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Payment Matters
May 28, 2008
Final PRRB Rules Issued
By: Leslie Demaree Goldsmith and Mark A. Stanley
Last Friday, May 23, 2008, CMS issued final rules addressing provider appeals before the Provider Reimbursement Review Board and fiscal intermediaries. A copy of that rule can be found at: http://edocket.access.gpo.gov/2008/pdf/E8-11227.pdf. With limited exceptions, the new regulations apply to all appeals pending as of, or filed on or after, August 21, 2008.
Click to continue...CMS "Clarifies" Bad Debt Policy Related to Claiming Bad Debts While Accounts Are at a Collection Agency, Removing Benefit of Moratorium
By: Carel T. Hedlund
One Medicare bad debt issue that is under appeal by many providers is whether bad debts can be claimed for Medicare reimbursement if, at the time the accounts are claimed, they are in the hands of an outside collection agency, or alternatively, whether the provider must wait until the bad debts are returned by the collection agency as uncollectible.
Some Intermediaries have been disallowing the bad debts if the provider has claimed them before they are returned from the outside collection agency. These disallowances are based on a finding that the bad debts were not "worthless" when claimed, and that sound business judgment had not established that there was no likelihood of recovery at any time in the future, as required by the regulatory provision (currently 42 C.F.R. § 413.89(e)).
Click to continue...Federal Court Dismisses Challenge to "Anti-Markup" Rule
By: S. Craig Holden
On May 5, the U.S. District Court for the District of Columbia dismissed a challenge to CMS's November regulations prohibiting the markup of certain purchased diagnostic tests. Atlantic Urological Associates, PA, et al. v. Leavitt, Case No. 08-141 (D.D.C.) In so doing, the court vacated a prior preliminary injunction against the regulation that it had issued in March.
The anti-markup rule, originally published in the November 27, 2007 Physician Fee Schedule, would limit payments for purchased diagnostic tests performed at a site other than the office of the billing physician or other supplier to the lesser of:
- The performing supplier's net charge to the billing physician or other supplier;
- The billing physician or other supplier's actual charge; or
- The fee schedule amount for that test.
