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Regulatory MonitoringArchive for February, 2009
The analysis was to be published February 27 in The New England Journal of Medicine. It found doctors who often order tests and admit patients to hospitals drive up costs.
“The incentives are there for growth,” Elliott S. Fisher, MD, the director of the Center of Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice and one of the work’s authors, told The Times.
“As long as Medicare pays for volume and intensity, that’s what you’re going to get,” Mark B. McClellan, MD, a health policy specialist at the Brookings Institution who oversaw the Medicare program during part of the previous administration, told The Times.
Obama’s plan is to extend health insurance to more Americans and control medical bills.
"We aim to get to universal coverage," administration budget aide Keith Fontenot said in The Washington Post. Obama is "open to any ideas people want to put forward. He wants to work openly with the Congress in a very inclusive process."
CMS issued Transmittal 1681 February 13, 2009, related to locality adjustment for payments made to hospitals derived from the Medicare Physician Fee Schedule (MPFS). The MPFS is used as the basis to determine payment amounts for several types of services, for instance physical therapy, speech language pathology, and occupational therapy. These payments will now be based on the MPFS amount for the ZIP code where the actual service facility is located rather than the main facility’s ZIP code.
Transmittal 1681 relates to a requirement dating from January 1, 2007, for providers to submit ZIP codes for the actual service locations for outpatient services. Although providers were required to report these ZIP codes since that time, the Fiscal Intermediary Standard System (FISS) could not process them. Transmittal 1681 implements a process change in FISS to capture the ZIP code data and make it available for the payment processing logic. This will allow payments for MPFS based services to be based on the ZIP code of the service location.
The transmittal also clarifies that providers may bring to the attention of their contractor claims that were paid incorrectly due to the ZIP code not being taken into account. The contractors have been instructed to adjust these claims if brought to their attention. The effective date of the transmittal is October 1, 2007, meaning providers may go back to October of 2007 and request claims adjustments for affected claims.
Note, however that the transmittal has an implementation date of July 6, 2009. This means that the system changes to process these claims correctly, taking into account the ZIP code information, may not be in place until that date. For this reason, providers should contact their local FI or MAC and determine when system changes have been implemented and how to submit adjustment requests. Providers may need to submit adjustment requests for any claims processed before the implementation date later this year.
- Payments to Institutional Providers with Multiple Service Delivery Locations
- Corrections to the Inpatient Prospective Payment System Wage Index for Fiscal Year (FY) 2009
- Clarification on Use of National Drug Codes (NDCs) in 837 I Billing
- Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2009
February 16-23 Issuances: CMS updates FAQs, OIG releases audit reports, and more
CMS released several updated frequently asked questions (FAQ) last week, related to Medicare fee-for-service payment and coding.
View the fee-for-service FAQs.
OIG releases review of outpatient claims processed by TriSpan Health Services for CY 2006
On February 17, the OIG issued a report on outpatient claims processed by TriSpan Health Services during 2006. The OIG found that TriSpan underpaid one provider $13,856 during that time.
OIG reviews oxaliplatin billing at San Jacinto Methodist Hospital for CYs 2004 and 2005
On February 18, the OIG issued a report on oxaliplatin billing at San Jacinto Methodist Hospital for CYs 2004 and 2005. During that time, the OIG found, San Jacinto billed for 10 times the number of units of oxaliplatin that were actually administered and received overpayments totaling $104,106 for the three outpatient claims that the OIG reviewed.
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