NYUMC Office of Compliance

If it concerns you, it concerns us.

NYUHC Regulatory Information Bulletin

One can almost predict what legislatures will do next if you pay attention to the trends in the industry.  That is why we decided to add an occassional column called “Hot Topics in Healthcare.”   In this column we will explore items that are on the precipice of becoming rules or laws— things that are hotly debated.  See this month’s column about over-crowding in emergency rooms.  And remember you can find previous issues of RIB on the Compliance Website.  Happy reading!

Editor’s Corner!

Volume 1, Issue 5

Fascinating Additions & Proposals to Federal Law . . .

· CMS’ FAQs are questions submitted by providers in answer to regulatory questions.  They are updated regularly.  Here’s a sample question:  Which Healthcare Provider Taxonomy Code(s) should be selected by medical students, interns, residents and fellows when applying for National Provider Identifiers (NPIs)?  Find the answer (and many more answers) at CMS’ FAQs.

· Medicare’s CERT Program has recently identified an error trend in Medicare payments for ambulance services used for inter-hospital transport and associated mileage.  Inter-hospital transport  to the nearest facility is payable when the beneficiary is in need of a clinical service that is not available at the hospital of origin.  Empire Medicare Services has posted some materials to help explain this coverage rule to patients and their families.

·  CMS released the Final Rule, effective October 23, 2006, on Fire Safety and the use of Alcohol Based Hand Rub Solutions.  This rule modifies the Hospital Conditions of Participation and its implementation is mandatory.

· DHHS Office of Inspector General releases its Work Plan for FY2007.  The work plan represents the OIG’s focus areas for compliance reviews.  The plan includes focus areas for Medicare Hospitals, Medicaid Hospitals, and Physicians.  Moreover the work plan touches all aspects of business related to these provider-types.  We encourage you to review the work plan and to open a dialogue with a member of Compliance to answer any questions you may have.

The RIB is e-mailed monthly to managers and above.  To remove your name from our mailing list, or for questions or comments, please e-mail the Office of Compliance’s Regulatory Information & Education area or call (212) 404-4070.

► The U.S. healthcare system, on average, failed to achieve any of 37 U.S. or international top-performance benchmarks for outcomes, quality, access, efficiency or equitable care, according to a scorecard of "achievable" performance developed by the Commonwealth Fund.

►►Preventing Gattaca?  Representative Paul (R-TX) has introduced a bill prohibiting healthcare plans and employers from discriminating based on genetic information. A comparable bill was introduced earlier this year by Senator Obama.

· A DOH Emergency Rule effective August 28, 2006 making Neonatal Herpes a reportable, communicable disease.  This rule makes it a requirement to report cases, suspected cases, and certain carriers of the disease.  It also requires the submission of lab specimens in such cases.

· DOH has promulgated an Emergency Rule making additional changes to the NYS-AP-DRG classification system to ensure that it is consistent with the one used by the Medicare Prospective Payment System.  This rule was effective August 14, 2006. (Go to the middle of page 23.)

· The Department of Insurance has published a proposed rule requiring insurers to report health providers who have exhibited patterns of overcharging, excessive treatment, or other improper actions.  Such reports are required within 30 days of discovery and insurers are to report them to different agencies depending on the type of health provider in question.

· Medicaid Inspector General explains her new, expanded role in October’s Medicaid Update.

Notable New York Laws & Regulations . . .

· MM5292:  Termination of HCPCS Code G0107

· MM5270:  Quarterly ASP Drug Pricing File (Oct 2006)

· DEA Policy Statement on Scope of authority in regulating prescribers under the Controlled Substances Act

· LCD-L3032:  Anesthesia Services Prior to Postponement of Surgery (Rev. Eff. 9/8/06)

· LCD-L3500:  Breast Imaging: Mammography/Breast MRI/Ductography (Rev. Eff. 7/1/06)

· Corrections to the Inpatient Rehab Facility PPS FY2007 Final Rule

September 29, 2006

The problem of overcrowding in emergency departments is the result of a number of factors: high premiums mean fewer people with insurance, greater number of immigrants and indigent patients are using the ER as primary healthcare, and the aging baby boomer population requires more care. Here’s what some hospitals are doing in response:

· Duke Clinical Research Institute aims to coordinate emergency care to better manage heart attack patients. Getting patients to angioplasty in just 90 minutes.

· 15 Florida-based HCA hospitals instituted a program to re-direct non-emergency patients to nearby clinics.

· A University of Chicago Hospitals’ program educates patients about their options for follow-up treatment after receiving care in the ER. This helps patients find a "medical home."

 

Recent publicity about overcrowding has prompted the Senate to hear testimony on the problem as well as possible solutions.  It is likely that a bill is forthcoming.