Medicaid still covers drugs not reviewed by the government–about $200 million worth since 2004, the Associated Press reports.
The medications, linked to dozens of deaths, are decades old. The Food and Drug Administration had less restrictive measures then and has tried, to no avail, to eliminate them from the market.
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CMS rescinds and replaces previous transmittal on Medicare deductible, coinsurance, and premium rates for 2009
On November 17, CMS rescinded and replaced its November 7 transmittal updating the Medicare deductible, coinsurance, and premium rates for 2009. The new transmittal adds information inadvertently left out in section 20.6 of the manual. The 2009 income parameters for determining the Part B premium were not complete. All other information remains the same.
Effective date: January 1, 2009
Implementation date: January 5, 2009
View the transmittal.
Q: One of the challenges that many providers have faced is the inability to sufficiently interface (e.g., to see a human, get a return phone call, or otherwise interact in a personalized manner) with a RAC with respect to questions, concerns or confusion that occasionally arise. Will the permanent RACs be more welcoming of human interaction?
A: Yes. When you contact the RAC, they are required to return a phone call within one business day. In the permanent program, if a provider calls during the second period—or at any time—to discuss a determination, the RAC is required to let the provider speak to the medical director or the person that reviewed the claim.
Editor’s note: This Q&A was adapted from the November 13 RAC Open Door Forum. A CMS representative answered this question.
The permanent RAC program may be on hold for a short time. However, this doesn’t mean you should stop preparing for RACs. Using the 100 days to review and study the Office of Inspector General (OIG) reports and work plans is one way to internally identify like behaviors that may put you at risk for a RAC audit, suggests William L Malm, ND, partner at Health Revenue Integrity Services in Westlake, OH. The OIG has clearly outlined much of what the RACs are looking for in them, he notes.
So while you have this brief reprieve, get your facility in line by studying the OIG publications, Malm says. Taking the time to read and understand them can help you avoid recoupments.
Editor’s note: To view the latest OIG Work Plan, click here. To see a list of OIG reports, click here.
Improper payments for Medicare fee-for-service (FFS) decreased from 3.9% to 3.6% in fiscal year (FY) 2007, CMS announced in a November 17 press release. The change represents approximately $400 million.
For the first time CMS also reported Medicare Advantage improper payment rates for calendar year 2006 and national composite error rates for Medicaid and for the State Children’s Health Insurance Program (SCHIP) for 2007. CMS made $6.8 billion (or 10.6%) in improper payments for Medicare Advantage during calendar year 2006. The Medicaid composite error rate is 10.5% ($32.7 billion, the federal share being $18.6 billion). The SCHIP composite error rate is 14.7% ($1.2 billion, the federal share being $0.8 billion).
The improper payments do not necessarily reflect fraud, according to the press release. Incorrect coding or medically unnecessary procedures account for many of the improper payments. Inadequate documentation is a common problem leading to Medicaid and SCHIP improper payments.
CMS’ has gone to great efforts to reduce payment errors; the Medicare FFS error rate has declined more than 10% since 1996, according to the press release.
"We are using the most effective information-gathering tools available to help us identify and eliminate improper payments in our efforts to protect the integrity of CMS programs," Kerry Weems, CMS acting administrator said in the press release.
