Corporate Compliance

Other Issuances: OIG releases reports on high-dollar payments, CMS issues PT test decision memo, and more

Medicare Insider, December 2, 2008

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OIG issues report on high-dollar outpatient claims processed by Cahaba Government Benefit Administrators for the period January 1, 2004, through December 31, 2006
 
On November 25, the OIG issued a report on high-dollar outpatient claims processed by Cahaba Government Benefit Administrators, a fiscal intermediary, for the period January 1, 2004, through December 31, 2006. The OIG found that Cahaba overpaid hospitals in Alabama $355,000 from 2004-2006.
 
View the OIG report.
 
OIG issues report on high-dollar payments for Maryland and District of Columbia Medicare hospital outpatient claims processed by Highmark Medicare Services for the period October 1 through December 31, 2005
 
On November 25, the OIG issued a report on high-dollar payments for outpatient claims from Maryland and the District of Columbiaprocessed by Highmark Medicare Services, a fiscal intermediary, for the period October 1 through December 31, 2005. The OIG found that Highmark overpaid $54,000 for the five high-dollar payments it made during this time period in these jurisdictions.
 
View the OIG report.
 
CMS issues decision memo for prothrombin time (PT) tests
 
On November 24, CMS issued a decision memo in which it determined that ICD-9-CM diagnosis code 197.7 (secondary malignant neoplasm of liver), flows from the existing narrative for conditions for which a PT test is reasonable and necessary. CMS is therefore adding ICD-9-CM code 197.7 to the list of codes covered by Medicare under this NCD.
 
View the decision memo.
 
CMS issues memorandum on new critical access hospital (CAH) requirements under 42 CFR 485.610(e)
 
On November 21, CMS issued a memorandum on new critical access hospital (CAH) requirements under 42 CFR 485.610(e) related to CAH co-location and CAH provider-based locations.
 
View the memo.
 
CMS issues memorandum on waivers and phase-in time extensions for the implementation of the new end stage renal disease (ESRD) conditions for coverage
 
On November 21, CMS issued a memorandum on waivers and phase-in time extensions for the implementation of the new ESRD conditions for coverage.
 
View the memo.



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