A Few More Details Following Round One Delay

WASHINGTON–Last week the HHS Office of Inspector General
assured Medicare providers they will not risk sanctions if they do
not collect retroactive fee increases from beneficiaries because of
payment changes under the Medicare Improvements for Patients and
Providers Act of 2008, or MIPPA.

In a policy statement issued Thursday, the OIG said Medicare
providers, practitioners and suppliers affected by retroactive
increases in payment rates mandated by the new law “will not
be subject to OIG administrative sanctions if they waive
retroactive beneficiary cost-sharing amounts attributable to those
increased payment rates, subject to the conditions noted in the
policy statement.”

Under MIPPA–which halted DMEPOS competitive bidding July 15 and
reinstated the higher reimbursement rates that had been in effect
before the bid program started July 1–CMS had said that
beneficiary liability for cost-sharing also could increase
retroactively.

The federal anti-kickback statute normally prohibits Medicare
suppliers from waiving beneficiary cost-sharing amounts, and the
OIG can levy civil monetary penalties and exclude providers from
Medicare for violating the law. But according to the OIG statement,
providers who waive beneficiaries’ retroactive liability due
to payment increases resulting from MIPPA won’t be subject to
administrative sanctions.

In a footnote, the policy noted that although MIPPA was enacted
on July 15, “as a practical matter, the revised payment rates will
take time to be implemented by CMS (or the relevant contractors and
intermediaries). We are informed by CMS that the exact
implementation dates may vary by benefit, contractor and
intermediary. Until such time as the new payment rates are
implemented, some providers may continue to calculate beneficiary
cost-sharing obligations based on the prior, temporary payment
rates, and the beneficiaries may pay, or be billed for, a lower
amount than they actually owe under MIPPA.”

The statement also noted that it applies only to providers in
the 10 competitive bidding areas, “and then only to beneficiary
liability related to the specific items to which competitive
bidding would have applied.”

The OIG also cautioned that “this policy statement applies
only to retroactive beneficiary liability, which is the increase in
the beneficiaries’ cost-sharing obligation attributable to
the increase in payment rates under MIPPA. This policy does not
apply to waivers of beneficiary cost-sharing amounts that were
calculated using the lower payment rates temporarily in effect
since July 1, 2008.”

The OIG advised that waiving retroactive beneficiary liability
could not be “conditional in any manner of the provision of
future items, supplies or services.”

In addition, the OIG said, “nothing in this policy statement
requires providers to waive retroactive beneficiary liability.”

To view the policy statement, click here for a PDF.

In other information related to MIPPA and the delay of
competitive bidding: –For the 10 areas where competitive bidding
was initiated, CMS said it will begin processing all incoming
claims under standard fee-for-service rules no later than today
(July 28). Any claims that were held will be processed no later
than Aug. 4. “To the extent possible,” an agency notice
said, “CMS will also automatically reprocess claims that were
paid under the competitive bidding program and those claims denied
based solely due to DMEPOS competitive bidding rules.

“Note that in some instances suppliers will need to alert
the contractor to claims that should be adjusted,” CMS
said.

–CMS has also issued an MLN Matters article (SE0826) containing a
compilation of messages that were issued on July 16 regarding
MIPPA. Titled “Important Information on the New Medicare Law
– The Medicare Improvements for Patients and Providers Act of
2008,” you can download a PDF of the article by clicking here.