Medical Practice Compliance Alert - Nov 2013
For the past few years, providers have eyed O&P as a fertile expansion opportunity, but what is the funding and regulatory reality?
- By David Kopf
- Oct 01, 2013
For the past few years, many home medical equipment providers have looked toward orthotics and prosthetics with considerable interest. While the home medical equipment business has been besieged by a number of funding and regulatory threats — competitive bidding and audits chief among them — that have promised to all but decimate their reimbursement, the O&P market has seemingly been operating in carefree conditions and reaping what looked from the HME perspective to be reimbursement rates that seemed on par with the fabled age of the “golden commode.”
Can providers keep their businesses and industry on the rails?
- By David Kopf
- Oct 01, 2013
Ever since the Centers for Medicare and Medicaid Services began testing its competitive bidding program, providers have been on a roller coaster trying to stop the program. They’ve seen some bright points, such as the delay through the Medicare Improvements for Patients and Providers Act, but they’ve seen even more terrifying plummets, such as the Round One implementation, and now the even more precipitous Round Two implementation.
WASHINGTON – A new auditor that’s in the works has the potential to streamline the process, but it will likely mean more activity, as well, industry stakeholders say.
“Anytime there’s a new contractor, they tend to be more active,” said Wayne van Halem, president of the Atlanta-based van Halem Group.
CMS this month announced plans to create a new program integrity contractor for Medicare and Medicaid called a Unified Program Integrity Contractor (UPIC). The agency plans to fold the existing ZPICs and the Medicaid program integrity contractors into the UPICs.
A likely result of the shake-up will be an increase in audits for Medicaid, stakeholders say.
WASHINGTON – In a June 21 letter to the Office of the Inspector General (OIG), Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, call on the agency to investigate the possibility that CMS deliberately overlooked its own rules when awarding contracts for competitive bidding, according to a press release.
The OIG is charged with identifying and combating waste, fraud and abuse in more than 300 programs, including Medicare.
“We have asked the Inspector General to look into the shortfalls, but also to investigate the possibility that officials at Medicare intentionally ignored their own rules when problems began to arise,” Thompson stated.
The Centers for Medicare & Medicaid Services (CMS) reportedly is developing a new integrity contractor called a Unified Program Integrity Contractor (UPIC).
These contractors will focus on both Medicare and Medicaid integrity issues, and the Zone Program Integrity Contractors (ZPICs) and the Medicare Administrative Contractors (MACs) will be folded into the UPICs, according to an email sent last Friday by Dianne De La Mare, vice president of legal affairs for the American Health Care Association (AHCA).
De La Mar was reporting on what she described in her email as a conference call held last Friday by CMS Program Integrity. She added that MACs would not be going away; however, their integrity responsibilities will be folded into those of the UPICs.
Writing that the Medicaid Integrity Contractors (MICs), will be phased out, De La Mar also indicated that the recovery auditors will remain in place. Moreover, she concluded, CMS will be consolidating all of its Medicare and Medicaid data into one unified database.
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