Medicare Compliance & Reimbursement

The OIG may be checking the record to make sure.

Did your payment rates increase under the Benefits Improvement Plan Act of 2000?  If so, you may be called on to account for how any extra federal dollars were spent.
 
That was the objective of an audit of Missouri-based Mercy Health Plans. The HHS Office of Inspector General wanted assurance that changes to the plan's 2001 adjusted community proposal rate were in fact legit -- and that extra funding benefited beneficiaries, not the MCO's bottom line.

To find out, auditors inspected cover letters submitted by Mercy in 2001 which outlined the organization's plans for extra BIPA money, examined support for changes from its original rate proposal to the BIPA rate proposal, as well as the mathematic accuracy for each plan's direct medical cost projections.

Mercy sailed through the audit -- all proposal modifications were properly supported, and increased BIPA funding was channeled appropriately. Need a reminder on what qualifies as "appropriate"? According to sections 601 and 602 of BIPA, here are the only right ways to spend additional money: reduce beneficiary premiums and/or cost sharing,
enhance benefits, 
contribute to a benefit stabilization fund, or
enhance the network of health care providers available to beneficiaries To see the audit report, titled, "Review of the Benefits Improvement Protection Act (BIPA) Modifications to Mercy Health Plans' St. Louis, Missouri Calendar Year 2001 Adjusted Community Rate Proposal Under Contract Number H-2667, Plan Numbers 001, 003, 004, 005 and 006" (A-07-04-01001), go to: http://oig.hhs.gov/oas/reports/region7/70401001.pdf. 

Lesson Learned: MCOs need to ensure that they are in compliance with BIPA regulations regarding additional funding.