Corporate Compliance

Other issuances: CMS issues NCDs and OIG issues inappropriate billing reports

Medicare Insider, August 14, 2012

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CMS issues NCD for TAVR (20.32)

On August 8, CMS issued a national coverage determination (NCD) for transcatheter aortic valve replacement (TAVR) (20.32).

View the NCD.

CMS issues NCD for TENS for chronic low back pain (160.27)

On August 7, CMS issued a national coverage determination (NCD) for transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (160.27).

View the NCD.

CMS revises NCD for adult liver transplantation (260.1)

On August 7, CMS issued a revision to the national coverage determination for adult liver transplantation (260.1).

View the NCD.
 
OIG issues review on payments in Jurisdiction 12 for Herceptin

On August 6, the OIG issued a review which found that most Medicare payments that were made to providers in four of the five states in Jurisdiction 12 Delaware, the District of Columbia, New Jersey, and Pennsylvania) from January 2008 through December 2010 were incorrect. Of 1,454 line items reviewed, 1,165 were incorrect and included overpayments totaling $1.6 million.

View the OIG report.

OIG issues review on payments in Jurisdiction 6 for Herceptin

On August 6, the OIG issued a review which found that most Medicare payments that Noridian Administrative Services made to providers for full vials of Herceptin were incorrect. Of 464 line items reviewed, 368 were incorrect and included overpayments totaling $557,000.

View the OIG report.

OIG issues report on inappropriate and questionable billing by home health agencies

On August 2, the OIG issued a review of Medicare home health agency payments in 2010. The review found that in 2010, Medicare inappropriately paid $5 million for home health claims with three specific errors: overlapping with claims for inpatient hospital stays, overlapping with claims for skilled nursing facility stays, or billing for services on dates after beneficiaries' deaths.

View the OIG report.



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