From the Report Introduction: Medicare Payment Advisory Commission’s March 2011 Report to the Congress fulfills the MEDPAC Commission’s legislative mandate to evaluate Medicare payment issues and to make recommendations to the Congress. The report contains 13 chapters: • context for those that follow by documenting the rise in Medicare and total health care spending. • […]

Medicare OPPS Final Rule for FY2011 Published The final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health […]

Procedures That Will be Paid Only as Inpatient for CY2011 This is a zip file for download.  CPT® license agreement required. 2011 OPPS Final Addenda [ZIP, 1.54MB](The 2011 Inpatient Only List is here as Addendum E.) Additional information is found in Part 4 of the Medicare Claims Processing Manual beginning on page 126.

Below are direct links to the OIG site. Click on the links to see an Executive Summary of each report, with a download link below the summary text. FY2011 09-29-2011 Verification of Saint Francis Medical Center’s Refund of Place-of-Service Overpayments for Calendar Years 2009 Through 2010 (A-01-11-00512) 09-26-2011 Medicare Compliance Review of Baystate Medical Center […]

The Centers for Medicare & Medicaid Services (CMS) today issued a final rule to update the Home Health Prospective Payment System (HH PPS) rates for Calendar Year (CY) 2011.  This final rule reflects CMS’ ongoing efforts to improve quality of care provided by home health agencies to Medicare beneficiaries. The rule promotes efficiency in payments, […]

FY 2011 Update from the CMS Annual Update: CMS is adding 4 new measures for the FY 2011 program, and retiring one existing measure. For some of these new measures, the hospitals will not have to affirmatively report data to CMS. Instead, CMS will calculate the measures using Medicare claims data. The total number of […]

  Corporate Integrity Agreement between OIG and The Christ Hospital in Cinncinnati, Ohio From the OIG Press Release: On May 24, 2010, OIG notified TCH that OIG was considering excluding TCH based on evidence that TCH improperly rewarded cardiologists for referring patients to TCH in violation of the anti-kickback statute. The facts underlying the potential exclusion […]

Workshop Regarding Accountable Care Organizations and Implications Regarding Antitrust, Physican Self-Referral, Anti-Kickback and Civil Monetary Penalty Laws The Federal Trade Commission, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General presented a workshop on several issues associated with Accountable Care Organizations (ACOs).  These organizations […]