The shared mission of California’s hospitals is to be on the front-lines of serving the health care needs of their local communities – 24 hours a day, seven days a week. Hospitals and their medical staff are relied upon to care and cure patients; this task requires a relationship with their communities built on trust, reliability, and compassion. CHA works with hospitals and payers to strengthen these relationships, and reassure patients, regardless of their ability to pay, of hospitals' commitment to caring.
The shared mission of California’s hospitals is to be on the front-lines of serving the health care needs of their local communities – 24 hours a day, seven days a week. Hospitals and their medical staff are relied upon to care and cure patients; this task requires a relationship with their communities built on trust, reliability, and compassion. CHA works with hospitals and payers to strengthen these relationships, and reassure patients, regardless of their ability to pay, of hospitals’ commitment to caring.
Effective last week, all hospitals billing sleep studies under jurisdiction of Noridian — the Medicare Local Coverage Determination for California — must maintain proper certification documentation by acquiring credentials from the American Academy of Sleep Medicine (inpatient or outpatient), The Joint Commission sleep-specific credentials for ambulatory care sleep centers or the Accreditation Commission for Health Care. Labs that do not yet have the required credentials must apply for credentialing by one of these organizations within the next 90 days and must make available, upon Noridian’s request, both the application and a letter from the credentialing organization verifying that an application is in process.
All sleep labs must have final credentialing by one of the organizations listed above within the next 12 months. CHA is seeking clarification on the deadlines and will publish those dates, when available, in CHA News. More information is available on the Centers for Medicare & Medicaid Services website.
Earlier this week, the U.S. Government Accountability Office (GAO) released a report examining Medicare administrative contractor (MAC) provider education departments’ efforts to reduce improper payments in the Medicare fee-for-service program. To help ensure payments are made properly, the Centers for Medicare & Medicaid Services (CMS) contracts with MACs to conduct provider education efforts. However, for fiscal year 2016, the Department of Health and Human Services reported an estimated 11 percent improper payment rate and $41.1 billion in improper payments. The GAO’s report examines the efforts made to reduce improper payments, CMS’ oversight of these efforts and the extent to which the efforts were effective.
According to the GAO, CMS collects limited information about areas particularly vulnerable to improper billing and has not required MACs to provide specifics on the areas addressed by their provider education departments. In addition, CMS does not require MACs to educate providers who refer patients for durable medical equipment or home health services on proper billing documentation — but this area comprises a large portion of improper payment rates due to insufficient documentation.
The Centers for Medicare & Medicaid Services (CMS) has released a frequently asked questions document addressing recent changes to billing for rural health clinics. As previously reported in CHA News, effective April 1, rural health clinics were required to report the appropriate HCPCS code for each service line, along with the revenue code and other required billing codes. This change was mandated by the calendar year 2016 physician fee schedule final rule. The attached FAQ addresses questions related to modifier CG, as well as modifiers 25 and 59. Facilities are reminded that charges greater than or equal to $0.01 should be reported with the appropriate HCPCS code. More information about rural health clinic payment and policies is available on the CMS website.
The Hospital Financial Assistance Policies and Community Benefit Laws explains the requirements of the Hospital Fair Pricing Policies law, the Emergency Physician Fair Pricing Policies law, the financial assistance requirements for tax-exempt hospitals of Internal Revenue Code Section 501(r), and other related laws.