Vol. X, No.26 – July 3, 2008 | Please direct all comments to subscriptions@hcca-info.org.
About HCCA | CCB Certification | Shop Online | Events | Career Opportunities
Is Your Inpatient Rehabilitation Program In Shape? Current Compliance Issues - July 31, 2008 August 12th - Legal EHR Michelle Dougherty, American Health Information Management Association, Rita Scichilone, American Health Information Management Association August 14 – Medicaid Integrity Program - Brian Flood, KPMG August 21 - e-Discovery in Healthcare – Michelle Dougherty, American Health Information Management Association, Ron Hedges, former US Dist Court Judge. Currently with Nixon Peabody LLP August 29 - Still In The Dark? Reporting Meaningful Metrics to the Board - Jose Tabuena, Medical Edge Health Care, Eric Klavetter, Mayo Clinic September 3 – Revenue Cycle Analysis - Michael Berger ParenteRandolph LLC Accountants & Consultants September 4 – Compliance Effectiveness - John Beattie, Managing Director, ParenteRandolf LLC Accountants & Consultants September 9th – How to Document Fair Market Value For Compliant Physician Arrangement - Part 1 September 23rd - How To Operationalize the Stark Act - September 11th – Physician Services Evaluation & Management – Alice Anne Andress, Director of Physician Services, ParenteRandolph LLC Accountants and Consultants September 25- Whistleblower Claims In Healthcare – BlickenWolf Corporate Integrity & Investigative Services – PART 1 October 8- Whistleblower Claims In Healthcare – BlickenWolf Corporate Integrity & Investigative Services – PART 2 October 14 – Update on Laboratory Compliance – John Beattie, Frank Mesaros, ParenteRandolph LLC Accountants and Consultants October 23 – 2009 OIG Work Plan for Hospitals October 24 - 2009 OIG Work Plan for Physicians November – FCPA II – Jim Lord-US. Government, Nina Gross - Deloitte Order a Past HCCA Audio/Web Conference
Regional Conference Prospectus Alaska Regional Conference Anchorage, AK New England Regional Conference Boston, MA Upper Midwest Regional Conference Minneapolis, MN Kansas City, MO North Central Regional Conference Chicago, IL East Central Regional Conference Pittsburgh, PA Hawaii Regional Conference Honolulu, HI Mountain Regional Conference Denver, CO South Central Regional Conference Nashville, TN Mid Central Regional Conference Louisville, KY
Advanced Academy October Advanced Academy Dallas, TX October 20, 2008 to CHC Application November Compliance Academy Orlando, FL November 03, 2008 to CHC Application December Compliance Academy San Diego, CA December 01, 2008 to CHC Application The HCCA/Jones Day iPod® Nano Giveaway!
Products |
NEW The HCCA HIPAA Training Handbook A Supplement to Your Deficit Reduction Act Compliance Training Program: 
Here's an easy way to train your employees on some of the increasingly complex laws and regulations facing health care organizations today. The NEW Health Care Auditing & Monitoring Tools The NEW Health Care Auditing & Monitoring Tools features dozens of tools, policies, and procedures used in auditing and monitoring programs. Includes CD-ROM. Click Here to Buy Now!Click for Description Preview the manual Compliance 101 This
Week's HCCA Corporate Members |
|
|
Headlines
DoJ Has Backlog of Whistleblower Cases
Mother and Daughter Receive Prison Term for Medicare Fraud Scheme
Maryland Doctor Receives Prison Term
California Physician Sentenced for Medicare Fraud Scheme
Virginia Man Posing as Doctor Charged With Identity Theft
Chicago Area Doctor Indicted
Another Cardiologist Settles with Government Over Improper Patient Referrals to UMDNJ
Texas Psychologist Convicted of Medicaid Fraud
Regulatory News
CMS Proposes Quality Improvements and Other Changes for Hospital Outpatient and Ambulatory Surgical Center Services for 2009
CMS Proposes Payment, Policy Changes for Physicians’ Services in 2009
CMS Adds Third Recognized Source to Help Determine Coverage for Anti-Cancer Chemotherapy Drugs
2009 Joint Commission Standards Available Online
In the Federal Register
CMS Transmittals
CMS Fact Sheets
From the OIG
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
DoJ Has Backlog of Whistleblower Cases
According to a July 2, 2008 report in the Washington Post, “More than 900 cases alleging that government contractors and drugmakers have defrauded taxpayers out of billions of dollars are languishing in a backlog that has built up over the past decade because the Justice Department cannot keep pace with the surge in charges brought by whistle-blowers, according to lawyers involved in the disputes.” For more: http://www.washingtonpost.com/wp-dyn/content/article/2008/07/01/AR2008070103071.html
