Health Industry Washington Watch : Washington DC Healthcare Industry Law Firm : Reed Smith : Health Industry Washington Watch : Regulations, Medicare/Medicaid, Governmental Organizations

A number of Congressional panels have held hearings this month on health policy issues, including Senate Health, Education, Labor and Pensions (HELP) Committee hearings entitled “First, Do No Harm: Improving Health Quality and Patient Safety” and "Diverting Non-Urgent Emergency Room Use: Providing Better Care and Lower Costs." Both the House Energy & Commerce Subcommittee on Health and the House Ways and Means Committee have examined reform of the Medicare Sustainable Growth Rate/physician fee schedule formula. In addition, the House Education and the Workforce Committee held a hearing on "Policies and Priorities of the U.S. Department of Health and Human Services." Looking ahead, on May 17, the HELP Committee has scheduled a hearing on “Strengthening Medical and Public Health Preparedness and Response.”

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The OIG has issued a report entitled “Medicare Payments for Diagnostic Radiology Services in Emergency Departments.” According to the OIG, because of insufficient documentation, Medicare erroneously allowed 19% ($29 million) of claims for interpretation and reports for computed tomography and magnetic resonance imaging, along with 14% ($9 million) of claims for interpretation and reports for x-rays in hospital outpatient emergency departments in 2008. Examples of insufficient documentation included missing physicians’ orders and records documenting that interpretation and reports had been performed.  The OIG investigators also measured compliance with reporting guidelines recommended by the American College of Radiology. The report did not address the widespread delivery of preliminary interpretation services in thousands of US hospitals.  The OIG recommended that CMS improve provider education regarding documentation requirements and take appropriate action on the erroneously allowed claims identified by the OIG; CMS concurred with these recommendations. CMS did not agree with a separate OIG recommendation that CMS require that claimed services be contemporaneous or identify circumstances in which noncontemporaneous interpretations may be appropriate; CMS noted that it does not believe that a single billed interpretation must in all cases be contemporaneous with the beneficiary’s diagnosis and treatment to contribute to that diagnosis and treatment.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

CMS is hosting three listening sessions on provider compliance issues March 22-24, 2011, focusing on a number of OIG reports. The schedule is as follows:

Tuesday, March 22

• Inappropriate Medicare Payments for Transforaminal Epidural Injections Services
• Medicare Part B Services During a Non-Part A Nursing Home Stays: Mental Health
• Medicare Part B services during Non-Part A Nursing Home Stays: Enteral Nutrition Therapy
• Review of Point Of Service (POS) Coding for Physician Services Processed by Part B Carriers

Wednesday, March 23

• Medicare Part B Payments for Ambulance Services Rendered to Beneficiaries During Inpatient Stays
• Review of Inpatient Rehabilitation Facilities (IRF) Compliance with Medicare Transfer Regulation
• Part A ER Department Adjust Nationwide Review of Medicare Part A Emergency Dept Adjustments for Inpatient Psychiatric Facilities
• Nationwide Review of IRF Transmission of Patients’ Assessment Instruments

Thursday, March 24

• Review of Claims for Capped Rental Durable Medical Equipment
• Questionable Billing for Physicians Services for Hospice Beneficiaries
• Questionable Billing for Medicare Outpatient Therapy Services
• Chiropractor Outreach and Education

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On December 23, 2010, CMS published an advance notice of proposed rulemaking soliciting comments on the need for a proposed rule to address two policies related to the Emergency Medical Treatment and Labor Act (EMTALA). Specifically, CMS is requesting comments regarding its need to revisit rules adopted in 2003 and 2008 concerning the applicability of EMTALA to hospital inpatients and the responsibilities of hospitals with specialized capabilities, respectively. CMS states that there have been different interpretations regarding the applicability of EMTALA once an individual has been admitted to a hospital. CMS also notes continued questions regarding whether EMTALA should apply when a hospital transfers an individual, who was admitted as a hospital inpatient after seeking treatment for an emergency medical condition, to a hospital with specialized capabilities because the admitted inpatient continues to have an unstabilized emergency medical condition requiring specialized treatment.  CMS will accept comments on these issues until February 22, 2011.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

HHS has launched a new national website for the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), a national network of state-based programs that verifies the identity, licenses, and credentials of health professionals prior to an emergency. By providing a single point of entry for potential volunteers, HHS expects the ESAR-VHP website to enable health professionals to volunteer quickly without waiting for their credentials to be verified. HHS encourages all health professionals to visit and register with the ESAR-VHP website (registration does not obligate health professionals to provide volunteer services).

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The HHS Emergency Care Coordination Center has issued a request for information (RFI) that will be used to help development demonstration programs that design and evaluate innovative models of regionalized, coordinated and accountable emergency care and trauma systems. Responses to the RFI will be accepted until September 30, 2009. 

 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

A new GAO report on emergency department overcrowding concludes that emergency department crowding continues to occur in hospital emergency departments, with about one-fourth of hospitals reporting diverting ambulances at least once in 2006. Wait times in emergency department have increased nationally, and in some cases exceeded recommended time frames. Boarding of patients in the emergency department while awaiting transfer to an inpatient bed or another facility continues to be reported as a problem, but national data is limited. Based on articles and interviews, the GAO concludes that a lack of access to inpatient beds continues to be the main factor contributing to emergency department crowding.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The OIG has issued a report on Medicare Part D payments to community pharmacies. Among other things, the OIG found that Medicare Part D payments (excluding dispensing fees) exceeded the pharmacies’ drug acquisition costs by about 18.1 percent when drug wholesalers rebates to pharmacies were included. Excluding rebates, Part D payments exceeded drug acquisition costs by an estimated 17.3 percent, with a much larger difference for generic drugs than for brand-name drugs.   A separate OIG report addresses the ability of physician-owned specialty hospitals to manage medical emergencies. The OIG found that about half of all physician-owned specialty hospitals have emergency departments, with the majority having one emergency bed. Not all physician-owned specialty hospitals had nurses on duty and physicians on call during the review period, and 66 percent use 9-1-1 as part of their emergency response procedures. In addition, the OIG has issued a report entitled "National Institutes of Health: Conflicts of Interest in Extramural Research," which includes a series of recommendations to increase oversight of grantee institutions to ensure their compliance with federal financial conflicts-of-interest regulations.

• Email This
• Print
• Comments
• Trackbacks
• Share Link