Blog: Healthcare Legal Updates

The Centers for Medicare & Medicaid Services (“CMS”) recently announced that it awarded Noridian Administrative Services the contract for administration of Medicare Part A and Part B fee-for-service claims for California, Nevada, Hawaii and the American territories of American Samoa, Guam and the Northern Mariana Islands. Noridian will also take over additional Medicare operational functions, including provider enrollment functions. According to CMS, the workload transfer is to be complete by early 2013. However, if Palmetto GBA protests the bid award, this could significantly delay implementation.

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The Centers for Medicare & Medicaid Services (“CMS”) has begun the process of revalidating most Medicare provider and supplier enrollments, which must be completed by 2015. This effort began making waves in the provider and supplier community when letters sent last fall from the Medicare Administrative Contractors (“MACs”) gave recipients 60 days to respond with a complete Medicare revalidation application. The consequences of failure to comply with a MAC request to revalidate include deactivation of a provider or supplier’s enrollment, which means that the Medicare revenue stream ceases.

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The Centers for Medicare & Medicaid Services (CMS) finalized changes for Medicare skilled nursing facility (SNF) payments for calendar year (CY) 2012. The final rule will be published in the August 8, 2011, Federal Register. CMS finalized an 11.1% decrease to SNF Medicare payments, reflecting the net effects of a downward recalibration of case-mix indexes, a market basket increase and a multi-factor productivity adjustment to the SNF prospective payment system (PPS) rates. In addition, CMS revised several SNF payment policies effective October 1, 2011.

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The Centers for Medicare & Medicaid Services (CMS) proposed changes for Medicare home health agency (HHA) payments for calendar year (CY) 2012. The proposed rule, which was published in the July 12, 2011, Federal Register, results in a net 3.35% decrease to HHA Medicare payments after taking into account the effects of both market basket and wage index updates and reductions in the home health prospective payment system (PPS) rates.

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On July 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule with policy and payment changes for Hospital Outpatient Departments (HOPDs) and Ambulatory Surgical Centers (ASCs). The proposed rule would affect Medicare payments commencing in calendar year (CY) 2012. The proposed rule will be published in the July 18, 2011, Federal Register.

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On July 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued proposed payment rate and policy changes for the Medicare physician fee schedule that would go into effect for calendar year (CY) 2012. The proposed rule will be published in the July 19, 2011, Federal Register. Highlights of the proposed changes are discussed below. Note that the proposed rule does not address CMS’ projected reduction of 29.5% to the conversion factor for CY 2012 that is based on the application of the sustainable growth rate (SGR). The reason is that this reduction can only be averted through a change in law. The President’s budget submission for fiscal year (FY) 2012 would extend current payment rates through Dec. 31, 2013.

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Few surgery centers can remain economically viable without at least some level of government payor reimbursement. So imagine a scenario where the ASC’s Medicare or Medicaid receivables come to a screeching halt without warning; the enrollment has been deactivated. This does happen; sorting out why and how to fix it can take many months.

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Starting today, Department of Health Care Services (“DHCS”) is required to collect Medi-Cal enrollment fees of $505 per enrollment for “institutional providers.” DHCS Provider Enrollment Unit has issued no formal guidance regarding how it will implement the new requirements, and requests for information guidance from DHCS’ Acting Chief of Provider Enrollment have revealed few details regarding how a provider can comply with the new requirements.

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The Centers for Medicare & Medicaid Services (“CMS”) recently published proposed regulations that would implement provisions of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Affordable Care Act”) relating to provider enrollment in Medicare, Medicaid and Children’s Health Insurance Program (“CHIP”). Published in the September 23, 2010 Federal Register, the proposed rules, if adopted, would introduce fingerprinting to the public-program enrollment process, expand provider-types subject to pre-enrollment and post-enrollment on-site agency review, specify details relating to the payment of fees for processing Medicare enrollment and revalidation applications, and provide new mechanisms for the establishment of Medicare and Medicaid enrollment moratoriums.

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