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Archive for October, 2008

RAC Contractors Selected

Friday, October 17th, 2008

The Centers for Medicare & Medicaid Services (CMS) has selected four companies to serve as recovery audit contractors (RACs) when it initiates the program nationwide. They are CGI Technologies and Solutions Inc. of Fairfax, VA; Connolly Consulting Associates Inc. of Wilton, CT; Diversified Collection Services Inc. of Livermore, CA; and HealthDataInsights Inc. of Las Vegas, NV. RACs identify Medicare overpayments and underpayments, and receive a percentage of the improper payments they collect from health care providers. CMS will roll out its permanent RAC program in three phases, and began educating health care providers about the program in October. Hospitals in the first phase may begin to receive requests for medical records or reimbursement of overpayments as early as December.

For more on the RAC program, visit http://www.cms.hhs.gov/RAC/.

Health Care Consumer Initiatives Web Site Updated

Friday, October 17th, 2008

The Health Care Consumer Initiatives Web site has been updated by the Centers for Medicare & Medicaid Services (CMS) to include calendar year 2007 data on average Medicare payments made for common and elective procedures and services provided by physicians. Ambulatory surgical center payment information was recently updated, and the hospital outpatient department payment information will be added later this fall.

To access the information, go to http://www.cms.hhs.gov/HealthCareConInit/.

Part B Medicare Claims Edits Published

Friday, October 17th, 2008

The Centers for Medicare & Medicaid Services (CMS) has published edits that will be used by its claims processing software to check for possible billing errors on Part B Medicare claims. To prevent errors involving too many units of service, the Medically Unlikely Edit (MUE) software program checks the number of times a service is reported by a health care provider or supplier for the same patient on the same date. CMS implemented the MUE program in January 2007. The current version of the software assigns unit values to 9,700 procedural codes.

The published edits will be available at http://www.cms.hhs.gov/.

PQRI Program Web Site Updated

Friday, October 17th, 2008

The Centers for Medicare & Medicaid Services (CMS) has announced a new E-Prescribing Incentive Program section page on the Physician Quality Reporting Initiative (PQRI) web page on the CMS web site. This new section will provide information about the new E-Prescribing incentive program that was authorized by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

For more information, visit www.cms.hhs.gov/pqri/03_EPrescribingIncentiveProgram.asp.

Disclosure of Physician Financial Relationships Discussed by MedPAC

Friday, October 17th, 2008

The Medicare Payment Advisory Commission (MedPAC) has reviewed draft recommendations requiring public disclosure of financial relationships between physicians and drug and device manufacturers, and physician ownership interests in hospitals, ambulatory surgery centers and other entities that bill the Medicare program. MedPAC also suggested that the Centers for Medicare & Medicaid Services (CMS) issue a report on the prevalence of non-ownership relationships, such as leasing and compensation arrangements, between physicians and hospitals, ASCs and other entities. The report would be based on CMS’ proposed Disclosure of Financial Relationships Report (DFFR) in which the agency plans to collect from a sample of 500 hospitals. Several issues remain for discussion at future MedPAC meetings, including how to handle information on free drug samples, and the appropriate scope and thresholds for reportable relationships.

For further details, visit www.Medpac.gov.