Corporate Compliance

The week in Medicare updates

Medicare Insider, April 1, 2014

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Health Professional Shortage Area (HPSA) Post-payment Review Process
On March 25, CMS issued a rescind and replace transmittal to remove language in Transmittal 2890 that references the HPSA quarterly report. All other information remains the same.
 
 
Effective date: March 31, 2014
Implementation date: March 31, 2014
 
 
Medicare National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease
On March 27, CMS issued a rescind and replace transmittal to update the NCD for PET in dementia and neurodegenerative disease.  Effective for claims with dates of service on or after, September 27, 2013, Medicare will only allow coverage for PET Aβ imaging (one PET Aβ scan per patient) through coverage with evidence development (CED) to: (1) develop better treatments or prevention strategies for AD, or, as a strategy to identify subpopulations at risk for developing AD, or (2) resolve clinically difficult differential diagnoses (e.g., frontotemporal dementia (FTD) versus AD) where the use of PET Aβ imaging appears to improve health outcomes, when the patient is enrolled in an approved clinical study under CED.
 
 
 
Effective date: September 27, 2013
Implementation date: July 7, 2014
 
 
Medicare Contractors for Jurisdiction 8 Overpaid Providers for Selected Outpatient Drugs
On March 18, the OIG issued a report stating that payments that the Medicare contractors for Jurisdiction 8 made to providers for 692 of the 1,177 line items for outpatient drugs we
reviewed were not correct. These incorrect payments resulted in overpayments of $2.9 million and underpayments of $28,000 that the providers had not identified, refunded, or adjusted by the beginning of OIG's audit.
 
 
CMS did not always correctly make clinic visit payments to hospitals
On March 12, the OIG issued a report stating that CMS made incorrect outpatient payments to hospitals for established patients' clinic visits.
 



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