Compliance 101 |
Vol. VIII, No. 31 – September 26, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Advanced Academy
Compliance Academy
Table of Contents
Headlines
OIG Releases FY 2007 Work Plan
Norwalk Named Acting Administrator for CMS
Medical Device Salesman Sentenced
Panel: HIV/AIDS Medicare Fraud Pervasive
Pediatrix Settlement Announced
Hospital Settles
Former Clinic Employee Indicted
Regulatory News
HHS Partners with States on LTC Education Efforts
CMS Updates
In the Federal Register
CMS Transmittals
From OIG
This
Week’s Link
Acronym Library
Visit
HCCA's Web site
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Headquarters - Contact Information
Headlines:
OIG Releases FY 2007 Work Plan
On September 25, 2006, the U.S. Department of Health and Human Services Office of Inspector General released its 2007 Work Plan. This valuable tool for compliance officers is available at the following link:
http://oig.hhs.gov/publications/docs/workplan/2007/ Work%20Plan%202007.pdf
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Norwalk Named Acting Administrator for CMS
According to a report from Modern Healthcare, "HHS Secretary Mike Leavitt named Leslie Norwalk as acting administrator for the CMS effective Oct. 15. Norwalk has served as deputy administrator for the agency that oversees $740 billion in federal spending on Medicare and Medicaid. She replaces Mark McClellan, who resigned from the CMS on Sept. 5."
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Medical Device Salesman Sentenced
On September 21, US Attorney for the Southern District of Florida
R. Alexander Acosta announced that defendant, Troy Guzman, 42, of Spanish Fort, Alabama, was sentenced today in a criminal case arising out of a Miami-based FDA investigation named Operation Miami Device.
Guzman was sentenced for his role in a conspiracy to transport and sell in interstate commerce various stolen prescription medical devices, in violation of Title 18, United States Code, Section 371. Guzman was sentenced to a period of one year and a day imprisonment, followed by a period of three years of supervised release. In addition, Guzman was ordered to forfeit $1,775,916.80, which represents the amount of personal gain to Guzman as a result of his participation in the criminal conspiracy. For more:
http://www.usdoj.gov/usao/fls/PressReleases/060921-05.html
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Panel: HIV/AIDS Medicare Fraud Pervasive
The Herald reported on September 25 that “A panel of experts agreed Saturday that fraud in billing Medicare for HIV/AIDS treatments is a massive problem.
''We're very concerned,'' said Sandra Colón, a Medicare investigator. ''This healthcare fraud is endangering the health of our beneficiaries.'' She said the federal agency was ''aggressively'' taking measures to stop the fraud.“Representatives of the Federal Bureau of Investigation, the Florida Department of Health, Medicare and First Coast Service Options spoke during a roundtable at the 2006 U.S. Conference on AIDS, held at the Diplomat Hotel in Hollywood.” For more:
http://www.bradenton.com/mld/bradenton/news/ nation/15604778.htm
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Pediatrix Settlement Announced
Modern Healthcare reported on September 22 that “Pediatrix Medical Group, Fort Lauderdale, Fla., will pay $25.1 million to settle civil Medicaid fraud allegations that it upcoded claims for neonatal intensive-care services from 1996 to 1999. Pediatrix, which denied the allegations in the settlement, also signed a five-year corporate integrity agreement with HHS' inspector general's office. For more: http://www.modernhealthcare.com/ news.cms?newsId=5628&potId=BN
Government Press Release: http://www.usdoj.gov/usao/fls/PressReleases/060921-05.html
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Hospital Settles
On August 18, US Attorney for the Northern District of Ohio Gregory A. White announced that the United States has settled a lawsuit against University Hospitals of Cleveland for $13,880,000. The settlement arose from a federal lawsuit filed under seal by Thomas J. Kirby, M.D., a physician formerly affiliated with University Hospitals. The seal on the lawsuit was lifted by U.S. District Judge Donald C. Nugent on August 18, 2006. For more: http://www.usdoj.gov/usao/ohn/news/18August2006.htm
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Former Clinic Employee Indicted
On September 15, The Naples Daily News reported that “The indictment of a former Cleveland Clinic Florida employee for conspiracy to commit health care fraud with personal information of more than 1,100 Naples patients isn’t likely to bring a hammer of civil fines against the hospital by the federal government, which has yet to sanction a hospital or other health care entity for patient privacy
breaches.” For more:
http://www.naplesnews.com/news/2006/sep/15/ florida_health_fraud_case_breaks_new_legal_ground/ ?local_news
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MediRegs provided the following Regulatory News items: In the Federal Register and CMS Transmittals.
