AHA to CMS: Rebilling limitation unlawful and unfair   04/18/2013
The AHA yesterday pressed the Centers for Medicare & Medicaid Services to revise a March 13 Ruling that would permit hospitals to rebill Part A claims denied by Medicare Recovery Audit Contractors only if they are currently being appealed or the time for appeal has not lapsed. The ruling would prohibit hospitals from rebilling tens of thousands of denied claims for which the time to appeal has expired. The letter urges CMS to take immediate action to ensure that hospitals can seek and receive payments for all previously denied claims, noting that hospitals long refrained from rebilling based on CMS representations that it would be futile to do so. “CMS now admits that its representations did not comport with the law,” AHA President Rich Umbdenstock wrote to Health and Human Services Secretary Kathleen Sebelius. “And yet in the same breath, [the agency] states that hospitals that relied on those representations have forfeited their right to be paid for reasonable and necessary services they provided. The Administrative Procedure Act and fundamental principles of equity and fair play do not permit that result.”
OIG updates self-disclosure protocol for health care providers   04/18/2013
The Department of Health and Human Services' Office of Inspector General yesterday released a revised protocol for health care providers who wish to voluntarily disclose self-discovered evidence of potential fraud to OIG. Originally published in 1998, the protocol establishes a process for health care providers to disclose potential fraud involving federal health care programs, and provides guidance on how to investigate and report such conduct to resolve the provider's liability exposure under OIG's civil money penalty authorities. The revised protocol supersedes and replaces the original 1998 Federal Register notice and three subsequent “open letters” that provided additional guidance. The agency solicited comments on the prior Provider Self-Disclosure Protocol last June. “On the basis of our experience and the comments we received, we have decided to revise the SDP in its entirety at this time,” yesterday’s notice states.
Center releases proposal to contain health care costs   04/18/2013
A Bipartisan Policy Center project today proposed strategies to contain health care spending. Proposals include a new option under traditional Medicare called “Medicare Networks, described as “an improved version of accountable care organizations that encourages providers to meet the full spectrum of their patients’ needs.” Other Medicare proposals include expanding the voluntary payment bundling demonstration into a standard Medicare payment method; limiting annual per beneficiary spending growth to per capita growth in gross domestic product plus 0.5 percentage points; equalizing certain payment rates for evaluation and management services to the rate in the lowest cost setting; and changes to the Medicare benefit design and indirect medical education. The report also calls for streamlining and clarifying federal guidance for private-sector entities seeking to form integrated care delivery systems; prioritizing, consolidating and improving the use of quality measures; and investing the Prevention and Public Health Fund in demonstration programs to identify the most cost-effective prevention strategies, among other proposals.
Hospitals treat injured from Texas explosion   04/18/2013
Texas hospitals have treated more than 160 people injured when a fertilizer plant exploded last night in the town of West, about 20 miles north of Waco, according to multiple news reports. According to the latest update from the Texas Department of Public Safety, there have been more than 50 hospital admissions. A significant portion of the town was evacuated due to health and safety concerns from the explosion, which also impacted nearby buildings including a nursing home. The exact number of casualties is unknown, but some news outlets are reporting as many as 15.