NYUMC Office of Compliance

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NYUHC Regulatory Information Bulletin

Volume 1, Issue 6

Fascinating Additions & Proposals to Federal Law . . .

· The DEA passed a final rule that was effective  October 20, 2006 exempting anabolic steroids Essian™ H.S. and Essian™ from Schedule III.  This exemption status means that the normal handling, recordkeeping, security and other requirements imposed by the Controlled Substances Act are waived.  State law restrictions still apply.  See the text of the original proposed rule for details.

· FDA released the Guidance for Industry: Implementation of Acceptable Full-Length Donor History Questionnaire and Accompanying Materials for Use in Screening Donors of Blood and Blood Components, dated October 2006.  It finalizes the draft guidance originally published in April 2004.

· Corrections for the Hospital Inpatient Prospective Payment System rules were posted in the Federal Register.   Highlights of the corrections include a new DRG for carotid artery stents (577) and corrections to Table 5—- List of DRGs, Relative Weighting Factors & Geometric & Arithmetic Mean Length of Stay.

· In compliance with the Medicare Modernization Act, CMS created a new process for the correction of minor claims errors and omissions without a formal appeals process.  This process is outlined in a new chapter of the Medicare Claims Processing Manual.  CMS will be implement the new process starting November 29th.

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.

► AHRQ released the 2006 Guide to Clinical Preventive Services, a guide containing 53 new or revised evidence-based clinical preventive service recommendations.   These recommendations are considered the gold standard for clinical preventive services.  Get a pocket guide online or call 800-358-9295 to order. ►►  We are getting closer to a final National Coverage Analysis for Clinical Trials; the Medicare Coverage Advisory Committee meets on December 13th to discuss this NCA.

· On October 4th, Attorney General Spitzer’s office adopted as final a rule that applies to charitable organizations that are required to register with and report to the AG’s office.  The rule clarifies the registration and annual filing requirements under Executive Law 7-A and Estates, Powers and Trusts Law Article 8, simplify the procedures for registration, and implements new procedures in anticipation of an automated process.  The rule is effective for the next reporting period.

· Effective October 11th, NYS Department of Health expanded required laboratory test reporting to include viral load and CD4 test results and HIV drug resistance testing.  The rule also revises the consent form to conform to federal privacy regulations making the old form in Section 63.11 (of Title 10 Part 63) obsolete.

· Office of the Medicaid Inspector General has their website up and running.  One thing it includes is a list of banned Medicaid providers.  These are providers who are not authorized to prescribe/order services for any Medicaid recipient.  The list is updated monthly.  Check out the list.

· Governor George E. Pataki announced that the Centers for Medicare and Medicaid Services has approved New York State’s to receive up to $1.5 billion in federal funding to be invested in the State’s health care reform initiatives designed to right-size the acute care delivery system, restructure the delivery of long-term care services and foster the adoption of health information technology.  See the press release.

Notable New York Laws & Regulations . . .

·  MM5039: Line Item Billing Requirement for End-Stage Renal Disease Claims.

·  TM1080:  New SSI Data for IPPPS.

· NCD:  New guidance on the use  of Infrared Therapy Devices.

· L3021:  Abdominal Ultrasound new allowable diagnosis code effective 10/1/2006.

· MM5204:  Billing for Psychological and Neuropsychological Testing

· L3484: Brachytherapy

· L3635: Cardiovascular Nuclear Medicine

· L3506: Additional diagnoses approved for use of ECG or EKGs

October 31, 2006

According to Empire Medicare, CMS has shortened the time (from 90 to 75 days) that providers have to produce medical records in response to Comprehensive Error Rate Testing (CERT) contractors' documentation requests. The new CERT schedule takes effect with initial documentation requests made on 11/1/06. On the 76th day, if the provider has not responded, CMS automatically deems the claim at issue an erroneous claim, and recoups the Medicare reimbursement. CMS takes the deadline very seriously because the Medicare fee-for-service error rate has historically been attributable partly to providers' failure to comply with contractor documentation requests. That means a claim is deemed erroneous by virtue of absent documentation regardless of whether the documentation would support the claim. Click here for more details.