Congress urged to stop OFCCP jurisdiction grab   03/13/2014
AHA today urged Congress to pass the Protecting Health Care Providers from Increased Administrative Burdens Act (H.R. 3633), legislation that would prevent the Department of Labor’s Office of Federal Contract Compliance Programs from expanding the reach of its regulatory oversight to hospitals and other health care organizations that provide care for uniformed service members and other federal employees. The bill would clarify the existing limits of OFCCP’s jurisdiction without disturbing the agency’s authority over institutions that have voluntarily entered into federal contracts; prevent needless and costly litigation over the classification of health care providers as federal contractors and subcontractors; and remove obstacles to hospitals and other health care providers providing health care services to members of the military, federal employees and their families, AHA outside counsel Curt Kirschner, a partner with the Jones Day law firm, told the House Education and Workforce Subcommittee on Workforce Protections at a hearing on the legislation. While the National Defense Authorization Act for fiscal year 2012 memorialized explicitly in statute the exemption of TRICARE network providers from federal contractor status, the OFCCP’s “persistent attempts to circumvent the NDAA confirm the need for legislation that places clear limits on the agency’s jurisdiction,” he said.
CMS updates two-midnight guidance on medical review of inpatient claims   03/13/2014
The Centers for Medicare & Medicaid Services will instruct Medicare Administrative Contractors to use its general two-midnight policy when conducting prepayment reviews of claims in which a surgical procedure was canceled, the agency said yesterday in an update to its guidance on medical review of inpatient claims. “In other words, if the physician reasonably expects the beneficiary to require a hospital stay for two or more midnights at the time of the inpatient order and formal admission, and this expectation is documented in the medical record, the inpatient admission is generally appropriate for Medicare Part A payment,” the guidance states. On its website, the agency also reiterated that hospitals with claims denied before Jan. 30 under its Probe & Educate prepayment review process have until Sept. 30 to file a request for redetermination. Last month, CMS said it will require MACs to re-review all claims denied to date under its Probe & Educate prepayment review process to ensure that their decisions and subsequent education were consistent with the agency’s clarifications on Jan. 30.
AHA survey on Probe & Educate audits extended to March 21   03/13/2014
AHA encourages all members to complete by March 21 a short survey on the Center for Medicare & Medicaid Services’ two-midnight policy and related Probe & Educate audit process. Emailed to members again today, the survey will help determine whether Medicare Administrative Contractors are conducting the Probe & Educate audits consistent with standards set forth by CMS, and whether the audits will be completed by Sept. 30. Responses will help the association in its advocacy efforts on the two-midnight policy, including any issues or concerns with the Probe & Educate audits.