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October 20, 2014

Recent Stories of Interest

From Report on Medicare Compliance - An upstate New York hospital has agreed to pay $3.373 million to settle a false claims case over Medicare rules on provider-based status. From Feb. 8, 2008, to Sept. 16, 2013, 242-bed Our Lady of Lourdes Memorial Hospital in Binghamton improperly billed Medicare for services provided at its off-campus mobile hyperbaric oxygen facility, which was operated by Mobile Hyperbaric Centers, LLC, the U.S. Attorney’s Office for the Northern District of New York said on Oct. 16. Read more

While hospitals fend off claim denials in core compliance risk areas, they… Read more

As hospitals ramp up their use of technology, they invite more vendors… Read more

CMS on Oct. 9 tried to put to rest the question of… Read more

From the Editor

Welcome to your Report on Medicare Compliance subscriber-only Web page

Be sure to visit often, for PDFs of issues, archives of articles, links to government documents and more!

Please e-mail me with your comments on the last issue of Report on Medicare Compliance, story ideas for future issues, or any other suggestions you have that can make the newsletter more useful for you.

October 23, 2014
CMS Indirectly Extends 68% Deadline

CMS indirectly extended the 68% settlement process deadline for hospitals that request a list of potential eligible claims.

October 23, 2014
A DeFacto Extension on the 68% Claims Deadline

CMS said that hospitals that ask it for a list of claim denials that may qualify for Medicare partial payment buy more time to decide whether to accept 68% of the net Medicare amount of claims for pre-Oct. 1, 2013, inpatient admissions that were denied because they should have been outpatient/observation services in exchange for dropping their appeals.

“If you are on the fence or unable to submit information to the settlement process [by Oct. 31], if you request a list of potential claims as an intent to participate, it gets you in the queue…with the ability to participate,” Gerald Walters, senior advisor to the chief financial officer in the CMS Office of Financial Management, said Oct. 21 at the third national provider call on the 68% settlement process. But once they receive the potentials list, they should submit the administrative agreement and spreadsheet of eligible claims within 14 days, although that time frame is not carved in stone.

The request for the potentials list should be sent to, with a subject line of “request for potentials list from (name of hospital) and six-digit provider number.” The body of the e-mail also needs to state all national provider numbers associated with the hospital. CMS says it will confirm receipt of the email and recommends that hospitals resend the email if they don't get confirmation.

A full story on these developments will be included in the Oct. 27 issue of RMC and is being transmitted to RMC subscribers today in a special E-Alert.

October 23, 2014
OIG Posts Multiple Reviews on Billing for Kwashiorkor

OIG posts three separate reviews on improper inpatient billing for kwashiorkor:, and

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