Medicare Compliance & Reimbursement

Home health agencies in Connecticut and Massachusetts may be in line for a paperwork break when it comes to dual eligible beneficiaries. In a May 30 program memorandum (A-03-046; http://cms.hhs.gov/manuals/pm_trans/A03046.pdf), the Centers for Medicare & Medicaid Services outlines a new demonstration project that uses sampling to determine the Medicare share of home health claims for services provided to dual eligibles and paid for by Medicaid. The process will replace the cumbersome assembly of Medicare documentation from HHAs for all dual-eligible claims the state may have paid erroneously. "This process will eliminate the need for the HHAs to assemble, copy, and submit large numbers of medical records," the memo says. In other recent program memoranda CMS: sets the single drug pricer allowance for SDP code J7342 at $15.40 (AB-03-080; http://cms.hhs.gov/manuals/pm_trans/AB03080.pdf); outlines payment policies for direct graduate medical education and nursing and allied health education for Medicare+Choice enrollees for non-prospective payment system hospitals (A-03-045; http://cms.hhs.gov/manuals/pm_trans/A03045.pdf); and updates the Electronic Correspondence Referral System User Manual (AB-03-081; http://cms.hhs.gov/manuals/pm_trans/AB03081.pdf).