Ohio Hospital Association
Compliance
Update
June
25, 2002
www.ohanet.org
In
this Issue:
OHA
Meetings, Seminars & Announcements
Compliance on the Internet
Compliance Quote of Note
The
Office of Inspector General of the Department of Health and Human Services (OIG)
is planning to revise its compliance program guidance for the hospital industry
and is asking hospitals for their recommendations. Noting the many changes in
government health programs, such as Medicare and Medicaid, since the last set of
hospital-specific compliance guidance was published in 1998, the OIG says it
plans to revise and update the guidelines this year. The agency, responsible for
investigating provider fraud and abuse, believes hospitals are in excellent
positions to provide feedback on problems and inefficiencies within compliance
programs. The OIG solicitation to
hospitals appeared in the June
18 Federal Register.
Hospitals should submit comments by August 19 to:
Department
of Health and Human Services, Office of Inspector General
Attention: OIG-12-CPG
Room 5527 A, Cohen Building
330 Independence Avenue, SW
Washington, DC 20201
Those
who do not wish to submit comments on their own may send ideas and suggestions
to Mary
Gallagher, for inclusion in OHA’s recommendations.
The
OIG has issued several recent advisory opinions, adding to its efforts to
provide meaningful advice on the application of the anti-kickback statute and
other OIG sanction statutes in specific factual situations.
In Advisory
Opinion 02-9, the OIG concluded a proposed arrangement
under which a physician is the sole owner of an endoscopy center, while
continuing practice in a group, fits within the safe harbor protecting
investment interests in single-specialty ambulatory surgical centers.
In Advisory
Opinion 02-8, the OIG assures a parish (county)
ambulance district that owns an ambulance service and bills insurance only for
parish residents it will not impose administrative sanctions.
The OIG points to CMS Carrier Manual Section 2309.4 to allow the wavier
of co-payments and deductibles by the ambulance district.
The OIG issued a rare negative opinion in Advisory Opinion 02-7, posted June 12, 2002. Under the proposed arrangement, a mobile x-ray provider proposes to waive Medicare Part B cost-sharing amounts for full dual eligibles (Medicare beneficiaries who qualify for full Medicaid benefits) who reside in nursing facilities. The waiver program was developed to address a state Medicaid rule forbidding Medicaid coverage of x-ray services provided by entities owned by non-practitioners. In concluding the arrangement would generate prohibited remuneration and could elicit administrative sanctions, the OIG pointed to factors such as: 1) the waiver of co-payments and deductibles is not based on individual financial need and is not applied uniformly to all beneficiaries; 2) nursing facilities are referral sources for the x-ray company; and 3) the waiver would give the x-ray company a competitive advantage over competitors.
According
to testimony offered June 13 in Congress, the Bush Administration will devote
more than $10 million from the Health Care Fraud and Abuse Control account to
develop a comprehensive Medicaid program integrity plan geared toward reducing
improper payments this year.
Officials
from Centers for Medicare & Medicaid Services (CMS) and the OIG testified
before the House Government Reform Committee that the funding would be used to
coordinate a federal oversight strategy based on risk management techniques.
In partnership with existing state Medicaid Fraud Control Units and the
National Association of State Medicaid Directors, the agency officials pledged
to improve cooperation and information sharing to better investigate and pursue
cases of abuse. The officials added
that the strategy would strive to implement recent General Accounting Office
recommendations, which have centered on agency weaknesses in reducing identified
“risk areas” in the Medicaid program, performing ongoing risk assessments,
and monitoring the effectiveness of improvement efforts.
Click here for the CMS and OIG testimony or contact OHA for copies.
CMS
finally responded to the American Hospital Association’s comments and
questions about the Emergency Medical Treatment and Active Labor Act (EMTALA)
on-call requirements in two program memoranda issued to regional administrators
June 13, 2002. In program
memorandum S&C-02-34, CMS published seven questions
and answers responding to “concerns that the implementation and enforcement of
EMTALA for on-call physicians is not being applied consistently across the
country.” CMS emphasizes the
flexibility hospitals have to meet the on-call requirements of EMTALA and states
it does not require coverage 24 hours per day, 365 days per week.
In addition, CMS explains an on-call policy that exempts senior medical
staff does not constitute a per se violation of EMTALA.
However, on-call lists must identify individual physician names, not
medical group names, to meet regulatory requirements.