***top***
Mother and Daughter Receive Prison Term for Medicare Fraud Scheme
The U.S. Department of Justice announced that the owners of four Miami-based health care corporations were sentenced and remanded to prison yesterday for their roles in schemes to defraud the Medicare program, Acting Assistant Attorney General Matthew Friedrich of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced on June 27, 2008. Collectively, the three defendants through their companies collected more than $14 million from the Medicare program for unnecessary medicine, durable medical equipment (DME) and home health care services. For more: http://www.usdoj.gov/opa/pr/2008/June/08-crm-573.html
***top***
Maryland Doctor Receives Prison Term
The U.S. Attorney for Maryland Rod J. Rosenstein announced on July 1, 2008, that U.S. District Judge Alexander Williams, Jr. sentenced Ndubuisi Joseph Okafor, M.D., age 48, of Mitchellville, Maryland to 65 months in prison followed by three years of supervised release for tax evasion and health care fraud. Judge Williams ordered that Dr. Okafor pay restitution of $769,192 to federal and state taxing authorities and $33,060.80 to Medicare. Dr. Okafor was immediately taken into custody following the sentence to begin serving his sentence. For more: http://www.usdoj.gov/usao/md/Public-Affairs/press_releases/press08/
MarylandDoctorSentencedforDefraudingFederalHealthCareProgramsandEvadingTaxes.html
***top***
California Physician Sentenced for Medicare Fraud Scheme
On June 27, 2008, U.S. Attorney for the Northern District of California Joseph P. Russoniello announced that the physician owner and operator of Milpitas Medical Clinic (“MMC”) was sentenced yesterday by United States District Court Judge Jeremy Fogel for perpetrating a scheme that defrauded Medicare of over $1 million for ultrasound tests that were based on his falsified physician orders, which claimed the tests were performed because they were medically necessary. For more: http://www.usdoj.gov/usao/can/press/2008/2008_06_27_tollete.sentenced.press.html
***top***
Virginia Man Posing as Doctor Charged With Identity Theft
On June 27, 2008, U.S. Attorney for the District of Columbia announced that a federal grand jury indicted a Virginia man, Mansour Salahmand, on numerous charges for pretending to be a licensed physician and stealing the names and identification numbers of doctors. For more: http://www.usdoj.gov/usao/dc/Press_Releases/2008%20Archives/June/08-160.html
***top***
Chicago Area Doctor Indicted
Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois announced on June 27, 2008 that an area physician and businessman was indicted on federal charges for his alleged role in defrauding a north suburban medical school and a charitable organization in a multimillion dollar scheme with his longtime business partner and others. The defendant, Robert J. Weinstein, and his partner, Stuart Levine, were both trustees of the two alleged fraud victims – the Rosalind Franklin University of Medicine and Science, formerly known as the Finch University of Health Sciences/the Chicago Medical School (CMS) in North Chicago, and the Northshore Supporting Organization (NSO), which Weinstein created in 2001 ostensibly to provide financial support to CMS. For more: http://www.usdoj.gov/usao/iln/pr/chicago/2008/pr0627_01.pdf
***top***
Another Cardiologist Settles with Government Over Improper Patient Referrals to UMDNJ
The U.S. Attorney’s Office has entered into a settlement for approximately
$1.4 Million with Bakul Desai, a private-practice cardiologist, for taking a salary from the University of Medicine and Dentistry of New Jersey while improperly referring cardiac patients, U.S. Attorney Christopher J. Christie announced on June 30, 2008. For more: http://www.usdoj.gov/usao/nj/press/press/files/pdffiles/desa0630%20rel.pdf
***top***
Texas Psychologist Convicted of Medicaid Fraud
On July 1, 2008, U.S. Attorney for the Southern District of Texas Don DeGabrielle and Texas Attorney General Greg Abbot announced that a federal jury convicted Dr. Sam Smith Hill III, 61, a licensed psychologist with a professional office in Corpus Christi, of defrauding Medicaid. The jury’s verdict was announced Monday evening, June 30, 2008, after approximately seven hours of deliberation. For more: http://www.usdoj.gov/usao/txs/releases/July%202008/070108Hill.htm
***top***
This week, MediRegs provided TWCC readers with the following Regulatory information: In the Federal Register, CMS Transmittals, CMS Frequently Asked Questions, and From the OIG.