Regulatory News
HHS Partners with States on LTC Education Efforts
On September 25, the US Department of Health and Human Services announced
a partnership with six states that would help Americans take an active role in planning ahead for their future long-term care needs.
Georgia, Massachusetts, Michigan, Nebraska, South Dakota, and Texas were chosen to participate in the next round of HHS’ “Own Your Future" campaign, an aggressive education and outreach effort designed to promote long-term care planning among state residents. These six states were selected from 16 applications received in response to HHS’ invitation for proposals. For more:
http://www.hhs.gov/news/press/2006pres/20060925.html
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CMS Updates
NPI Info -
Make sure to get your National Provider Identifier! The compliance date, May 23, 2007, is only 8 months away. It’s every provider’s responsibility to make sure that an NPI is obtained if the provider is required to do so. If you’re not sure, it’s time to investigate. Get your NPI now so you have time to prepare before the compliance date. This includes sharing your NPI and appropriately testing it with payers to avoid a disruption in cash flow. To learn more on how to apply visit http://www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.
Have your NPI and don’t know what to do with it? Share it. Share it with health plans you bill and the colleagues who rely on having your NPI to submit their claims (e.g. those who bill for ordered or referred services). You should also share it with your billing service, vendor, or clearinghouse, if you have any of them as business associates. Find out when and how the health plans with which you do business will begin accepting the NPI in claims and other standard transactions.
Once your health plans have informed you that they are ready to accept NPIs, begin the testing process. It is important to test before May 23, 2007 to avoid a disruption in your cash flow. Consider sending only a few claims at first as you test the ability of plans to accept the NPI. Fewer claims will make it easier to keep track of status and payment, as well as troubleshooting any potential problems that may arise during the testing process.
New NPI Information for Medicare Providers
Clarification of the Taxonomy Requirement Outlined in CR5243
Effective January 1, 2007, institutional Medicare providers who submit claims for their primary facility and its subparts (such as
psychiatric unit, rehabilitation unit, etc.) must report a taxonomy code on all claims submitted to their Fiscal Intermediary. CMS posted a FAQ that clarifies this requirement. Visit CMS website and click on questions: http://www.cms.hhs.gov
Reminder to Supply Legacy Identifiers on NPI Application
CMS continues to urge providers to include legacy identifiers on their NPI applications. This will help all health plans, including Medicare, to get ready for May 23, 2007. If reporting a Medicaid legacy number, include the associated State name. If providers have already been assigned NPIs, CMS asks them to consider going back into the NPPES and updating their information with their legacy identifiers if they did not include those identifiers when they applied for NPIs. This information is critical for health plans and health care clearinghouses in the development of crosswalks to aid in the transition to the NPI.
Information on Covered Entities Under HIPAA
CMS has posted a new “Frequently Asked Question” to the CMS website that addresses whether a health care provider is a covered entity under HIPAA if they receive health information electronically (e.g. an electronic remittance advice), but do not transmit any health information electronically. Visit CMS website and click on questions: http://www.cms.hhs.gov
New WEDI Early Adopters Series
The Workgroup for Electronic Data Interchange (WEDI) has developed a series of monthly 90-minute audio casts that highlight the NPI related planning, management, communication and implementation activities. The first audio cast is scheduled for Wednesday, October 4, 2006 from 2-3:30 PM ET. Visit the WEDI website for more information and to register for this audio cast at http://www.wedi.org/npioi/index.shtml on the web. Please note that there is a cost to register for this WEDI event.
