In brief: Berwick steps down, OIG releases semiannual report

Tuesday, November 22, 2011

WASHINGTON – CMS Administrator Don Berwick will step down from his post Dec. 2, according to news reports last week. He will be replaced by Marilyn Tavenner, principal deputy administrator and COO. Berwick, a pediatrician before becoming a Harvard professor, stepped down after Republicans succeeded in blocking his confirmation by the Senate. His temporary appointment was scheduled to run out at the end of the year. Tavenner was formerly Virginia’s top healthcare official.

OIG releases semiannual report

WASHINGTON – The Office of Inspector General’s Fall 2011 Semiannual Report to Congress, released last week, details a 61% error rate for power wheelchair claims. The report describes reviews, investigative outcomes, outreach and other activities from April 1, 2011, through Sept. 30, 2011. Other items included in the report: Medicare has not received any DME overpayments through surety bonds; and Medicare has made inappropriate payments for lower limb prostheses, including $43 million for certain prostheses that do not meet Medicare requirements and another $61 million for beneficiaries for whom no claims were filed by physicians. Read the report at

CMS: Where are your physician orders?

BALTIMORE – Missing physician orders have led to an increase in comprehensive error rate testing (CERT), CMS stated in a message last week. The physician order is required for diagnostic tests to be performed. Written orders can be hand-delivered, mailed, emailed or faxed to the testing facility or phoned in, and documented by both physician and testing facility in the patient's medical record. Physician orders must have legible signatures, either electronic or handwritten. CERT testing randomly samples claims to determine if claims submission and payment is correct.

Senior Patrol program gets grant

WASHINGTON – The Department of Health and Human Services (HHS) on Nov. 22 announced a $9 million grant from CMS to Senior Medicare Patrol (SMP) programs across the country. SMPs are run by the Administration on Aging in partnership with the HHS Office of Inspector General and CMS. More than 5,000 SMP volunteers work to educate beneficiaries, family members and caregivers about the importance of reviewing Medicare notices for errors or potential fraud.

Support surfaces fail test

WASHINGTON – Add Group 2 support surfaces to the list of DME that has a high error rate. National Government Services, the Jurisdiction B DME MAC, stated in a message last week that the product category has a 93% error rate. Of 285 claims reviewed, 108 were denied because no additional documentation was received in response to a request letter. Other reasons for denial: Invalid physician orders; invalid proof of delivery; lack of documentation for a comprehensive treatment program; and the beneficiary's medical condition did not meet coverage criteria.

HIPAA compliance pushed back

BALTIMORE – CMS's Office of E-Health Standards and Services will not take action against any HIPAA covered entities that are not in compliance with Version 5010 until March 31, 2012. The original date: Jan. 1, 2012. Industry feedback showed that a majority of covered entities and their trading partners would not be able to meet that date. Many covered entities are also still awaiting software upgrades. For more information: