Revenue Cycle

Important Medicare Updates

Medicare Update for CAHs, November 2, 2011

OIG reviews Medicare outpatient billing for selected drugs at Central Peninsula General Hospital

On October 6, the OIG issued a report of Medicare outpatient drug billing at Central Peninsula General Hospital. Central Peninsula billed Medicare for the incorrect number of units of service of doxorubicin hydrochloride liposome and paclitaxel administered. As a result, the hospital received overpayments totaling $99,000.

View the OIG report.

OIG reviews Medicare outpatient billing for selected drugs at Madison Memorial Hospital

On October 6, the OIG issued a report of Medicare outpatient drug billing at Madison Memorial Hospital. Madison Memorial billed Medicare for the incorrect number of units of service of infliximab administered. As a result, the hospital received overpayments totaling $32,000.

View the OIG report.

CMS issues proposals for Medicare Advantage

On October 11, CMS published a proposed rule in the Federal Register to make changes to the Medicare Advantage and prescription drug programs (Part C and Part D). CMS says the proposals will implement new statutory requirements; strengthen beneficiary protections; exclude plan participants that perform poorly; improve program efficiencies; and clarify program requirements.

View the proposed rule.

CMS issues ACO fact sheets

On October 20, CMS published eight fact sheets about accountable care organizations and the Medicare Shared Savings Program.

Read the fact sheets

DOJ/FTC issue final statement of antitrust policy enforcement regarding accountable care organizations

On October 20, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) issued the final version of a joint policy statement detailing how the agencies will enforce U.S. antitrust laws with respect to new accountable care organizations (ACO).

Read the press release
http://www.justice.gov/opa/pr/2011/October/11-at-1384.html

CMS tests three new surveyor worksheets

CMS is testing three new surveyor worksheets for assessing compliance with three hospital Conditions of Participation: discharge planning, infection control, and quality assessment and performance improvement. CMS is focusing on compliance with these areas as a means to reduce healthcare-acquired conditions and hospital readmissions.

Read the policy memo

CMS issues proposal for ASC conditions of coverage

On October 24, CMS issued a proposed rule that would revise the ambulatory surgical centers (ASC) conditions for coverage to allow patient rights information to be provided to the patient, the patient’s representative, or the patient’s surrogate prior to the start of the surgical procedure. CMS also made minor changes to the conditions for coverage for patient rights requirements.

View the proposed rule.

CMS issues proposal to revise hospital participation requirements

On October 24, CMS issued a proposed rule that would revise the requirements that hospitals and critical access hospitals must meet to participate in the Medicare and Medicaid programs. According to CMS, the proposed changes would reduce the procedural burdens on providers.

View the proposed rule.

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