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In the Federal Register
CMS Proposes Rule Limiting Recoupment of Provider and Supplier Overpayments
On September 22, 2006, CMS proposed a new rule that would implement a provision of the MMA prohibiting recoupment of overpayments when an appeal is received from a provider or supplier until a decision is rendered by a Qualified Independent Contractor. The proposed rule defines the overpayments to which the limitation applies, how the limitation works in concert with the appeals process, and the change in CMS' obligation to pay interest to a provider or supplier whose appeal is successful at levels above the QIC. http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=0609226&h=top1.html&t=80&s=twcc
Final Rule on Fire Safety Requirements for Certain Health Care Facilities
CMS adopted, on September 22, 2006, the substance of the April 15, 2004 tentative interim amendment 00-1 (101), Alcohol Based Hand Rub Solutions, an amendment to the 2000 edition of the Life Safety Code, published by the National Fire Protection Association. The amendment allows certain health care facilities to place alcohol-based hand rub dispensers in egress corridors under specified conditions. The final rule also requires that nursing facilities at least install battery-operated single station smoke alarms in resident rooms and common areas if they are not fully sprinklered or they do not have system-based smoke detectors in those areas.:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=0609227&h=top1.html&t=80&s=twcc
CMS Revises Rural Heath Clinic Regulations
CMS published an interim final rule on September 22nd reverting to the rural health clinic regulations extant before publication of the December 24, 2003 RHC final rule. That final rule established a process and criteria for disqualifying from the RHC program clinics that no longer meet basic location requirements, required RHCs to establish quality assessment and performance improvement programs and prohibited "commingling" of an RHC with another entity. CMS intends to reissue new rules to reinstate the current provisions. These revisions do not impact the effectiveness of the self-implementing provisions of the BBA or any provisions previously implemented or enforced through program memoranda.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=0609228&h=top1.html&t=80&s=twcc
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CMS Transmittals
General Information, Eligibility and Entitlement (PUB. 100-01)
Transmittal #40, Scheduled Release for October 2006 Software Programs and Pricing/Coding Files:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_01&u=mrpm10001r40gi&h=top1.html&t=80&s=twcc
Includes the October 2006 schedule for software programs and pricing/coding files.
Medicare Benefit Policy - Basic Coverage Rules (PUB. 100-02)
Transmittal #54, Clarification/Update to Chapter 8, Pub. 100-02:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_02&u=mrepm10002r54bp&h=top1.html&t=80&s=twcc
Medicare Claims Processing (PUB. 100-04)
Transmittal #1061, October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor Specifications Version 22.0:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1061cp&h=top1.html&t=80&s=twcc
Transmittal #1060, October 2006 Update of the Hospital Outpatient Prospective Payment System: Summary of Payment Policy Changes:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1060cp&h=top1.html&t=80&s=twcc
Transmittal #1059, 2006 October 2006 Quarterly Average Sales Price Medicare Part B Drug Pricing File, Effective October 1, 2006, and Revisions to January 2006, April 2006 and July 2006 Quarterly ASP Medicare Part B Drug Pricing Files:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1059cp&h=top1.html&t=80&s=twcc
Transmittal #1058, Additional Requirements Necessary to Implement the Revised Health Insurance Claim Form CMS-1500 (08/05):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1058cp&h=top1.html&t=80&s=twcc
Transmittal #1057, Maintenance and Update of the Temporary Hook Created to Hold OPPS Claims that Include Certain Drug HCPCS Codes:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1057cp&h=top1.html&t=80&s=twcc
Transmittal #1056, October 2006 Quarterly Average Sales Price Medicare Part B Drug Pricing File, Effective October 1, 2006, and
Revisions to January 2006, April 2006 and July 2006 Quarterly ASP Medicare Part B Drug Pricing Files:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1056cp&h=top1.html&t=80&s=twcc
CMS One-Time Special Notification (PUB. 100-20)
Transmittal #237, New Contractor Number for the Jurisdiction D DME MAC Workload for Noridian Administrative Services, LLC:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20&u=mrepm10020r237otn&h=top1.html&t=80&s=twcc
National Coverage Analyses
Carotid Artery Stenting Facilities - 09/07/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=carotidarterystentinglist14&h=top1.html&t=80&s=twcc
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From OIG
OIG Posts Three New Advisory Opinions
To access the Advisory Opinion document 06-11 (a municipality's exclusive contract arrangement for non-emergency inter-facility
ambulance transport services) go here: http://oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-11A.pdf
To access the Advisory Opinion document 06-12 (concerning a municipality's exclusive contract arrangement for non-emergency inter-facility ambulance transport services) go here: http://oig.hhs.gov/fraud/docs/advisoryopinions/2006/Adv-Opn06-12B.pdf
To access the Advisory Opinion document 06-13 (concerning a nonprofit, tax-exempt, charitable organization's proposal to provide financially needy persons who have [diseases redacted] with grants to defray the costs of premiums and cost-sharing obligations under Medicare Part B, Medicare Part D, Medicare Supplementary Health Insurance, and Medicare Advantage) Go here: http://oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-13C.pdf
For the index of recent OIG Advisory Opinions, follow this link: http://oig.hhs.gov/fraud/advisoryopinions/opinions.html
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This Week‘s Link
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=40017
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Acronym Library
| MMS | (U.S.) Minerals Management Service General |
| MMS | Manpower Management System General |
| MMS | Metropolitan Medicare System General |
| MMWR | Morbidity & Mortality Weekly Report General, Health Care |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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