Medicare Compliance & Reimbursement

Plus: Only 10 percent of ALJ hearings take place in person -- and medical practices seem to like it that way, OIG says. If you're slacking off on your cost report duties because no reimbursement is directly tied to the document, CMS is not happy with you. "In reviewing the [Medicare Cost Report] data submitted by providers, it appears that many are failing to completely fill out their MCR with valid data likely due to the misconception that the data submitted on the MCR do not impact their payments," CMS says in Aug. 1 Transmittal No. 362 (CR 6132). "MCR data play a central role in the development of the input price indexes (market baskets) used to update PPS payments," CMS says in the transmittal. "Similarly, they are essential in evaluating Medicare payment adequacy." CMS instructs its contractors to tell providers why their cost report data is important. "It is crucial that Medicare providers fill out these reports with complete and valid data," the transmittal says. It's not just CMS who cares about the data. The Medicare Payment Advisory Commission also relies on it to make its influential policy recommendations, CMS notes. The transmittal is online at http://www.cms.hhs.gov/transmittals/downloads/R362OTN.pdf. In Other News ... • The next time you have a hearing before an administrative law judge, you might be dealing with Ma Bell. A July 29 OIG report indicates that 78 percent of ALJ hearings during the 2005 to 2006 period took place over the phone, 12 percent by video teleconference and just 10 percent in person. Most of the medical professionals who appealed to ALJs were satisfied with the telephone appeals process, so there's a good chance that the government will continue this method for future appeals. To read the OIG report, visit www.oig.hhs.gov/oei/reports/oei-02-06-00110.pdf. • A Miami durable medical equipment supplier has been taken into custody on charges that she defrauded the Florida Medicaid program of $447,000, says Florida's Attorney General. The Medicaid Fraud Control Unit began investigating Maria Escarpio, owner of Yema Home Health Care, after receiving information about suspicious billings, AG Bill McCollum says in a press release. In 2003 and 2004, Escarpio billed Medicaid for more than $440,000 for wound care supplies and more than $6,800 for oxygen equipment that were never furnished, investigators charge. Escarpio faces criminal charges and a civil lawsuit, the AG notes.