The results of recent recovery audit contractor (RAC) automated reviews of hospital services were outlined in the January 2013 Medicare Quarterly Provider Compliance Newsletter, Volume 3, Issue 2 . Among the hot topics discussed was a significant issue for physician providers: the RACs identified that inappropriate current procedural terminology (CPT) codes were being assigned for related professional evaluation and management (E/M) services “rendered in swing bed facilities (with nursing facility levels of care)” in the same episode of care as an acute inpatient stay, when the patient was not “on a leave of absence from the hospital.” Specifically, inpatient hospital CPT codes, i.e
The U.S. Supreme Court recently decided to uphold virtually all of the Affordable Care Act (ACA) as it was enacted. First and foremost, all Medicare-related provisions are left intact, so all payment cuts to providers that have already been implemented will remain
Payment Rate Updates CMS has proposed a 2.1 percent update to the federal operating standardized amount. This is based on a 3 percent market basket update, reduced by two factors mandated by the Patient Protection and Affordable Care Act (PPACA): a 0.8 percent economy wide productivity adjustment and an additional 0.1 percent reduction.
In accordance with the Patient Protection and Affordable Care Act (PPACA), the Secretary of Health and Human Services issued a report to Congress on April 11, 2012, addressing a plan to reform the Medicare wage index methodology.
On February 16, 2012, the Centers for Medicare & Medicaid Services (CMS) published proposed rules for reporting and returning overpayments. While providers and suppliers have been reporting and returning overpayments from the Medicare program for years, section 6402(a) of the Patient Protection & Affordable Care Act established a new section of the Social Security Act that essentially requires a provider or supplier receiving an overpayment from the Medicare program to report it in writing and return it to the appropriate entity, at the correct address.
The final rule for changes to the hospital inpatient acute care prospective payment system (PPS) for federal fiscal year 2012 was released by the Centers for Medicare & Medicaid Services (CMS) in early August. This release included two changes related to the amount of defined benefit pension costs a hospital is allowed to claim on its Medicare cost report. One of the changes relates to calculating allowable pension costs claimed on a PPS hospital’s wage index.
Have you received notification from your Medicare Administrative Contractor (MAC) to revalidate your Medicare enrollment information? If not, be prepared for it. Section 6401(a) of the Patient Protection and Affordable Care Act requires all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria.