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Archive for February, 2016

Mandatory 2% Payment Reduction Continues

Thursday, February 25th, 2016

Medicare Fee-For-Service (FFS) claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a 2 percent reduction in Medicare payment until further notice. Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), including claims under the DMEPOS Competitive Bidding Program, will continue to be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment will continue to be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction.

For more information, visit http://www.palmettogba.com/palmetto/providers.nsf/ls/JM%20Part%20B~9HTE2G2363?opendocument&utm_source=J11BL&utm_campaign=JMBLs&utm_medium=email

Proposed Rule Issued Implementing Program Integrity Requirements

Thursday, February 25th, 2016

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would implement additional program integrity requirements for health care providers and suppliers who participate in Medicare. The rule would allow the agency to remove or bar from Medicare providers and suppliers that attempt to circumvent provider enrollment requirements through name and identity changes or inter-provider relationships. The rule would require providers and suppliers to report affiliations with entities and individuals that have uncollected Medicare, Medicaid or Children’s Health Insurance Program debt; been subject to a payment suspension or Office of Inspector General exclusion; or had their Medicare, Medicaid or CHIP enrollment denied or revoked. CMS could revoke a physician or eligible professional’s Medicare enrollment if they have an “abusive” history of ordering, certifying, referring or prescribing Medicare Part A or B services, items, or drugs. The rule would raise the maximum re-enrollment bar for revoked providers or suppliers from three to ten years, adding three more years if they attempt to re-enroll in Medicare under a different name, numerical identifier or business identity, and impose a maximum 20-year bar for providers or suppliers who are revoked a second time.

The proposed rule can be found at https://federalregister.gov/a/2016-04312

CMS Publishes Medicare Fee-for-Service Provider and Supplier Lists

Monday, February 22nd, 2016

The Centers for Medicare & Medicaid Services (CMS) has released data on Medicare-enrolled providers and suppliers, and a mapping tool showing the availability and use of ambulance and home health services by region. The provider data will be updated quarterly from the Provider Enrollment, Chain and Ownership System (PECOS). The mapping tool indicates national, state and county-level data on the availability of Medicare fee-for-service home health providers and ground ambulance suppliers; the number of beneficiaries who use those services; and regions with moratoria on new providers and suppliers in Medicare, Medicaid and the Children’s Health Insurance Program.

The press release can be found at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-02-22.html

Final Rule Issued for Reporting and Repaying Overpayments

Thursday, February 11th, 2016

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule creating a reporting and repayment obligation for providers and suppliers who receive a Medicare overpayment. The final rule requires providers and suppliers to report and return any overpayments they identify within six years of receipt.

The final rule can be found https://www.gpo.gov/fdsys/pkg/FR-2016-02-12/pdf/2016-02789.pdf