Health Information Management

The week in Medicare updates

APCs Insider, September 11, 2015

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OIG posts Medicare Compliance Review of Saint Luke's Hospital
On August 24, the Office of Inspector General (OIG) posted a Medicare Compliance Review report stating Saint Luke's Hospital of Chesterfield, Missouri, 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 2011 and 2012 (12 claims) and 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.
 
CMS releases annual 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.
 
OIG posts Medicare Compliance Review of Moses H. Cone Memorial Hospital
On August 31, the OIG posted a report stating Moses H. Cone Memorial Hospital in North Carolina 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.
 
CMS posts Advisory Panel on Hospital Outpatient Payment recommendations
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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