The Patient Protection and Affordable Care Act made a number of change to the Medicare, Medicaid and CHIP programs designed to combat fraud, waste and abuse. Effective March 25, 2011, various screening tools, including unannounced site visits and criminal background checks may become standard procedure when a provider or supplier enrolls or re-validates their participation in these programs.
Providers will also be assessed an application fee (that will be used to fund the screening and integrity efforts) and undergo verification of licensure requirements as well as pre and post application examination of all enrollment criteria.
The new rule also authorizes CMS to impose moratoria on new provider enrollment to protect against fraud and authorizes the suspension of payments pending any investigation of a credible allegation of fraud. Additionally, a State may rely on the results of the screening conducted by Medicare or other State Medicaid programs to fulfill the provider screening requirements under Medicaid and CHIP or may may also establish additional screening methods if they so desire.
More information on the specifics of the Final Rule can be found here:
http://edocket.access.gpo.gov/2011/pdf/2011-1686.pdf
Wednesday, February 23, 2011
Thursday, February 17, 2011
Fixing the Medicare physician payments system
The White House budget released on Monday includes a two-year fix to the Sustainable Growth Rate (SGR) formula, which determines Medicare reimbursements. The two-year proposal includes a number of politically tough provisions, such as getting generic versions of biologic drugs to market faster and restricting generic manufacturer's ability to drop patent challenges in exchange for cash payments from brand-name drug makers.
A two-year fix is seen by some as vital for building physician support for the healthcare reform law and would give Congress thru 2013 to find a permanent solution.
Congress voted five times last year to delay cuts in Medicare physician payments. The mos recent $19 billion fix expires at the end of 2011. Physicians face a 28 percent cut in their reimbursements at the end of this year if the proposed fix, or some variation of it is not enacted this session.
A two-year fix is seen by some as vital for building physician support for the healthcare reform law and would give Congress thru 2013 to find a permanent solution.
Congress voted five times last year to delay cuts in Medicare physician payments. The mos recent $19 billion fix expires at the end of 2011. Physicians face a 28 percent cut in their reimbursements at the end of this year if the proposed fix, or some variation of it is not enacted this session.
Friday, February 4, 2011
Medicare proposes expansion to patient complaint process
Medicare took steps this week to make it easier for patients to file complaints about unsatisfactory medical care.
Already, hospitals must give patients a written notice telling them how to file a complaint with an independent review agency. Under the new proposal, the rule would be expanded to clinics, home health agencies, surgery centers, rehabilitation centers, nursing homes, hospices and other providers — all of which would have to give patients the notices. Doctors would not be included.
Examples of issues that could be raised include medication errors, unnecessary tests, wrong diagnoses or incorrect medical instructions.
Already, hospitals must give patients a written notice telling them how to file a complaint with an independent review agency. Under the new proposal, the rule would be expanded to clinics, home health agencies, surgery centers, rehabilitation centers, nursing homes, hospices and other providers — all of which would have to give patients the notices. Doctors would not be included.
Examples of issues that could be raised include medication errors, unnecessary tests, wrong diagnoses or incorrect medical instructions.
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