In brief: Provider sues over Medicare audit, Philips taps replacement

Thursday, May 13, 2010

TEXARKANA, Texas - A Texas provider has filed suit over a Medicare audit in which it says the agency didn't review individual claims, but instead extrapolated data from a sampling, according to local news reports. Artex Medical filed suit against Health and Human Services Secretary Kathleen Sebelius in the Eastern District of Texas April 30, alleging violations of the Social Security Act. The provider argues that statistical sampling is barred by federal law. A Medicare auditor reviewed 221 claims filed by Artex's determined the provider received an overpayment of $80,979.09 for the sampled claims but projected the sampling results to 1,191 claims for a total of $426,499.

Philips taps new leader

MURRYSVILLE, Pa. - Brent Shafer has been named CEO of Philips Home Healthcare Solutions, the company announced last week. Shafer replaces Don Spence, who left May 8. Shafer joined Philips in 2005, and has served as head of North America Sales and Service as well as executive vice president and CEO of Philips North America. "With his strong leadership, extensive healthcare background and customer focus, I cannot think of a better person to lead our home healthcare business into the future," stated Steve Rusckowski, CEO, Philips Healthcare, in a press release.

NHIA files complaint against CMS

ALEXANDRIA, Va. - The National Home Infusion Association is pressing CMS to improve its "burdensome" requirements on home infusion providers who bill Medicare Part B. The association has filed a "HIPAA complaint" against CMS for violating the agency's own simplification regulations that require that health plans use standard medical code sets. Medicare's billing codes for home infusion are different from industry standard per diem coding. Medicare does not cover most home infusion services so providers must submit "billings for denial" using the separate codes, before they can bill secondary insurers.

Minority of PSCs have majority of overpayments

BALTIMORE - Program safeguard contractors (PSCs) referred 4,239 overpayments totaling $835 million for collection in 2007, says a new report by the Office of Inspector General (OIG). Two of the 18 PSCs were responsible for 62% of that amount. PSCs differed widely in the dollar amount of overpayments that they referred for collection in 2007: amounts ranged from $3 million to $266 million, with a median of $15 million. The report also found that, while Part B payments represented 29 percent of PSCs'oversight responsibility ($87 billion of $296 billion), Part B overpayments accounted for 89 percent of PSCs' overpayment dollars referred for collection ($747 million of $835 million). To read the entire report:

Can't get no satisfaction? Respond to survey

BALTIMORE - CMS reminds providers that were selected to participate in the 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS) that time is running out. The survey give providers a chance to rate the services they receive from Medicare contractors. To respond to the survey or to designate a proxy respondent to complete it on your behalf, please call the MCPSS Provider Helpline today, at 1-800-835-7012, or send an email to Only providers who were selected can participate.