The 60-day repayment rule was implemented by the Centers for Medicare and Medicaid Services (CMS) effective March 14, 2016 to clarify Medicare providers’ obligations to investigate, report, and refund identified overpayments under the Affordable Care Act. The rule specifically details what it means to “identify” an overpayment and explains how to report and return identified overpayments to CMS.1 The rule also states that an overpayment must be reported and returned if it is identified within six years of the date it was received. This time period is generally referred to as the “lookback” period.
Continue Reading Lookback Periods for Medicaid Overpayments
How much does it cost to identify and repay federal health plan overpayments late?
Roughly $2.95 for each $1 overpaid (plus legal costs and the overpayment) based on an August 24, 2016, U.S. Attorney’s Office press release regarding settlement of State of New York, ex rel. Robert P. Kane v. Healthfirst, Inc. et al case in the U.S. District Court for the Southern District of New York. Defendants previously lost a motion to dismiss this case based, in part, on the fact that defendants actually identified and repaid the overpayments. Specifically, about $1 million in overpayments were presented to the defendants in the form of a spreadsheet in February 2011. Subsequently, defendants repaid the overpayments in more than 30 installments from April 2011 to March 2013. Notwithstanding, the government took the position that, under the False Claims Act, repayment should have been made within 60 days of the date of the claims were identified in the spreadsheet. Defendants argued, among other things, that there was ambiguity about the term “identify” as used in the False Claims Act and that the spreadsheet was merely the first component of an investigation into the overpayments that was ongoing through the repayment process. Almost a year after losing the motion to dismiss, defendants settled the case for $2.95 million.
Continue Reading How much does it cost to identify and repay federal health plan overpayments late?
CMS targets inappropriate social media use in nursing homes
The U.S. Dept. of Health & Human Services Centers for Medicare and Medicaid Services (CMS) published a memo (Ref: S&C: 16-33-NH) Aug. 5, 2016, to state nursing home survey agency directors related to protecting resident privacy and prohibiting mental abuse related to photographs and audio/video recordings by nursing home staff. The memo is a response to recent media reports regarding inappropriate posting to social media of pictures of nursing home residents – namely a disconcerting report by ProPublica detailing 47 incidents in which workers shared photos or videos with friends or the public – these incidents involved both mistreatment of residents and inadvertent disclosure or patient health information. Within 30 days of the memo, surveyors are to implement changes to address these issues.
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CMS’ quest for quality – proposed merit-based and alternative payment model rules released
On April 27, 2016, the Department of Health & Human Services Centers for Medicare & Medicaid Services (CMS) released its proposed rule regarding models for tying professional reimbursement to quality. While this may be great news for providers who enjoy the challenges of tracking and reporting data, these challenges are going to cause problems (namely, reimbursement reductions) for some providers. Regardless of whether providers think this is good or bad, providers should start looking at the proposed regulations now because, as proposed, quality-based payments will be a fact of life for all physicians, mid-levels, CRNAs and groups effective Jan. 1, 2019. The regulations will be published in the May 9, 2016, Federal Register. The comment period will officially start at that time and run through 5 p.m. on June 27, 2016.
Continue Reading CMS’ quest for quality – proposed merit-based and alternative payment model rules released
Summary of the final HHS rule for reporting and returning of overpayments
On Feb. 12, the Department of Health and Human Services’ (“HHS”) Centers for Medicare & Medicaid Services (“CMS”) published its final rule regarding reporting and returning Medicare overpayments. This final rule comes nearly four years after its proposed rule regarding the reporting and return of Medicare overpayments that left the provider community nervous and uncertain about when an overpayment would be considered “overdue” under CMS’s vague 60-day standard.
Continue Reading Summary of the final HHS rule for reporting and returning of overpayments
CMS to rewrite the rules of EHR meaningful use
Recent remarks made by the Centers for Medicare & Medicaid Services (“CMS”) Acting Administrator Andy Slavitt at a healthcare conference indicated that CMS will be ending the “meaningful use” electronic health record (“EHR”) Incentive Program in 2016, five years ahead of its original final end date of 2021. Acting Administrator Slavitt did not elaborate on the specifics of what will replace meaningful use, but stated it would likely be tied to the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) and would include various streamlined quality reporting programs. MACRA emphasizes a new Merit-Based Incident Payment System and alternative payment models, and according to Acting Administrator Slavitt, this new law warrants a new streamlined regulatory approach to EHR as well.
Continue Reading CMS to rewrite the rules of EHR meaningful use
CMS Revises the 5-Star Quality Metrics System for Nursing Homes
On Friday, February 20, 2014, the Centers for Medicare & Medicaid Services (“CMS”) unveiled its adjustments to Nursing Home Compare, a website many view as the premier tool for evaluating the nation’s nursing homes. CMS hopes the changes will cause nursing homes to make quality improvements, while critics warn that that the information is still unreliable and could confuse consumers who witness a sudden downward change in a facility’s rating. Nearly a third of the nation’s nursing homes experienced lower star ratings as a result of the changes. CMS stated that 1.4 million viewers access the website annually, with 85 percent of users reporting that they found the information they sought regarding nursing homes.
Continue Reading CMS Revises the 5-Star Quality Metrics System for Nursing Homes
CMS Clarifies Rules Regarding Respite Care, Vaccines for Hospice Patients
This article was originally published by the American Health Lawyers Association. Copyright 2014, American Health Lawyers Association, Washington, DC. Reprint permission granted.
On February 5, CMS issued Change Request 8569 instructing Medicare administrative contractors (MACs) to implement system edits to prevent payment of respite care for more than five days at a time for any
New Quality Measures for Children’s Vaccines
CMS and the Office of the National Coordinator for Health IT (ONC) have released two additional draft Quality Measures under the Children’s Measures project for public comment. The draft measures are:
- Immunizations by 13 years of age – HPV
- Immunizations by 13 years of age – Meningococcus, Tetanus and Diptheria
The measures were released on
Could Your Facility Benefit from Telemedicine?
A study published in the February 2014 issue of Health Affairs concludes that the use of telemedicine by nursing homes can reduce hospitalizations and generate savings for Medicare. However, there are several barriers to successful implementation, including the cost of the technology, the willingness of staff to utilize the service and traditional Medicare and Medicaid payment methodologies.
The researchers noted previous studies suggesting that the lack of on-site physicians in many nursing homes during off-hours (evenings, weekends and holidays) may be one cause of inappropriate hospitalizations. Typically, if a medical issue arises off-hours, an on-call physician is phoned by nursing home staff. The physician can then either travel to the nursing home or, more likely, recommend that the resident be transferred to a hospital emergency room. Could the availability of telemedicine prevent some of these transfers?
Eleven for-profit Massachusetts nursing homes, owned by a single company, and all dually certified to accept both Medicare and Medicaid, were studied. All were very similar in terms of resident characteristics, staffing and quality scores. The nursing home residents received their primary care through physician group practices; prior to the study, most after-hours medical services involved the nursing home staff phoning the residents’ on-call physicians. Telemedicine services were introduced in six of the eleven nursing homes, with five serving as a control group. The six nursing homes utilizing telemedicine services each received a cart with equipment for two-way videoconferencing and a high-resolution camera for wound care. A remote medical call center staffed by an RN, a nurse practitioner and a physician provided the telemedicine services (most of the nursing home residents’ treating physicians had signed over their off-hours coverage to this remote center). Before the telemedicine service was introduced in the six nursing homes, separate training sessions were held for the direct care staff and the residents’ physicians. The annual cost of the telemedicine service was $30,000.00 per facility.
Continue Reading Could Your Facility Benefit from Telemedicine?