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Hello,
In this issue:
Oct.
1 marks effective date for several Stark law changes
Changes
to the physician self-referral ("Stark") law that were finalized
in the 2009 Inpatient Prospective Payment System rule go into effect Oct.
1. These changes, which were first reported
in the Aug. 5, 2008 MGMA Washington Connexion, effectively
prohibit most "under arrangement" relationships between hospitals
and group practices where the group provides services for which the
hospital bills. Arrangements that fit within this definition should be
reviewed to determine whether they comply with the new changes.
The
new restrictions also prohibit space or equipment leases when the
compensation paid is calculated based on a percentage of revenues
attributable to services performed in the space or using the equipment. A
similar prohibition on "per click" leases also goes into effect Oct.
1.
A
detailed analysis of these changes, prepared by MGMA Counsel Bob Saner
of the law firm Powers Pyles Sutter & Verville, PC, is available to
MGMA members.
CPT
codes created for H1N1 vaccine and its administration
In
preparation for the H1N1 vaccine release, the American Medical Association
created two new Current Procedural Terminology (CPT) codes describing the
H1N1 flu vaccine (90663) and its administration and counseling (90470) on
claims submitted to public and private health insurers. These codes are
effective immediately for both public and private insurers.
Practices
interested in administering the vaccine should contact your state or local
health official to register to participate in the H1N1 vaccine program. Visit
the Centers for Disease Control (CDC) Web page for
state/jurisdiction contact information.. On Sept. 21, the CDC indicated
that "states will be able to place first orders for H1N1 vaccine on
September 30, 2009. At that time up to 3 million doses of Live Attenuated
Influenza Vaccine (LAIV) will be available. Some injectable vaccine in 15
microgram pre-filled syringes licensed for use in children age 4 years and
up may also be available for ordering at that time. During the first two
weeks in October 2009, states will be able to place orders for 15 microgram
pre-filled syringes licensed for use in children age 4 and older, multidose
vials, and as well as additional LAIV."
CMS issues final rule limiting its
ability to collect overpayments, modifying interest provisions
In
a final rule issued to implement a requirement in the Medicare Prescription
Drug, Improvement and Modernization Act of 2003 (MMA), CMS finalized new
rules for the recoupment of overpayments and the assessment of interest
that Medicare will pay when providers are successful in having their
overpayment determination overturned.
Recoupment
is the process by which CMS collects an overpayment by reducing present or
future Medicare payments. Prior to passage of the MMA, CMS was not
restricted in recouping overpayments, even when the provider or supplier
appealed the determination. MGMA has long advocated that the agency should
not be allowed to recoup overpayments until the provider has an opportunity
to effectively appeal an overpayment determination.
The
MMA restricts the agency's ability to collect a determined overpayment when
a provider or supplier has an appeal before a qualified independent
contractor (the second level of appeal). CMS will also stop recoupment at
the first level of appeal (the redetermination stage) if the provider files
a timely appeal. To be considered timely, the first appeal must be filed
within 41 days, and the second appeal must be filed within 60 days.
The
final rule also implements a provision within the MMA relating to the accrual
of interest. For overpayments that are overturned beyond the second level
of appeal, CMS will be required to pay interest on money that it has
recouped from the date of the original demand letter.
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