The CMS has posted new resources to its “Open Payments” website to clarify its recently announced two-stage approach to registration and data submission. These resources include:
February 2014
OIG recommends expansion of Medicare DRG window payment policy but CMS demurs
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The Medicare DRG window payment policy requires that under certain conditions outpatient services furnished to a beneficiary before his/her inpatient hospital admission are not paid separately but rather are bundled into the inpatient diagnosis-related group (“DRG”) payment.
Under the DRG…
More than 200 groups send letter to CMS requesting a withdrawal of new Medicare Part D regulations
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On February 20, more than 200 organizations sent a letter to CMS Administrator Marilyn Tavenner imploring CMS to withdraw new proposed Medicare Part D regulations that, if finalized, would have “unintended consequences for seniors and beneficiaries with disabilities.”
In the…
CMS announces a pause in Recovery Audit Contractors document requests
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On February 18, the Centers for Medicare & Medicaid Services (“CMS”) announced it will suspend the ability of Recovery Audit Contractors (“RACs”) to request documents associated with claims reviews until it procures the next round of Recovery Audit Program contracts. …
US Senate and House of Representatives leaders introduce legislation to replace Medicare sustainable growth rate formula with new physician payment system
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Leaders from the US Senate and House of Representatives have introduced bipartisan legislation in both the Senate and the House, which if enacted will repeal the Medicare sustainable growth rate (“SGR”) formula and replace it with a new physician payment…
CMS delays data submission at least 30 days
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In a posting to its Open Payments website (through which it communicates about the Sunshine Act), CMS announced that the March 31 data submission deadline (originally set under the statute for March 31, 2013 and delayed by rule to March…
Estimates of ICD-10 roll-out costs rising, says AMA report
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The American Medical Association (“AMA”) has released a new report, prepared by Nachimson Advisors, that estimates the cost of implementing the ICD-10 medical coding system. The ICD, short for the International Classification of Diseases and Health Problems, is a list…
OIG reports that Medicare contractors in two regions overpaid providers by $7.2 million for outpatient drugs
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In Jurisdictions E and F, Medicare administrative contractors (“MACs”) overpaid providers by a total of $7.2 million for outpatient drugs between July 2009 and June 2012, according to reports from the OIG. The OIG noted that providers “attributed the incorrect…
OIG findings about diversion of 340B Program-purchased drugs & duplicate discounts through Medicaid
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On February 4, 2014, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) sent a Memorandum Report, titled Contract Pharmacy Arrangements in the 340B Program, to Mary Wakefield, Administrator for the Health Resources and Services Administration…
CMS delays enforcement of the “Two-Midnight” policy by six months
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On January 31, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a notice delaying by an additional six months (through September 30, 2014) enforcement of the “Two-Midnight” policy, referred to as the Inpatient Hospital Prepayment Review “Probe &…