Payment Matters

May 17, 2012

CMS Proposes Changes to GME/IME Payment Rules and Provides Guidelines for § 5506 Application Process

By: Thomas W. Coons

CMS has been busy addressing GME and IME issues in recent days. First, in late April, the agency issued its proposed Federal Fiscal Year 2013 inpatient prospective payment system (IPPS) update, www.gpo.gov/fdsys/pkg/FR-2012-05-11/pdf/2012-9985.pdf, which contains a number of proposed revisions regarding the GME and IME payment provisions. Second, at the very end of April, it issued guidance regarding applications for additional FTE slots under § 5506 of the Affordable Care Act (ACA). www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/Section-5506-Application-Guidelines.pdf.

Reactivation of Billing Privileges - More Onerous for HHAs

By: Donna J. Senft

In an April 6, 2012 Survey & Certification Letter (S&C: 12-26-HHA) [PDF], CMS reminded Home Health Agencies (HHAs) of the January 1, 2010 change in the process for an HHA to reactivate its billing privileges. Since the June 2006 overhaul of the Medicare enrollment rules, CMS and its contractors have had the authority under 42 C.F.R. § 424.540(a) to deactivate Medicare billing privileges when:

• A provider or supplier fails to submit any Medicare claims during a 12-month time period, or
• A provider or supplier does not report changes in its enrollment data within the time period required to report such changes.