No doubt you are aware that CMS has posted the proposed FY 2013 Inpatient Prospective Payment Rule for review and comment (comments are due by June 25; Federal Register publication is scheduled for May 11). Perhaps the best news is that this year the scramble to update systems with new ICD-9-CM codes, changes to MCCs and CCs, and revisions to the MS-DRGs won’t happen because CMS imposed a freeze on revisions to the codes to accommodate the implementation of ICD-10 on Oct. 1, 2013. Read more

Some hospitals have quit the recovery audit contractor (RAC) rebilling demonstration program, CMS and hospitals say, apparently because they are frustrated they had to relinquish appeal rights and/or didn’t understand the implications of this and other aspects of the demonstration. The Part A-to-Part-B rebilling demonstration allows participating hospitals to resubmit claims for allowable Part B payment after an auditor has determined that the Medicare beneficiary met the requirements for Part... Read more

Lewis Morris, the chief counsel to HHS Inspector General Dan Levinson, is retiring April 1 from OIG after 25 years. Morris has been integral to the expansion of OIG’s compliance guidance and enforcement activities. He also is a former special assistant U.S. attorney and board member of the Health Care Compliance Association and American Health Lawyers Association. He will be replaced by Gregory Demske, who has been assistant inspector general for legal affairs since 2005. Read more

In a March 1 notice, CMS said on its website that hospitals still have a shot at the Part A-to-Part-B rebilling demonstration even if they didn’t make the first cut. The enrollment process was closed on Dec. Read more

By now, most people probably know that HHS has delayed the October 2013 implementation date of ICD-10 diagnosis and procedure codes. While HHS apparently responded to concerns raised by some sectors of the industry, the jury is still out on whether the delay will serve providers well. On the one hand, the transition to ICD-10 can be overwhelming, and the delay helps providers ease into it. Read more

About five years ago, CMS started down the road toward penalizing hospitals for less-than-optimal patient outcomes with potential DRG cuts for hospital-acquired conditions (HACs). But as CMS implements new quality-related programs, such as value-based purchasing, readmission reductions and HACs for Medicaid, and sharpens its knives under existing programs (e.g., the worst HAC offenders will face bigger MS-DRG losses), hospitals will start to really feel the connection between quality and... Read more

There’s been no shortage of hospital civil monetary penalty (CMP) settlements for alleged Stark and kickback violations, most of them stemming from self-disclosures. The HHS Office of Inspector General rolled out a number of them in late December, and the settlement amounts aren’t small potatoes. For example, Westfields Hospital in Wisconsin agreed to pay $204,150 to resolve allegations that it violated the CMP law in connection with providing space, services and supplies to four physician... Read more