Payment Matters

November 29, 2011

CMS Final Rule Eliminates Requirement for Signed Laboratory Requisition: The Good, the Bad and the Unknown

By: Robert E. Mazer

In a previous Payment Matters article, we reported that CMS had proposed to retract its rule requiring a physician or qualified non-physician practitioner (NPP) to sign the requisition for a clinical diagnostic laboratory test. “CMS Proposes Rule on Signature on Laboratory Requisitions – A Trip Back to the Future” (July 14, 2011) The proposed rule was viewed as extremely good news by independent clinical laboratories and hospital laboratories that furnished services to non-hospital patients because of the difficulty they were having in obtaining signed requisitions from physicians and NPPs. We cautioned, however, that the proposed rule included potentially bad news – the agency did not appear willing to abandon totally the physician signature requirement. CMS indicated that, although the test requisition would not need to be signed, it would require generally that there be a signed order for a clinical laboratory test, such as a signed entry in the medical records.

Are You up for the Health Care Innovation Challenge? $1 Billion in Grant Money Announced

By: Sarah E. Swank

On November 14, 2011, the CMS Innovation Center (the Innovation Center) announced that it plans to award $1 billion in grants for local health care innovation projects across the country. The grants will range from $1 million to $3 million for those applicants that focus on workforce development and on transformative care and payment delivery models. Smaller grants may be available depending on the application submitted. The applicant pool is fairly broad, including but not limited to, providers, payors, local government, private-public partnerships, faith-based organizations, health information technology companies, universities and multipayor collaborations.

Medicare Catch-22: Licensure Conundrum under DMEPOS Competitive Bidding

By: Paul W. Kim and Donna J. Senft

CMS requires that DMEPOS suppliers participating in the federal competitive bidding program obtain and maintain all applicable state licenses. In addition, once selected as a contract supplier, the winning bidder must service any and all Medicare beneficiaries residing in the competitive bidding area (CBA). The requirement to serve all beneficiaries creates an additional licensure burden for certain DMEPOS suppliers.

Many states require licensure to provide certain in-home services and equipment, such as technically sophisticated devices. These home medical equipment laws often have licensure exemptions for services provided to residents in facilities, such as to Medicare beneficiaries residing in a nursing home. DMEPOS suppliers in these states that have chosen to limit services to only individuals residing in such facilities, have not previously had to obtain a home medical equipment license to do so. The lack of licensure, however, prohibits DMEPOS suppliers from servicing patients outside of nursing homes or other exempt facilities. Therefore, if such a DMEPOS supplier wins the bid and becomes a contract supplier, it may not be able to service all Medicare beneficiaries in the respective Contract Bidding Area unless it can obtain the necessary state licenses.
 

OIG's 2012 Work Plan - What Can Long-Term Care and Community-Based Providers Expect in the Coming Year?

By: John S. Linehan

Providers may refer to the Work Plan issued each year by the Department of Health and Human Services, Office of the Inspector General (OIG) to obtain guidance into enforcement priorities for the coming year. In the last issue we summarized provisions of the 2012 Work Plan that relate to hospitals and physicians.

This article focuses on both the Medicare and Medicaid provisions in the 2012 OIG Work Plan [PDF] that apply to long-term care facilities, hospices, and providers of home- and community- based services (HCBS). The discussion is organized into “new” and “continuing” initiatives, based on whether the OIG identified a topic as an enforcement priority in the 2011 Work Plan [PDF].