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.