JUNE 2017 COMPLIANCE UPDATES

by Becky Amann, Compliance Manager

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

PROVIDER COMPLIANCE

CMS’s website contains a Provider Compliance section that provides Compliance-related and Fraud and Abuse-related resources. This section includes a link to their “Fast Facts” that is updated regularly. Some of the topics include Preventive Services, Evaluation and Management Services, Hospital Discharge Day, Medical Necessity Documentation…. just to name a few.

These resources are located at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html

MEDICAID – REQUEST FOR PROVIDER DOCUMENTATION – PAYMENT ERROR RATE MEASUREMENT (PERM)

CMS in conjunction with the NYS Office of the Medicaid Inspector General (OMIG) will be measuring improper payments for Medicaid and Child Health Plus programs, under the Payment Error Rate Measurement (PERM) program.

Documentation for medical review of randomly selected claims will be requested by Chickasaw Nation Industries Advantage, LLC, who is the new CMS review contractor. Requests for documentation began in May and could be requested for claims paid during the timeframe of October 1, 2016 through September 30, 2017.

Failure to provide the requested documentation will result in a determination of erroneous payment and OMIG will pursue recovery.

Please ensure your staff is aware of these documentation requests.

OFFICE OF THE INSPECTOR GENERAL (OIG)

PROVIDER COMPLIANCE – REPORTING CHANGES IN OWNERSHIP

A recent report issued by the Office of the Inspector General (OIG) has indicated that providers may not be informing CMS of ownership changes. Providers must update their enrollment information within 30 days of any changes in ownership.

Owners are individuals or corporations with a 5 percent or more ownership or controlling interest. Failure to comply could result in revocation of your Medicare billing privileges. Please refer to the following MLN Matters Article for further information:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1617.pdf

For Compliance questions, please contact Becky Amann at 716-348-3902 or beckya@pracfirst.com

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