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Payment Matters
November 4, 2010
OIG’s 2011 Work Plan – What Can Long-Term Care and Community-Based Providers Expect to See in the Coming Year?
By: Mark A. Stanley
Providers can look to the Work Plan issued each year by the Department of Health and Human Services, Office of the Inspector General (OIG) in order to gain insight into enforcement priorities for the coming year. In the last issue we discussed the provisions of the 2011 Work Plan that affect hospitals and physicians.
This article focuses on the elements of the OIG Work Plan that apply to Long-Term Care facilities, hospices, and providers of home- and community-based services (HCBS). We have divided the discussion into “new” and “continuing” initiatives, based on whether the OIG identified a topic for enforcement priority in the 2010 Work Plan.
Click to continue...Medicaid RAC Cometh
By: Paul W. Kim
As if Medicare Recovery Audit Contractors (RACs) aren’t enough to worry about, very soon providers and suppliers will be subject to Medicaid RACs as well. Section 6411 of the Patient Protection and Affordable Care Act enlarged the jurisdiction of the RACs to include Medicaid Programs, by revising Section 1902(a)(42) of the Social Security Act and requiring States to establish RAC programs for their Medicaid Programs. Specifically, each State must contract with at least one RAC by December 31, 2010. The Centers for Medicare and Medicaid Services requires States to fully implement their RAC programs and begin auditing Medicaid providers and suppliers by April 1, 2011. CMS plans to issue regulations to provide additional guidance.
Click to continue...CMS Announces Access to Medicare DSH Eligibility Data
In a posting to those on the Medicare acute care hospital list serve and on the CMS website, CMS announced the availability of DSH eligibility data to hospitals that receive DSH payments. Medicare enrollment information will be available to hospitals for their patients. Specifically, hospitals will have access to information about their hospital patients regarding whether a patient is entitled to Medicare Part A benefits, enrolled in a Medicare managed care plan or has Medicare as a secondary insurance.
Click to continue...CMS Releases Final Rules for Outpatient PPS, Physician Fee Schedule, and Home Health PPS and Home Health/Hospice Certification
On November 2, 2010, CMS released the following final rules:
- Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates, etc. [PDF]
- Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CT 2011 [PDF]
- Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011: Changes in Certification Requirements for Home Health Agencies and Hospices [PDF]
Watch for discussions of these final rules in our next edition of Payment Matters.
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