Medicare Compliance & Reimbursement

There's a new way to find out.

Compliance officers have long struggled over how to demonstrate that their compliance programs are effective. If you work in a hospitals, however, you may be able to strut your stuff to the Centers for Medicare & Medicaid Services itself.
 
The program: CMS chief Mark McClellan May 18 unveiled a pilot project under which hospitals in 13 states and Washington, DC will work together to assess compliance program effectiveness. The goal of the project is to establish best practices -- which hopefully will be applicable to providers besides hospitals as well -- and how to implement such practices effectively.

The project will last 18 months and include two site visits from CMS staffers.

The goodies: CMS is looking into developing incentives -- such as expedited appeals or enhanced claims data -- for facilities that participate in the project.

The backers: A quartet of health care associations are participating in the project with CMS: the American Hospital Association, the American Association of Medical Colleges, the Medical Group Management Association and the Health Care Compliance Association.

Who can participate: The project will focus on acute care hospitals and academic medical centers with at least 100 beds in the New England states, Delaware, Maryland, New Jersey, New York, Pennsylvania, Virginia, West Virginia and Washington, DC. Inpatient revenue should account for at least 30 percent, and Medicare billings 25 percent, of participating hospitals total revenue. Hospitals interested in applying should contact CMS at compliance@cms.gov by June 25.

A heads up: Meanwhile, hospitals across the country should watch closely for the HHS Office of Inspector General's update to its 1998 compliance program guidance, which CMS says should hit the streets in the next several weeks.

Lesson Learned: Given the feds' stepped up activities on the compliance front, hospitals should make sure their compliance programs are up to snuff.