clinicians to see real-time scoring within each of the Merit-based Incentive Payment System (MIPS) performance categories. The 2017 data submission period runs from January 2, 2018 to March 31, 2018, for all eligible clinicians except groups using the CMS Web Interface.


Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens

On January 2, CMS published MLN Matters 10448 to accompany Medicare Claims Processing Transmittal 3942, dated December 22, 2017, regarding revisions of the payment of travel allowances for CY 2018 when billed on a per mileage basis using HCPCS code P9603 and when billed on a flat rate basis when using HCPCS code P9604.

Effective date: January 1, 2018

Implementation date: January 22, 2018


New Provider Self-Disclosure Settlements
On January 3, the OIG updated its list of Provider Self-Disclosure Settlements with multiple new settlements reached in December. The list includes four providers who reached settlements due to allegedly employing individuals they knew or should have known were excluded from participation in federal healthcare programs. Those providers include:

  • Kennon Stuart Legacy Trusts and the QTIP Trust, through its companies Victoria Special Care Center, Inc. d/b/a Shea Family Care Victoria and Magnolia Special Care Center, Inc. d/b/a Shea Family Care Magnolia, of California
  • HVL Corp d/b/a The Whittier Pavilion, of Massachusetts
  • Friendly Medical Transportation, LLC, of North Carolina
  • Meriwether Healthcare, LLC, d/b/a Warm Springs Medical Center and Warm Springs Nursing Home, of Georgia

The OIG also announced multiple new settlements reached in December with providers who self-disclosed other violations of the Civil Monetary Penalties law. These settlements include:

  • On December 6, Keystone Behavioral Pediatrics, LLC, of Florida, agreed to pay $26,245.50 for allegedly presenting claims to TRICARE for behavioral health supervision services that were not actually provided.
  • On December 19, Heart Center of Philadelphia, P.C., of Pennsylvania, agreed to pay $50,000 for allegedly receiving remuneration from a laboratory company in the form of “process, handling, and collection” payments related to blood collection. Heart Center also allegedly received improper remuneration from the laboratory company in exchange for referring patients for laboratory testing services paid by federal healthcare programs.
  • On December 20, Seton Medical Center, of California, agreed to pay $27,225 for allegedly submitting claims to Medicare for cataract extraction procedures when it did not supply the specialized Intraocular Lens for which it was reimbursed.
  • On December 22, Cavalier County Memorial Hospital Association, of North Dakota, agreed to pay $750,000 for paying improper remuneration to two physicians and a nurse practitioner in the form of excessive compensation. That remuneration created a prohibited financial relationship with the physicians, and the hospital association presented claims for designated health services that resulted from prohibited referrals made by the physicians


Updated List of Excluded Individuals and Entities (LEIE)

On January 3, the OIG updated its LEIE with an updated LEIE database for download and lists of December 2017 exclusions, reinstatements, and profile corrections.


Correction: Medicare, Medicaid, and Children’s Health Insurance Programs (CHIP); Provider Enrollment Application Fee Amount for Calendar Year 2018

On January 3, CMS published a Correction Notice in the Federal Register to correct technical and typographical errors from a previous notice, published December 4, 2017, which provided the provider enrollment application fee for the Medicare, Medicaid, and CHIP programs in 2018. The corrections include adjusting the number of newly enrolled institutional providers from 3,800 providers to 10,700 providers, as the original number of providers was incorrect. The notice also makes several corrections to calculations which had been based on the previously incorrect number of providers.

Effective date: This correction notice takes effect on January 1, 2018


Comment Request: Application for Participation in the Intravenous Immune Globulin Demonstration

On January 4, CMS published a Comment Request in the Federal Register to seek comments on the information collection titled, “Application for Participation in the Intravenous Immune Globulin (IVIG) Demonstration.” Comments are due to the OMB desk officer by February 5, 2018.


Updated Corporate Integrity Agreement Documents

On January 4, the OIG published information on new Corporate Integrity Agreements with the following organizations:

  • Robert J. Edwards, D.D.S, of Baton Rouge, LA
  • Portnow, M.D., P.A., Arthur S. d/b/a Apple Medical and Cardiovascular Group, d/b/a Apple Medical Group, and Arthur S. Portnow, M.D., of Sarasota, FL
  • Ioannides, M.D., Dr. Tim, and Tim Ioannides, M.D., LLC, d/b/a Treasure Coast Dermatology, of Port St. Lucie, FL


Advisory Opinion on Neurosurgeons Agreeing to Implement Cost-Reduction Measures in Designated Procedures at Medical Center and Sharing Percentage of Cost Savings with Medical Center

On January 5, the OIG posted Advisory Opinion 17-09 regarding an arrangement in which certain neurosurgeons agreed to implement cost-reduction measures in designated surgical procedures performed at a medical center. The arrangement would then have the neurosurgeons share the cost savings from these measures with the medical center. The involved parties sought an advisory opinion to determine whether the arrangement would violate a civil monetary penalty provision for hospital payment to physicians to induce the reduction or limitation of medically necessary services (gainsharing) and whether the arrangement would violate the anti-kickback statute.

The OIG noted that while the arrangement would implicate both the gainsharing civil monetary penalty provision and the anti-kickback statute, it would not impose sanctions in this specific case due to details explained within the advisory opinion.


Letter to PhRMA Regarding Drug Companies Providing Free Drugs to Federal Health Care Program Beneficiaries

On January 5, the OIG published a Letter it sent to Pharmaceutical Research and Manufacturers of America (PhRMA) regarding drugs used by patients who have been receiving financial assistance from Caring Voice Coalition, Inc. (CVC). Because CVC will not be offering financial assistance to patients in 2018, the OIG wrote that it will not pursue administrative sanctions against any drug company providing free drugs during 2018 to federal healthcare program beneficiaries who were receiving cost-sharing support from CVC for those drugs as of November 28, 2017 as long as the drug company follows safeguards described in the letter. 

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