Program
memorandum S&C-02-35
specifically addresses on-call arrangements that entail one physician providing
on-call coverage simultaneously at several hospitals.
CMS announced that is has revised its policy to allow simultaneous
on-call, as long as all hospitals involved are aware of the on-call schedule so
each hospital adequately meets its EMTALA obligation.
These EMTALA on-call clarifications will be added to the State Operations
Manual at its next revision.
According
to CMS and the OIG, “inherent reasonableness” authority and competitive
bidding procedures within HHS could go far to fix discrepancies in Durable
Medical Equipment (DME) reimbursements.
Tom
Scully, CMS Administrator, testified before the Senate Appropriations Committee
this month to report that the agency would soon release a final regulation
granting the HHS the authority to adjust Medicare Part B medical supply payments
that are unreasonably high or low. Scully
also alluded to early indications from a demonstration project being overseen by
CMS that competitive bidding practices eventually could net a $5 billion savings
over 10 years.
Janet
Rehnquist, chief of the OIG, agreed with Scully, and highlighted previous OIG
studies that have shown Medicare pays more for medical equipment than the
Veterans Administration or the Federal Employees Health Benefits Plan. She also
unveiled a report
from her agency showing that Medicare paid
substantially more for maintenance on rented equipment than repairs for
purchased equipment.
See
Scully’s
testimony and Rehnquist’s
testimony online or contact OHA for copies.
It’s
not too late to register for the 2002 OHA Compliance Briefing Series!
The series features seven sessions on targeted topics for hospital
compliance officers and others. The
one-hour sessions take place via teleconference, and fees are paid per phone
line — so many hospitals use the
briefings to train staff. Contact
OHA’s Center for Education
(614/221-7614)
for more information. June’s
session featured a discussion of the development of Local Medical Review
Policies by AdminaStar’s Director of Fiscal Intermediary Medical
Review/Medical Policy, Melanie Alexander. Upcoming
topics include:
Ø
July
9, 11:00 a.m., “Anti-Kickback Issues,”
Mike Phillips, Calfee, Halter & Griswold, Cleveland
Ø
September
10, 11:00 a.m., “Inpatient Coding
Compliance: Key Issues,”
Charlene Wolf, Quality Management Consulting Group, Columbus
Ø
October
8, 11:00 a.m., “Compliance Issues
Concerning the Pharmaceutical Industry,” John Green, Porter,
Wright, Morris & Arthur, Dayton
Ø
November
12, 11:00 a.m., “The Changing EMTALA
Landscape: Off Campus Facilities and Other Considerations,”
Gretchen McBeath, Bricker & Eckler, Columbus
Ø
December
10, 11:00 a.m. Topic TBA
And
Don’t Forget the 2002 Coding and Reimbursement Telephone Briefing Series!
Join
OHA and nationally recognized billing consultant Duane Abbey, Ph.D. for the 2002
Coding and Reimbursement Telephone Briefing Series.
Each session runs from 9:00 a.m. until 11:00 a.m. and features a
different hot topic each month. Contact
the OHA
Center for Education
for details about the year’s remaining sessions.
Ø
July
18, 9:00 a.m., “ED Coding, Billing &
Reimbursement”
Ø
August
15, 9:00 a.m., “Assuring Charge Master
Compliance”
Ø
September
19, 9:00 a.m., “HIPAA for Coding, Billing
& Reimbursement”
Ø
October
17, 9:00 a.m., “Conducting Coding, Billing,
Reimbursement Audits”
Ø
November
21, 9:00 a.m., “ED and EMTALA Compliance”
Ø
December
19, 9:00 a.m., “DME Coding, Billing &
Reimbursement”
American Hospital Association, Compliance Issues Page (www.aha.org/compliance): The American Hospital Association has compiled advocacy and other resources on compliance issues, including EMTALA, lab unbundling, False Claims Act and gainsharing. Find correspondence with legislators, regulators and courts about many hot compliance topics.
“Sadly, the last sentence of that section is a horrible amalgamation of negatives arranged like an inside joke prompting laughter only from seasoned and sadistic bureaucrats.”
-Chief
U.S. District Judge James R. Nowlin
interpreting IRS tax exemption regulations in
St. David’s Health Care System v. U.S.
Order Granting Plaintiff’s Summary Judgment Motion
Civil No. A-01-CA-046, June 7, 2002