Quality Improvement Organization Releases Guidance on Short-Stay Reviews – As previously reported, in July 2015, CMS announced that Quality Improvement Organizations (QIOs) would begin conducting reviews of certain inpatient stays effective October 1, 2015, thus transitioning these reviews away from the Medicare Administrative Contractors (MACs). To prepare for the initiation of these reviews, KEPRO, a QIO, conducted a webinar on September 30, 2015 and released related guidance. Of note, KEPRO indicated that it plans to review 10 claims biannually for small hospitals and 25 claims biannually for large hospitals. KEPRO stated that they may refer hospitals with denial rates greater than 20 percent to Recovery Auditors (RACs) for provider-specific audits, but did not provide additional detail regarding the parameters of such RAC referrals. To view the KEPRO webinar transcript and presentation materials, click here and here.
Comment Period on Alternative Payment Models Extended – CMS announced a fifteen-day extension for the deadline to submit comments in response to CMS’s October 1, 2015 Request for Information (RFI) on merit-based incentive payments and alternative payment models. Accordingly, comments are now due by November 17, 2015, rather than the original deadline of November 2, 2015. In its announcement, CMS also identifies certain priority issues on which CMS suggests comments focus.
OIG Releases Report on Medicaid Durable Medical Equipment Expenditures – In a recently-released report, the OIG found that four State Medicaid programs could have saved approximately $18.1 million had they based Durable Medical Equipment (DME) reimbursement on the prices obtained through the Medicare competitive bidding program. As a result, the OIG recommends that CMS seek legislative authority to limit Medicaid DME reimbursement rates to Medicare program rates. To view the OIG report, click here.
King & Spalding to Host Roundtable on Options for Dealing with Competitors Illegally Gaining Business Advantages – On Tuesday, October 20, 2015, King & Spalding will host a roundtable event analyzing strategic options that healthcare and life sciences companies may consider when faced with credible evidence that a competitor is breaking the law to gain an unfair business advantage. The event will be in-person in the Atlanta office and will also be offered via webinar. For additional information and to register for the event, please click here.
King & Spalding Named Top Government Influencer by The National Law Journal – The National Law Journal has named King & Spalding as the top government influencer in its annual rankings of the Influence 50. These rankings include all forms of government advocacy, including lobbying and representation in executive and legislative branch investigations, life sciences and healthcare, trade, antitrust, and political law. The full ranking is available here (subscription required).