Corporate Compliance

Other issuances: OIG issues billing compliance reports, CMS issues guidance on determination rural location, and more

Medicare Insider, May 1, 2012

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OIG issues report on Southern Calif. Renal Disease Council inc. billing compliance

On April 27, the OIG issued a report of an audit it conducted where it reviewed $1.34 million of the $7.91 million that Southern California Renal Disease Council, Inc., claimed under Medicare contract number 500-02-NW18CH for the period September 30, 2002, through September 28, 2006. Of the $1.34 million we reviewed, $651,000 was allowable under the terms of the contract and pursuant to applicable Federal regulations. The remaining $687,000 consisted of $29,000 in salaries and wages, fringe benefits, travel costs, and other direct costs that we determined were unallowable and $658,000 that we set aside for CMS resolution.

View the OIG report.

OIG issues report on Jurisdiction 4 IRF claims that did not comply with transfer regulations

On April 27, the OIG issued a review of Medicare claims in 2008 and 2009 for Jurisdiction 4 (TrailBlazer Health Enterprises, LLC) that did not comply with inpatient rehabilitation facility transfer regulations. TrailBlazer incorrectly paid 73 transfer claims as discharges. As a result, Medicare overpaid 30 facilities by $385,000 for FYs 2008 and 2009.

View the OIG report.

CMS issues guidance on determining rural location for swing bed and RHC eligibility

On April 20, CMS issued additional guidance on determining rural location for hospital swing bed and rural health clinic eligibility. Specifically, CMS provides instructions for utilization the Census Bureau American FactFinder Database to make rural area location determinations.

View the certification letter.

CMS issues minor edits to ABN instructions form

On April 19, CMS issued an update stating that minor edits have been made in the ABN instructions to clarify that the provider/supplier is responsible for inserting wording in all of the blanks labeled “D” on the notice including the “D” blanks that are within the “Options” section.  Please click the link in the list below to download the updated ABN instructions.

View the updated instructions.

CMS issues April 2012 Medicare NCD Coding Policy Manual and Change Report

On April 27, CMS issued the Medicare national coverage determinations (NCD) Coding Policy and Manual Change Report for clinical diagnostic laboratory services for April 2012.

View the report.

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