BNA’s Health Care Daily Report™ sets the standard for reliable, high-intensity coverage of breaking health care news, covering all major legal, policy, industry, and consumer developments in a...
The Department of Health and Human Services Office of Inspector General will focus some of its work in 2013 on determining the effects of nonhospital-owned physician practices billing Medicare as hospital-based physician practices, a new topic for the agency and one compliance officials in an Oct. 22 webinar said they were concerned about.
The agency's Work Plan for Fiscal Year 2013 highlighted several new areas of concern surrounding hospitals, including payments for mechanical ventilation, payments for canceled surgical procedures, and compliance with Medicare's patient transfer policy, all of which are under OIG review, with reports expected to be issued in FY 2013 (191 HCDR, 10/3/12).
The webinar, sponsored by the Health Care Compliance Association, focused solely on the aspects of the work plan related to hospitals. As experts explained the hospital issues OIG plans to address, compliance officials focused most of their technical questions about the enforcement of nonhospital providers billing as if they were part of hospitals.
OIG in its work plan said it will determine the extent to which practices using the hospital-, or provider-based status met the billing requirements of the Centers for Medicare & Medicaid Services. According to OIG, provider-based status allows a subordinate facility to bill as part of the main provider. Provider-based status can result in additional Medicare payments for services furnished at provider-based facilities and may also increase beneficiaries' coinsurance liabilities.
Lewis Morris, an attorney at Adelman, Sheff & Smith in Annapolis, Md., did not dismiss the concerns of the webinar listeners. He noted, however, that just because OIG is addressing a project for the first time in a work plan does not mean it has not been discussed previously within the agency or elsewhere. For example, the Medicare Payment Advisory Commission (MedPAC) in 2011 expressed concerns about the financial incentives presented by provider-based status and stated that Medicare should seek to pay similar amounts for similar services.
MedPAC noted that higher payments for provider-based departments are appropriate because of the increased costs hospitals incur. According to the commission, hospitals have been increasing employment of physicians, and services are likely to shift from freestanding physician practices to hospital outpatient departments (HOPDs). The problem, commissioners agreed, is that payments under the hospital outpatient prospective payment system are typically much higher than the physician fee schedule rates (51 HCDR, 3/16/12).
Morris said the overall theme of the OIG work plan that should trigger the attention of compliance officials is the increasing use by the agency of predictive analytical data. The work plan projects are examples of “how OIG is using data in a creative way. It allows them to cast a broader net and look at” multiple issues at the same time, he said. He also said it can allow them to better identify outliers across the health care spectrum, not just those related to technical payments.
The emerging use of technology, Morris said, “is not a passing fad.” In a follow-up interview, he told BNA that hospital compliance officers should be looking at the same data as the OIG, “not to anticipate a particular audit, because you can't. But if the government is looking at your data, you should, too.”
He said following the work plan itself is not enough to form a comprehensive compliance program, and data should be used to “understand your unique risks” and the “new and emerging issues” unique to a particular hospital.
By Nathaniel Weixel
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)