Corporate Compliance

This week in Medicare updates

Medicare Insider, August 4, 2015

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Signature requirements

On July 24, CMS released a change request to allow contractors to use alternate medical documentation to identify an illegible handwritten signature.

Effective date: August 25, 2015
Implementation date: August 25, 2015

View Transmittal R604PI.

Hospice of New York, LLC, improperly claimed Medicare reimbursement for some hospice services

On July 27, the OIG posted a report stating Hospice of New York, LLC, claimed Medicare reimbursement for some hospice services that did not comply with certain Medicare requirements. Of the 100 beneficiary-months in the random sample for which the hospice claimed Medicare reimbursement, 79 beneficiary-months complied with Medicare requirements, but 21 did not. OIG estimated that the hospice received at least $1.3 million in improper Medicare reimbursement.

View the report.

Medicare contractors' payments to providers for hospital outpatient dental services in Jurisdiction K did not comply with Medicare requirements

On July 27, the OIG posted a report stating Medicare contractor payments to providers in Jurisdiction K (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont) for hospital outpatient dental services did not comply with Medicare requirements. Of the 100 dental services in the stratified random sample, 85 did not comply with Medicare requirements. OIG estimated that Medicare contractors improperly paid providers at least $2,276,853 for dental services provided during the period January 1, 2011, through December 31, 2013.

View the report.

Announcement of extended temporary moratoria on enrollment of ambulance suppliers and home health agencies in designated geographic locations

On July 28, CMS posted a notice in the Federal Register announcing the extension of temporary moratoria on the enrollment of new ambulance suppliers and home health agencies, subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse. The effective date is July 29, 2015.

View the notice in the Federal Register.

OIG Advisory Opinion No. 15-10

On July 28, the OIG posted an opinion in response to a request for an advisory opinion regarding a hospital system’s proposal to lease non-clinician employees and to provide operational and management services to a related psychiatric hospital for an amount equal to the hospital system’s fully loaded costs.

View the opinion.

2014-2024 Projections of National Health Expenditures Data Released

On July 28, CMS posted a press release stating total healthcare spending growth is expected to average 5.8% in aggregate over 2014-2024, according to a report published today in Health Affairs authored by CMS’ Office of the Actuary (OACT). The authors noted that this rate of growth is still substantially lower than the 9% average rate seen in the three decades before 2008.

View the press release.

Medicare and Medicaid at 50: Keeping America Healthy and Driving Innovation in Healthcare

On July 28, CMS posted a press release stating that, on its 50th anniversary, more than 55 million Americans are covered by Medicare. On July 30, CMS posted a fact sheet marking the 50th Anniversary of Medicare and Medicaid, both historic social achievements that dramatically changed the healthcare landscape for seniors, low-income children and adults, and people with disabilities. These programs have greatly reduced the number of uninsured people and have helped create a health care system that is better, smarter, and more comprehensive.

View the fact sheet.

View the press release.

Medicare Part B Overpaid Millions for Selected Outpatient Drugs

On July 29, the OIG posted a report stating Medicare contractors in 13 jurisdictions overpaid providers $35.8 million for selected outpatient drugs during our audit period (July 1, 2009, through June 30, 2012). For the majority of the overpayments (88%), providers billed either incorrect units of service or a combination of incorrect units of service and incorrect HCPCS codes. During the audit period, the Medicare claims processing systems did not have sufficient prepayment edits in place to prevent all overpayments. In particular, Medically Unlikely Edits (MUE) did not exist for many of the HCPCS codes associated with the outpatient drugs in the review.

View the report.

Speech Generating Devices

On July 29, CMS posted a final decision memorandum and accompanying fact sheet related to coverage of speech generating devices. Speech generating devices are considered to fall within the Medicare durable medical equipment (DME) benefit category. The current NCD for speech generating devices was established in 2001 and covers devices that generate speech for patients with a severe speech impairment. The 2001 NCD limits coverage to devices that are not capable of performing functions other than generating speech. Software that generates speech and is used on a laptop computer, tablet, or other non-DME device is also covered under the NCD implemented in 2001, but the device the software is used on is not covered.

View the final decision memorandum.

View the fact sheet.

Medicare prescription drug premiums projected to remain stable

On July 29, CMS posted a press release stating that the average premium for a basic Medicare Part D prescription drug plan in 2016 will remain stable, at an estimated $32.50 per month. This news comes despite the fact that total Part D costs per capita grew by almost 11% in 2014, driven largely by high cost specialty drugs and their effect on spending in the catastrophic benefit phase.

View the press release.

Performance data for the Senior Medicare Patrol projects: July 2015 Performance Report

On July 30, the OIG posted a memorandum report presenting performance data for the Senior Medicare Patrol (SMP) projects, which receive grants to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of health care fraud. OIG has collected these performance data since 1997. In July 2010, the Administration on Aging (AoA) requested that OIG continue to collect and report these data to support AoA's efforts to evaluate and improve the SMP projects' performance.

View the memorandum.

Final fiscal year 2016 payment and policy changes for Medicare skilled nursing facilities

On July 30, CMS posted a fact sheet regarding a final rule outlining FY 2016 Medicare payment rates for SNFs. The final rule promotes policies that continue to shift Medicare payments from volume to value. It includes policies that advance that vision and support building a healthcare system that delivers better care, spends healthcare dollars more wisely, and results in healthier people.

View the fact sheet.

Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System Policy Changes and FY 2016 Rates

On July 31, CMS posted the hospital IPPS for acute care hospitals and the LTCH hospital prospective payment system policy changes and FY 2016 rates. CMS is addressing the update of the rate of increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016. As an interim final rule with comment period, CMS is implementing the statutory extensions of the Medicare-dependent, small rural hospital (MDH) Program and changes to the payment adjustment for low-volume hospitals under the IPPS. It also establishes new requirements or revisions of existing requirements for quality reporting by specific providers (acute care hospitals, PPS exempt cancer hospitals, and LTCHs) participating in Medicare and updates policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the HAC Reduction Program.

View the IPPS final rule.

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