Report on Medicare Compliance 30, no. 15 (April 19, 2021)

◆ CMS’s supplemental medical review contractor (SMRC) has added outpatient therapy claims to its list of postpayment reviews, according to its website.^[1] The SMRC, Noridian Healthcare Solutions LLC, will audit claims with dates of service from Jan. 1, 2018, through Dec. 31, 2018.

◆ In a message posted April 15, HHS Principal Deputy Inspector General Christi Grimm reminded providers that vaccines should be administered free to patients.^[2] “OIG is aware of complaints by patients about charges by providers when getting their COVID-19 vaccines. Providers that charge impermissible fees must refund them and ensure that individuals are not charged fees for the COVID-19 vaccine or vaccine administration in the future,” she said. “Consistent with the CDC Vaccination Program, providers are permitted to bill third-party payers (such as Medicare, Medicaid, the HRSA [Health Resources and Services Administration] COVID-19 Uninsured Program, or a private insurer) for an administration fee, in accordance with the payer's applicable billing rules.”

◆ CMS’s reviews of short hospital stays are resuming soon nationally. Livanta LLC on April 12 announced its national claim review task order under the CMS Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO) program.^[3] A spokeswoman told RMC that Livanta is now working with CMS to transition into the short stay reviews. “Claim reviews will begin according to the finalized sampling plans and timelines. We will be sharing additional details with the hospital community via our website, provider bulletins, and other communications,” she said. Ronald Hirsch, M.D., vice president of R1 RCM, said it’s unfortunate that a contract dispute has delayed auditing of compliance with the two-midnight rule for so long. “This is more important now that so many more surgeries are no longer on the inpatient only list,” he noted. “Livanta did a very good job interpreting the regulations when they were auditing these stays in the past, especially in regard to the case-by-case exception that CMS added in 2016. As a reminder, this allows a physician to admit as inpatient a patient who does not have a two-midnight expectation if the medical record supports the physician’s determination that inpatient admission is warranted based on factors such as the patient’s history and comorbidities and current medical needs, the severity of signs and symptoms, or the risks of an adverse event.”

◆ The HHS Office of Inspector General has updated its Work Plan.^[4] There are nine new items, and they’re all over the map. They include items on vaccinations, skilled nursing facility reimbursement and duplicate medical professional billing to Part B by critical access hospitals and the health care practitioner.

1 “01-044 Therapy Reviews Notification of Medical Review,” Noridian Healthcare Solutions, last updated April 8, 2021, https://bit.ly/3deg6Tn.
2 Christi A. Grimm, “Message from HHS-OIG Leadership on the COVID-19 Vaccination Program and Provider Compliance,” HHS, April 15, 2021, https://bit.ly/2OSnkmV.
3 Livanta, “Livanta Awarded CMS Claim Review Services Contract,” news release, Intrado, April 12, 2021, https://bit.ly/3ggB4Dm.
4 “Recently Added” Work Plan, HHS, accessed April 16, 2021, https://bit.ly/2AxFtyP.

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