Tag: OIG report

WASHINGTON – CMS has an opportunity to strengthen state oversight of reporting by Medicaid managed care plans on medical loss ratios (MLRs), according to a new report from the Office of Inspector General. States reported that most Medicaid managed care plans submitted MLR reports; however, the OIG found that 49% of the 495 MLR reports reviewed were incomplete. These incomplete MLR reports were missing at least one of seven numeric data elements that are essential to the MLR calculation....

LAFAYETTE, La. – Viemed Healthcare says a recent report from the Office of Inspector General shows how disconnected investigators are from CMS’s clinical protocols for non-invasive ventilators and shines a light on the lack of understanding of the critical role HME providers play in providing this life-saving care to patients.  The OIG in May published a report saying most of the Medicare claims submitted for the monthly rental of NIV by Viemed, under its original name Sleep...

WASHINGTON - Medicare contractors were inconsistent in how they reviewed overpayments during the appeals process, says the Office of Inspector General in a new report. Although MACs and QICs generally reviewed appealed extrapolated overpayments in a manner that conforms with existing requirements, CMS did not always provide sufficient guidance and oversight to ensure that these reviews were performed in a consistent manner, the report states. The most significant inconsistency involved a type of...

WASHINGTON - Temporary transitional payments for home infusion therapy are moving forward, according to an upcoming proposed rule.The rule, which will be published in the July 12 Federal Register, contains information on the implementation of the payments, which will fix a payment gap created by the 21st Century Cures Act. The Cures Act requires Medicare to pay for services associated with providing Part B home infusion drugs, but not until 2021.The temporary payment, which was passed as part of...

WASHINGTON - The MACs collected only 20% of Medicare overpayments referred by ZPICs and PSCs in 2014, says a new report from the Office of Inspector General.The ZPICs and PSCs referred $559 million in overpayments in 2014, but the MACs sought $482 million and collected only $96 million, according to the OIG.The ZPICs and PSCs send the highest number of referrals for Part B (60%) and DME (26%). They sent the highest dollar amount of referrals, however, for home health and hospice (43%), the OIG found.In...

WASHINGTON - Suppliers in Medicare's national mail-order program provided 18 types of diabetes test strips to beneficiaries from July through September 2016, according to a new report from the Office of Inspector General.The top strip type accounted for 43% of the mail-order market, and the top 10 strip types accounted for 98% of the market, the OIG found.The OIG conducted its report by sampling 1,210 claims from a population of 456,784 claims for mail-order test strips.Suppliers must comply...

On Saturday, I cracked open a window, cleaned out my car and stowed my winter boots in the closet. This morning, I donned mittens while I chipped snow and ice off of my car (in Maine, we keep the ice scrapers at hand year round). Ahh … spring. Last week, the industry got whacked with its own wet blanket: Two reports issued by the OIG and the GAO on the competitive bidding program. The first found that CMS generally complied with its own bidding rules and said that CMS should continue to follow its...

WASHINGTON - As part of the Round 1 of competitive bidding, CMS generally selected DMEPOS suppliers and correctly computed the sampled single payment amounts in accordance with its established procedures and applicable federal requirements, according to a report published today by the Office of Inspector General (OIG).Specifically, the OIG determined that for 255 of the 266 contract suppliers associated with the sampled single payment amounts reviewed, CMS consistently followed its procedures and...

I read the article titled “New OIG report: Is it good or bad?” (January 2013). While I would agree that current CMS policy is too ambiguous to allow for consistent determination of claim reimbursement, I do not agree that CMS's proposal of requiring providers to pay for appeals is appropriate unless the following is allowed: If CMS requires providers to pay a fee to appeal a denied or recouped claim, we can accept that only if, when the provider wins the appeal at any level, the fee is...