Regulatory News
CMS Proposes Quality Improvements and Other Changes for Hospital Outpatient and Ambulatory Surgical Center Services for 2009
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on July 3, 2008, that will update payment rates for calendar year (CY) 2009 and improve quality of services provided in hospital outpatient departments and ambulatory surgical centers (ASCs). The proposed rule builds on efforts across Medicare to transform the program into a prudent purchaser of health care services, paying based on quality of care, not just quantity of services. For more: http://www.cms.hhs.gov/apps/media/press_releases.asp
To read the CMS Fact sheet issued today click here: http://www.cms.hhs.gov/apps/media/fact_sheets.asp
For more information on the CY 2009 proposals for the OPPS and ASC payment system, please see the CMS Web site at:
OPPS: http://www.cms.hhs.gov/HospitalOutpatientPPS/
ASC payment system: http://www.cms.hhs.gov/ASCPayment/
***top***
CMS Proposes Payment, Policy Changes for Physicians’ Services in 2009
On June 30, 2008, the Centers for Medicare & Medicaid Services (CMS) proposed new efforts to promote access to higher quality and more efficient health care delivered by the nation’s physicians to people with Medicare under the 2009 Medicare Physician Fee Schedule (MPFS).
The MPFS was created by Congress and is updated annually to set the Medicare payment rates for more than 980,000 physicians and nonphysician practitioners (NPPs) who bill Medicare for the services they furnish to beneficiaries. Under a formula in the Medicare statute, CMS is required to reduce 2009 Physician Fee Schedule by 5.4 percent. Total Medicare spending under the 2009 Physician Fee Schedule is projected at $54 billion, down 5 percent from the $57 billion projected for 2008.
Nearly 95 percent of physicians enrolled in Medicare accept the fee schedule rate as payment in full. Medicare pays 80 percent of the fee schedule rate, while the beneficiary is responsible for the remaining 20 percent. For more: www.cms.hhs.gov/center/physician.asp.
The CMS Fact Sheet can be accessed at http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter
=3183&intNumPerPage=10&checkDate=&checkKey=&srchType
=1&numDays=3500&srchOpt=0&srchData=&keywordType
=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date .
***top***
CMS Adds Third Recognized Source to Help Determine Coverage for Anti-Cancer Chemotherapy Drugs
On July 2, 2008, the Centers for Medicare & Medicaid Services (CMS) announced additional updates to the information it uses in determining which drugs may be covered under Medicare Part B when used to treat patients undergoing cancer treatment through chemotherapy.
CMS will add Elsevier Gold Standard’s Clinical Pharmacology compendium to the list of Medicare anti-cancer treatment compendia.
For more information about these compendium decisions, please visit the CMS website at
http://www.cms.hhs.gov/mcd/ncpc_view_document.asp?id=17
***top***
2009 Joint Commission Standards Available Online
On July 1, 2008, the Joint Commission announced that its revised standards, rationales and elements of performance for 2009 are now available online. The standards will take effect January 1, 2009 and have been placed online to give all health care organizations time to become familiar with the new language, ordering and numbering. For more: http://www.jointcommission.org/NewsRoom/NewsReleases/nr_sii_gen.htm
***top***
CMS Update
Claims Paid Under the Medicare Physician Fee Schedule
To the extent possible, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other Fee-For-Service (FFS) providers of services paid under the Medicare physician fee schedule, beginning July 1. In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July. This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures.
After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.
Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1-June 30, 2008, fee schedule will be automatically reprocessed if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to re-submit a revised claim.
