Medicare Compliance & Reimbursement

What's coming down the pike from CMS and the OIG.

Medicare's regulatory framework is a fast-changing environment, and health care providers can't afford to fall behind. The Department of Health and Human Services' Regulatory Agenda, published in the Dec. 22 Federal Register, makes that point clear. Dozens of new proposals affecting Medicare providers are in the works, ranging from new anti-kickback safe harbors to new policies on self-administered drugs. In addition, the much-anticipated "Phase II" final rule on the Stark physician self-referral law is due any time now. Among the proposals included in the agenda: a safe harbor for arrangements involving federally qualified health centers; criteria for determining whether a drug is considered self-administered; updated conditions of participation for hospitals and hospices; nursing home requirements involving identifying numbers of licensed and unlicensed nurses, and payment updates for inpatient psychiatric facilities, hospitals, inpatient rehabilitation facilities, physicians, home health agencies and other provider types. To see the agenda, go to www.gpoaccess.gov/ua/index.html. Lesson Learned: Health care providers should make sure they keep track of all changes to Medicare regulations that affect the way they do business.