Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, September 21, 2015

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Medicare Compliance Review of Saint Luke's Hospital of Chesterfield for 2011 and 2012

On August 24, the OIG posted a Medicare Compliance Review report stating Saint Luke's Hospital of Chesterfield complied with Medicare billing requirements for 174 of the 188 outpatient and inpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 14 claims, resulting in overpayments of $120,000 for calendar years (CY) 2011 and 2012 (12 claims) and CYs 2010 and 2013 (two claims). Specifically, five outpatient claims had billing errors, resulting in overpayments of $78,000, and nine inpatient claims had billing errors, resulting in overpayments of $42,000. These errors occurred primarily because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

View the report.

Annual 2015-2016 season update for influenza vaccine payment allowances

On August 28, CMS released a recurring update notification stating that the payment allowances for the following seasonal influenza virus vaccines, effective August 1, are still pending.

Effective date: August 1, 2015
Implementation date: No later than November 24, 2015

View Transmittal R3341CP.

View MLN Matters article MM9299.

NCD for screening for colorectal cancer using Cologuard™

On August 28, CMS recommunicated Transmittals 3319 and 183. Pub. 100-03 NCD Manual, Section 210.3, Colorectal Cancer Screening, has been revised to include minor formatting and editorial changes that do not impact on the policy criteria contained therein. The Transmittal Number, date of Transmittal, and all other information remains the same.

Effective date: October 9, 2014
Implementation date: September 8, 2015, for non-shared MAC edits; January 4, 2016, for all shared system changes

View Transmittal R3319CP.

View Transmittal R183NCD.

Revised Quality Indicator Survey (QIS) training process and clarification of trainer roles and responsibilities

On August 28, CMS posted a survey and certification letter stating it has revised the training procedures for State Survey Agencies (SA) and Regional Offices (RO) utilizing the QIS to:

  • Eliminate the mock survey and replace it with a survey of record
  • Eliminate the T3.5 process formerly called “The Trainer Instructor Training”
  • Update the compliance process and associated tool used for evaluating surveyors
  • Clarify the role of certified trainers

This revised QIS training protocol does not replace the structured training program each SA and RO is required to have as outlined in Exhibit 42 of the State Operations Manual.

View the survey and certification letter.

Medicare Compliance Review of Moses H. Cone Memorial Hospital for 2012

On August 31, the OIG posted a report stating Moses H. Cone Memorial Hospital complied with Medicare billing requirements for 152 of the 225 inpatient and outpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 73 claims, resulting in net overpayments of approximately $458,000. On the basis of the sample results, OIG estimated that the hospital received overpayments of at least $1.8 million for the audit period. These errors occurred primarily because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

View the report.

Advisory Panel on Hospital Outpatient Payment recommendations posted

On August 31, the Advisory Panel on Hospital Outpatient Payment posted the agenda and recommendations following the August 24 meeting. To view, visit the link below, click on the link named “August 24, 2015 Agenda and Recommendations,” and download the ZIP files.

View the page.



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