NYUMC Office of Compliance

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NYUHC Regulatory Information Bulletin

We are excited to present our second issue of the RIB.  Hopefully you are finding them useful and informative.  So far, we have received some very positive feedback.  One subscriber said it was “like a good box of chocolates—something for everyone.”  Special thanks to Rebecca Fishman who noticed that RIB was not forwarding (via e-mail) correctly.  As a result, we have changed the format to make forwarding to staff easier.  Please note, however, this adjustment makes the file size considerably larger.

As always there are live links throughout this newsletter.  Please use them to see the source documents or to obtain additional information.  Happy reading!

Editor’s Corner!

Volume 1, Issue 2

Fascinating Additions to Federal Law . . .

· CMS Proposed Changes to the Medicare Physician Fee Schedule in the Federal Register today.  These changes reflect a substantial increase for  E/M Codes.  Two components of physician payments addressed: a review of the Physician RVU and changed methodology for calculating practice expenses.  Click here to read the CMS press release. 

· CMS Updates Inpatient Psychiatric Facilities Prospective Payment System for Rate Year 2007.  It includes changes in the per diem rate, comorbidity adjustments, update to the ECT rate methodology, and more!

· CMS Clarifies Physician Supervision Requirement for Psych Testing.  The rule allows for reimbursement of diagnostic psychological testing services furnished under the general supervision of a clinical psychologist effective 9/21/06.

· CMS will pay for remote electronic analysis of an implanted cardiac device.  Transmittal #979 instructs fiscal intermediaries to pay for remotely obtained data on implanted cardiac devices via CPT® codes 93731, 93734, 93741, or 93743.

· Final Rule for Quality Measures for Organ Procurement Organizations (OPOs).  To receive CMS reimbursement OPOs must comply by 7/31/2006.

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.

· That CMS begins the first phase-in of MUE (Medically Unbelievable Event) edits for claims on January 1, 2007.  MUEs would limit the units of service for a particular CPT/HCPCS code that can be billed per Medicare beneficiary per day.  Claims exceeding the limits will be denied.  CMS plans more modification prior to MUE implementation.

· Two recent reports from GAO indicate that CMS will likely increase scrutiny of CLIA organizations.  Report GAO-06-416 reviewed the adequacy of CMS’ oversight of CLIA regulations.  Report GAO-06-879T includes 13 recommendations to CMS.

· Preferred Drug Program (PDP) Implementation Begins. DOH and First Health began implementing the PDP on June 28th.  The PDP requires the prescriber or dispenser to obtain prior authorization before dispensing to Medicaid patients any non-preferred drugs.  Non-preferred drugs are those that have not been authorized by the Commissioner of Health, as recommended by the NYS Medicaid Pharmacy and Therapeutics Committee. The NYSMP&T Committee consists of practicing medical professionals and consumer advocates.  Those classes of drugs not chosen for inclusion in the PDP will be handled the same way they are currently handled by the New York State Medicaid program. 

· DOH has made several Medicaid Program changes.  See them all in the June edition of Medicaid Update.

· The NYS Senate busy during its final days.  The Senate took action on several healthcare related laws that, if passed by the assembly unchanged will go to the Governor for signature.  RIB will keep a close watch on these as the session resumes. Need a quick reminder on how a NYS bill becomes a law?  Click here.

Notable New York Laws & Regulations . . .

· JCAHO issued the 2007 Patient Safety Goals.  They include a reporting mechanism for patients/families and a requirement that a complete list of medications for each patient is provided at discharge.

· DHHS’ OIG reports having recovered more than $1B from fighting fraud, waste & abuse.

Items To Check Out

June  29, 2006

NYS Proposed Items

· Revises Part 64 to strengthen the requirements for Nurse Practitioners to be certified in an additional specialty area of practice.  Comment through 6/30/06.

· Establishes requirements for licensure as a clinical laboratory technologist.  Comment through 7/8/06.

Did You Know?

Did You Know?