More beneficiaries will now qualify for the service and equipment. More patients on anticoagulants will be able to manage at home, thanks to a new National Coverage Decision from Medicare. Patients who are on warfarin and have mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (including deep venous thrombosis and pulmonary embolism) will now qualify for Medicare coverage of Prothrombin time (PT/INR) monitoring for home anticoagulation management, says a new NCD. Currently, Medicare covers home PT/INR monitoring only for patients with heart valves, the Centers for Medicare & Medicaid Services notes in July 25 Transmittal No. 90 (CR 6138). The change will take effect on Aug. 25, but will apply to claims with dates of service of March 19, 2008 and later. The transmittal, which includes specific qualifying criteria, is online at
http://www.cms.hhs.gov/transmittals/downloads/R90NCD.pdf. • One MIPPA billing headache is gone for providers furnishing Part B services and equipment. Durable medical equipment suppliers in the 10 competitive bidding areas won't be subject to OIG sanctions if they fail to charge beneficiaries their 20 percent copay based on the higher Medicare reimbursement rate mandated by the Medicare Improvements for Patients and Providers Act (MIP-PA). MIPPA delayed competitive bidding for 18 months and put in place rates that are lower than pre-bidding rates but higher than bidding rates. Suppliers were worried they would have to go back and recalculate the copays based on the higher rates that went back into effect thanks to MIPPA. "Ordinarily, routine waivers of Medicare cost-sharing amounts potentially implicate the Federal anti-kickback statute, ... laws related to kickbacks , and the civil monetary penalty law prohibiting inducements to beneficiaries," the OIG acknowledges. But in these specific circumstances, "Pro-viders will not be subject to OIG administrative sanctions if they waive Retroactive Beneficiary Liability" based on MIPPA rate changes, the agency says. More details are online at
http://oig.hhs.gov/fraud/docs/alertsandbulletins/2008/MIPPA_Policy_Statement.PDF. • The New York Attorney General continues to crack down on home care insurance fraudsters. AG Andrew Cuomo won a lawsuit against insurance broker Thomas Piccirillo, requiring him to pay $500,000 in restitution to seniors he defrauded, $100,000 in penalties, plus an additional $10,000 penalty to the state for targeting senior citizens. Piccirillo sold duplicative home care insurance policies to senior citizens, according to a release from the AG. In once case, Piccirillo sold overlapping insurance policies from Americare Home Care Services Inc. and Homeward Bound Services of North America Inc. to one elderly New York resident for $40,000 when the person didn't use any home care services. Earlier this year, Cuomo's Office obtained an order requiring Homeward Bound Services and its owners to pay $100,000 in restitution for failing to honor agreements. The owners also were required to pay [...]