To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.
In addition, be on the alert for more information about other legislative provisions which may affect Medicare FFS providers.
The Questions and Answers below apply to the recent decision by the Centers for Medicare & Medicare Services to hold claims paid under the Medicare physician fee schedule (MPFS) up to 10 business days that contain July 2008 dates of service.
Q1. Will claims containing services paid under the MPFS be held that contain both June and July dates of service?
A1. Yes, your local contractor will hold the entire claim for 10 business days.
Q2. Will claims be held that contain both services paid under the MPFS and services paid under a separate fee schedule?
A2. Yes, claims that contain both services paid and not paid under the MPFS will be held. For example, a claim with a July date containing an Evaluation and Management code and a drug code would be held.
Q3. Does the holding of claims paid under the MPFS also include anesthesia and purchased diagnostic services?
A3. Yes, contractors will hold all claims with dates of service July 1, 2008, and after that contain services paid under the MPFS, including anesthesia and purchased diagnostic services.
Clarification of Mail Order in the Centers for Medicare & Medicaid Services (CMS) DMEPOS Competitive Bidding Program
CMS has posted information on the Competitive Bidding Implementation Contractor (CBIC) website to clarify its policy with regard to mail order suppliers. This posting provides further guidance on common carriers and local storefront suppliers. Please visit the Supplier’s FAQ section at www.dmecompetitivebid.com for more information.
The Medicare DMEPOS Competitive Bidding Program is here---Supplier Directory Locator Tool Now Available!
As of Tuesday, July 1, 2008 the Supplier Directory on www.medicare.gov has been updated to reflect the start of the DMEPOS Competitive Bidding program in certain areas of the country.
Users can begin their search on the Supplier Directory by entering their zip code. Product categories in that zip code that are competitive bid are identified, and special messaging will let users know if they have chosen an applicable product in a Competitive Bid Area (CBA) and why that is important to know. Search results for CBAs are organized by city of the zip code that was entered, and then by state. Users can sort by Supplier Name, and whether or not the supplier is participating. The address and phone number of the supplier is available.
Users are encouraged to check the site frequently as CMS will be making regular updates during the start of this program.
Clarification of Common Carrier and Local Storefront Suppliers Under the CMS DMEPOS Competitive Bidding Program
Common carrier, in its basic meaning, includes individuals or companies that transport goods or cargo (e.g., diabetic testing supplies) for compensation. This means that suppliers that pay a common carrier such as the U.S. Postal Service, Federal Express, United Parcel Service, or other shipping or courier service companies to transport diabetic testing supplies to Medicare beneficiaries' homes must be mail order contract suppliers under the DMEPOS Competitive Bidding Program, regardless of any contract arrangements suppliers may have with common carriers to deliver these items.
Diabetic supplies delivered by a common carrier to a Medicare beneficiary's home in a competitive bidding area must be furnished by a mail order contract supplier in order for Medicare to make payment unless the supplies are delivered by a local storefront using its own vehicles and W2 employees. This local storefront supplier must have its own local storefront that services the competitive bidding area, have its own location-specific National Supplier Clearinghouse (NSC) number for that storefront, bill for the diabetic supplies using that NSC number, and meet all of Medicare's supplier standards. It must also offer beneficiaries the choice of either obtaining the diabetic supplies from the supplier's storefront or having the items home delivered by the local storefront supplier using its own vehicles and W2 employees.
Reminder: Enteral Nutrition is Not a “Grandfathered” Competitively Bid Item
Under the DMEPOS Competitive Bidding Program, enteral nutrition must be furnished by a contract supplier and cannot be provided by a non-contract grandfathered supplier. To ensure that there is no gap in service, this is important information for providers who order enteral nutrition for Medicare beneficiaries who permanently reside in or are visiting a CBA.
National Provider Call for Referral Agents and Non-Contract Suppliers –
July 8, 2008
CMS will host a national audio call to address additional questions on the DMEPOS Competitive Bidding Program, which was implemented July 1, 2008. The call will be held on July 8, 2008 from 2:30 – 4:00 PM EDT. This call will not address contract supplier issues, but will instead focus on questions from non-contract suppliers and referral agents (Medicare providers who order or refer DMEPOS in the 10 CBAs).
