Medicare Compliance & Reimbursement

Nursing homes and home health agencies, take note: Fiscal intermediaries will no longer be performing tentative settlements on cost reports that have no impact on reimbursement. In a July 25 program memorandum (A-03-061; http://cms.hhs.gov/manuals/pm_trans/A03061.pdf), the Centers for Medicare & Medicaid Services tells FIs not to do tentative settlements on HHA or skilled nursing facility cost reports if the provider didn't receive periodic interim payments or other interim payments, and if the cost report doesn't include claims for reimbursement outside the prospective payments system. In other recent program memoranda, CMS: clarifies - for the third time - policies relating to the ambulance fee schedule (AB-03-106; http://cms.hhs.gov/manuals/pm_trans/AB03106.pdf); amends policies on the coverage of hyperbaric oxygen therapy for treating diabetic wounds of the lower extremities (AB-03-102; http://cms.hhs.gov/manuals/pm_trans/AB03102.pdf); orders FIs and carriers to stop checking provider enrollment data against the Healthcare Integrity and Protection Data Bank (AB-03-109; http://cms.hhs.gov/manuals/pm_trans/AB03109.pdf); establishes a therapy modifier bypass for ambulance claims (B-03-051; http://cms.hhs.gov/manuals/pm_trans/B03051.pdf); directs regional home health intermediaries on implementing the fiscal year 2004 home health prospective payment system update (A-03-060; http://cms.hhs.gov/manuals/pm_trans/A03060.pdf); issues the October quarterly update for the durable medical equipment, prosthetics, orthotics, and supplies fee schedule (AB-03-100; http://cms.hhs.gov/manuals/pm_trans/AB03100.pdf); clarifies policies on the collection of fee-for-service payments made during periods of managed care enrollment (AB-03-101; http://cms.hhs.gov/manuals/pm_trans/AB03101.pdf); and implements a tracking system for Harkin Grantees, a longstanding anti-fraud program (AB-03-105; http://cms.hhs.gov/manuals/pm_trans/AB03105.pdf); and identifies Health Insurance Portability and Accountability Act transactions rule issues connected with the Healthcare Provider Taxonomy Code crosswalk (B-03-053; http://cms.hhs.gov/manuals/pm_trans/B03053.pdf).