Please note -- Participants will be able to submit questions through the online registration system at the time of sign up for the call. Registration details follow.
Conference call details:
Date: July 8, 2008
Conference Title: DMEPOS Competitive Bidding Program
Time: 2:30-4:00 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 2:30 p.m. EDT on July 7, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
|
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 4:30 p.m. EDT 7/8/2008 until 11:59 p.m. EDT 7/15/2008. The call in data for the replay is (800) 642-1687 and the passcode is 53825755.
Educational Products: New SNF/NF Specialty Supplier Tip Sheet!
Within the next day, CMS will post a new tip sheet on SNF/NF Specialty Suppliers under the DMEPOS Competitive Bidding Program.
Below is a complete listing of provider Tip Sheets that can be accessed from our dedicated web page:
-Tip Sheet for Skilled Nursing Facilities and Nursing Facilities: Specialty Contract Suppliers
-Tip Sheet for Referral Agents
-Tip Sheet for “Grandfathered” Suppliers
-Tip Sheet for Mail-Order Diabetic Testing Suppliers
-Tip Sheet for Physicians and Other Treating Practitioners Who Are Enrolled Medicare DMEPOS Suppliers
-Tip Sheet for Non-Contract Suppliers
Go to www.cms.hhs.gov/DMEPOSCompetitiveBid to access all the latest information on the new program. Just click on the “Provider Educational Products and Resources” tab on the left then scroll down to the "Downloads" section for all MLN Matters articles, Tip Sheets, and links to beneficiary educational products as well
Open Door Forums
The next Physicians, Nurses, and Allied Health Professionals Open Door Forum (ODF) is Tuesday, July 15, 2008. http://www.cms.hhs.gov/OpenDoorForums/23_ODF_PNAHP.asp#TopOfPage
The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, July 17, 2008. http://www.cms.hhs.gov/OpenDoorForums/18_ODF_Hospitals.asp#TopOfPage
The next Rural Health Open Door Forum (ODF) for Tuesday, July 29, 2008.
http://www.cms.hhs.gov/OpenDoorForums/24_ODF_RuralHealth.asp#TopOfPage
The next Skilled Nursing Facilities / Long-Term Care Open Door Forum has been scheduled for Thursday, July 31, 2008
http://www.cms.hhs.gov/OpenDoorForums/25_ODF_SNFLTC.asp#TopOfPage
The next Ambulance Open Door Forum is Tuesday, August 12, 2008. http://www.cms.hhs.gov/OpenDoorForums/10_ODF_Ambulance.asp#TopOfPage
***top***
In the Federal Register
Use of Repayment Plans
On June 27, 2008, CMS modified regulations pertaining to the use of repayment plans or extended repayment schedules for provider and supplier overpayments. The rule identifies the terms and conditions under which CMS will grant a provider or a supplier an ERS. The rule establishes criteria and procedures to apply for an ERS and defines the concepts of "hardship" and "extreme hardship."
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=08jn272&h=top1.html&t=80&s=twcc
Appeals of CMS or CMS Contractor Determinations When a Provider or Supplier Fails to Meet the Requirements for Medicare Billing Privileges
Also on June 27, 2008, CMS issued a final rule which established an appeals processes for all providers and suppliers whose enrollment, reenrollment or revalidation application for billing privileges is denied and whose billing privileges are revoked. It also established timeframes for deciding enrollment appeals by an ALJ, DAB, or Board and processing timeframes for fee-for-service. The rule allows FFS contractors to revoke billing privileges when a provider or supplier submits a claim or claims for services that could not have been furnished to a beneficiary. The rule also specifies that a contractor may establish an enrollment bar for any provider or supplier whose billing privileges have been revoked. Lastly, the rule requires that all providers and suppliers receive payments by electronic funds transfer if the provider or supplier is submitting an initial enrollment application to Medicare, changing their enrollment information, revalidating or re- enrolling in the program.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=08jn273&h=top1.html&t=80&s=twcc
Special Enrollment Period and Medicare Premium Changes
CMS, on June 27, 2008, also provided a special enrollment period for Part B and premium Part A for certain individuals who are sponsored by prescribed organizations as volunteers outside of the US and who have health insurance that covers them while outside the US. The rule also codified provisions that require certain beneficiaries to pay an income-related monthly adjustment amount in addition to the standard Part B premium, plus any applicable increase for late enrollment or reenrollment.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=08jn274&h=top1.html&t=80&s=twcc
Hospital CoP's
Also on June 27, 2008, CMS finalized the hospital conditions of participation requirements for hospitals that transfuse blood and blood components. The rule requires hospitals to: (1) prepare and follow written procedures for appropriate action when it is determined that blood and blood components the hospitals received and transfused are at increased risk for transmitting hepatitis C virus; (2) quarantine prior collections from a donor who is at increased risk for transmitting HCV infection; (3) notify transfusion recipients, as appropriate, of the need for HCV testing and counseling; and (4) extend the records retention period for transfusion-related data to 10 years.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=08jn275&h=top1.html&t=80&s=twcc
Conditions of Participation for Rural Health Clinics and Federally Qualified Health Centers
CMS, on June 27, 2008, proposed establishing location requirements including exception criteria for rural health clinics and requiring RHCs to establish a quality assessment and performance improvement program. In addition, the proposed rule would: (1) clarify policies on "commingling" of an RHC with another entity; (2) revise the RHC and Federally Qualified Health Centers payment methodology and exceptions to the per-visit payment limit to implement statutory requirements; (3) revise RHC and FQHC payment requirements for services furnished to skilled nursing facility patients; (4) allow RHCs to contract with RHC nonphysician providers under certain circumstances; (5) update the regulations pertaining to waivers to the staffing requirements; (6) add requirements for RHCs and FQHCs to maintain and document an infection control process and to post RHC or FQHC hours of clinical services; and (7) update the requirements under the emergency services standard and patient health records condition for certification to reflect advancements in technology and treatment.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=08jn276&h=top1.html&t=80&s=twcc
***top***
CMS Transmittals
Medicare Benefit Policy - Basic Coverage Rules (PUB. 100-02)
Transmittal #92, Date: June 27, 2008 Private Contracting/Opting out of Medicare (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_02&u=mrepm10002R92BP&h=top1.html&t=80&s=twcc
Transmittal #91, Date: June 20, 2008 Self-Administered Drug Exclusion Lists (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_02&u=mrepm10002R91BP&h=top1.html&t=80&s=twcc
Transmittal #90, Date: June 19, 2008 July 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_02&u=mrepm10002R90BP&h=top1.html&t=80&s=twcc
Transmittal #84, Date: June 27, 2008 FDG PET for Infection and Inflammation (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_03&u=mrepm10003r84ncd&h=top1.html&t=80&s=twcc
Transmittal #1544, Date: June 26, 2008 Manual Revisions to Reflect Special Billing Instructions for DMEPOS Items as a Result of the DMEPOS Competitive Bidding Program (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1544CP&h=top1.html&t=80&s=twcc
Transmittal #1543, Date: June 27, 2008 pdate-Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Rate Year 2009 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1543CP&h=top1.html&t=80&s=twcc
Transmittal #1540, Date: June 20, 2008 July 2008 Update to the ASC Payment System; Summary of Payment Policy Changes (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1540cp&h=top1.html&t=80&s=twcc
Transmittal #1542, Date: June 20, 2008 National Competitive Bidding (NCB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), Medicare Summary Notice (MSN), and Remittance Advice (RA) Messages **Rescinds Transmittal #1422, dated February 1, 2008**(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1542CP&h=top1.html&t=80&s=twcc
Transmittal #1541, Date: June 20, 2008 Screening Pelvic Examinations (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1541CP&h=top1.html&t=80&s=twcc
Transmittal #1539, Date: June 20, 2008 Self-Administered Drug Exclusion Lists (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1539CP&h=top1.html&t=80&s=twcc
Transmittal #1538, Date: June 20, 2008 New Waived Tests:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1538CP&h=top1.html&t=80&s=twcc
Transmittal #1537, Date: June 19, 2008 October Quarterly Update to 2008 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1537CP&h=top1.html&t=80&s=twcc
Transmittal #1536, Date: June 19, 2008 July 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004R1536CP&h=top1.html&t=80&s=twcc
Program Integrity (PUB. 100-08)
Transmittal #261, Date: June 27, 2008 Update to Section 12 of Chapter 10 of the Program Integrity Manual (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_08&u=mrpm10008R261PI&h=top1.html&t=80&s=twcc
Transmittal #260, Date: June 20, 2008 Clarification of Chapter 10 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_08&u=mrpm10008R260PI&h=top1.html&t=80&s=twcc
Demonstrations (PUB. 100-19)
Transmittal #58, Date: June 27, 2008 Medicare Acute Care Episode Demonstration - Rescinds and fully replaces CR 5767 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mr_pm_100_19&u=mremrpm10019R58DEMO&h=top1.html&t=80&s=twcc
Transmittal #356, Date: June 20, 2008 National Competitive Bidding (NCB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) - Phase VIIB of Implementation (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20&u=mrepm10020R356OTN&h=top1.html&t=80&s=twcc
***top***
CMS Fact Sheets
2008.06.26: CMS Issues Proposed Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Payment Provisions for Rural Health Clinics And Federally Qualified Health Centers:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_rrl_facts&u=fact20080626&h=top1.html&t=80&s=twcc
2008.06.22: Product Safety in the Americas:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_rrl_facts&u=productsafety&h=top1.html&t=80&s=twcc
Questions Updated on 06/26/2008:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cms_faqs&u=NEW&h=top1.html&t=80&s=twcc
***top***
From the OIG
State Medicaid Fraud Control Units Annual Report - Fiscal Year 2007:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_mfcu&u=mfcu2007&h=top1.html&t=80&s=twcc
Audit Reports
Medical Assistance Provided by Virginia to Hurricane Katrina Evacuees (A-03-07-00211) (06/18/08)(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2008&u=30700211&h=top1.html&t=80&s=twcc
Review of Medicaid Outpatient Drug Expenditures in Missouri for the Period October 1, 2002, Through September 30, 2004 (A-07-06-04063) (06/13/08) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2008&u=70604063&h=top1.html&t=80&s=twcc
Review of Illinois Medicare Part D Contributions to the Centers for Medicare & Medicaid Services for "Full-Duals" (A-05-07-00009) (06/16/08) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2008&u=50700009&h=top1.html&t=80&s=twcc
***top***
This Week’s Link:
Bakul Desai, MD Settlement Agreement
http://www.usdoj.gov/usao/nj/press/press/files/pdffiles/DesaiSettleAgree.pdf
***top***
Acronym Library
| HH | Home Health |
| HHA | Home Health Agency |
| HHABN | Home Health Advanced Beneficiary Notice |
| HHC | Home Health Care |
| HHCOV | Home Health Coverage |
| HHI | Home Health Intermediary |
| HHL | Home Health Line |
| HHPPS | Home Health Prospective Payment System |
| HHQI | Home Health Quality Initiative |
For more from CMS Acronyms: http://www.cms.hhs.gov/apps/acronyms/
***top***
Visit HCCA's Web site at http://www.hcca-info.org
NOTE: HCCA Members, please contact April Kiel at april.kiel@hcca-info.org if you have not received your password. This new
Web site allows members and visitors to register for conferences, order
products, or join HCCA online. HCCA Members can
update membership information and search for compliance resources
online in a secure environment, without faxing, emailing and other time-consuming
activities.HCCA's Web site
also offers E-Communities, which allow regional and
industry
specific information to be shared through a discussion forum
and list-serve. Members can view and respond to documents,
tools, forms, policies and other information posted by Regional and Compliance
Focus Group leaders!
Visit http://www.hcca-info.org and see for yourself.
***top***
HCCA Headquarters Contact Information
Your HCCA Office
is located at:
6500 Barrie Road, Suite 250
Minneapolis, MN 55435
HCCA Toll-Free Phone:
888-580-8373
Fax: 952-988-0146
Minnesota Phone: 952-988-0141
Email: info@hcca-info.org
Contact: Margaret
Dragon, Editor,
This Week in Corporate Compliance: 781-593-4924
To subscribe to TWCC, click here