Senate Finance Committee Seeks Feedback on Fighting Fraud & Abuse as They Look at ZPICs


Reposted from email blast received May 2, 2012.
FOR IMMEDIATE RELEASE
May 2, 2012
CONTACT:  Julia Lawless/Antonia Ferrier (Hatch)              (202) 224-4515
                            Communications Office (Baucus)                          (202) 224-4515 

HATCH, BAUCUS LEAD FINANCE COMMITTEE MEMBERS IN BIPARTISAN EFFORT TO COMBAT WASTE, FRAUD, & ABUSE IN
MEDICARE & MEDICAID PROGRAMS
In an open letter to members of the health care community Senators write, “Drawing on the collective wisdom and accumulated insights of thousands of professionals and individual experiences could offer a fresh perspective and potentially identify solutions that may have been overlooked or underutilized.”


WASHINGTON – Today, six members of the Senate Finance Committee, led by Ranking Member Orrin Hatch (R-Utah) and Chairman Max Baucus (D-Mont.), announced a bipartisan effort to begin soliciting ideas from interested stakeholders in the health care community regarding effective solutions to improve federal efforts to combat waste, fraud, and abuse in the Medicare and Medicaid programs. Joining Hatch and Baucus in the effort are:  Senators Tom Coburn (R-Okla.), Ron Wyden (D-Ore.), Chuck Grassley (R-Iowa), and Tom Carper (D-Del.).

In an open letter to members of the health care community, the Senators wrote, “We believe federal efforts would be strengthened by input from members across the health care community – providers, payers, health plans, contractors, non-profit entities, consumers, data analytics entities, governmental partners, and patients. Drawing on the collective wisdom and accumulated insights of thousands of professionals and individual experiences could offer a fresh perspective and potentially identify solutions that may have been overlooked or underutilized.”

This week, the lawmakers invited interested stakeholders to submit white papers offering recommendations and innovative solutions to improve program integrity efforts, strengthen payment reforms, and enhance fraud and abuse enforcement efforts. Submissions are due by June 29, 2012. A summary document highlighting key proposals will be compiled and released later this year.

The Senate Finance Committee has jurisdiction over the Medicare and Medicaid programs.

To view a signed copy of the letter click HERE.

Below is the full text of the letter:

May 2, 2012

To Members of the Health Care Community:

According to the Government Accountability Office (GAO), few programs are as much at risk for fraud, waste and abuse as the Medicare and Medicaid programs.  Estimates of the amount of fraud and misspending in these programs vary widely, from $20 billion to as much as $100 billion. Just this week, testimony before the Senate Finance Committee underscored the seriousness of this problem, as witnesses testified that while much has been accomplished in the fight against fraud and abuse, much more needs to be done.  As Senators and members of the Finance Committee, we have a duty to ensure that taxpayer funds are being spent wisely.

Combating fraud in Medicare and Medicaid has long been a challenge for the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services Inspector General (HHS OIG) and the Department of Justice (DOJ).  To date, numerous efforts have been made to reduce fraud, yielding a mixed record of successes and failures.  We believe federal efforts would be strengthened by input from members across the health care community – providers, payers, health plans, contractors, non-profit entities, consumers, data analytics entities, governmental partners, and patients. Drawing on the collective wisdom and accumulated insights of thousands of professionals and individual experiences could offer a fresh perspective and potentially identify solutions that may have been overlooked or underutilized.

Today we are announcing an effort to solicit ideas from all interested stakeholders in the health care community, regarding solutions and suggestions for how to better prevent and combat the multi-billion dollar problem of waste, fraud and abuse in the Medicare and Medicaid programs.  We invite you to submit white papers offering your best ideas, built on years of experience and insight.  We want to know what areas you see for improvement in current program integrity efforts, as well as additional solutions that we should consider. Working together, we hope to identify innovative solutions that will provide taxpayers with a better return on the investments being made to combat the overpayments in these federal health care programs.

Below are the general categories in which we seek input, though some recommendations may include multiple categories:

&#61623      Program Integrity Reforms to Protect Beneficiaries and Prevent Fraud and Abuse

&#61623      Payment Integrity Reforms to Ensure Accuracy, Efficiency and Value

&#61623      Fraud and Abuse Enforcement Reforms to Ensure Tougher Penalties Against Those Who Commit Fraud

 

Entities interested in submitting white papers should email a PDF or Microsoft Word document to ProgramIntegrityWhitePapers@finance.senate.gov by June 29, 2012.  Submissions should include summary information about the entity or individual submitting a white paper, as well as phone and email contact information. White papers should be as succinct and concrete as possible.  When possible, please include cost-benefit or potential savings information.  Our staff will review submissions and compile a summary document highlighting key proposals later this year.

We appreciate your submission of thoughtful and constructive solutions, as we work to conduct targeted oversight to improve federal efforts to reduce fraud and abuse in Medicare and Medicaid. Together, we believe we can improve program integrity and be better stewards of taxpayer dollars.

Sincerely,

BAUCUS
HATCH
COBURN
WYDEN
GRASSLEY
CARPER

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PECOS: Uncover the mystery! Extended 1/3/2011


**NEWS FLASH** Found at least one gov’t contract with an extension notice of Jan 3, 2011 posted!

What is PECOS? Basically, this is an online 855 application process which is also linked to NPPES (NPI database).  The official name  is Medicare Provider Enrollment Chain and Ownership System.

Where did the info in PECOS come from? They uploaded (in some fashion) from the fiscal intermediary that processes your 855 paper enroll applications.

Why do I need to bother if they have the information from 855? The information in many circumstances is inaccurate and it can stop your cash flow reimbursement.  My guess is, as with any software or data conversion, exceptions to eliminate terminated data were not built in sufficiently.  So, with that said, it is very possible information is incorrect which can result in revoked provider number. For example I recently worked on a provider’s PECOS records that showed locations that have been closed for several months. If the Medicare contractors visit locations or call a phone number that is no longer valid including an invalid area code, they can suspend or revoke the provider number.

You must register in PECOS.  This means you must obtain a username and password in PECOS to review and validate all your information.  Before you begin view and print (save to complete) the 855 they show. You may need copies of your previously submitted 855’s. If you did not keep a copy, do so for all applications in the future.  You can save the information and go back to finish if need be.   Do not click “begin submission” until you are 100% certain you are finished.  Any changes will require a “submission” then you must print out the certification documents for signature to submit hard copy to the address that prints on confirmations.

Do not let incorrect information or failure to register in PECOS stop your PESOS (Cash Flow).  Register deadline for PECOS by UPDATED**7/6/2010 or 1/1/2011 (depending on what article you read) will stop your Medicare payments also.   ADDED**This is the latest note I found on CMS’ website “July 6: Please read the news release found at the following location http://www.cms.gov/apps/media/press/release.asp?Counter=3774 , the January 2011 deadline was superseded by a statutorily established deadline in the Affordable care act. As soon as a firm enforcement date of the regulations has been determined we will announce it.”

This is not going away.  It will take 1-1.5 hours to gather corporate and provider documents.  It will take about 2 hours per provider record to review documents, data, make corrections, make necessary copies of documents, sign and mail.

I have provided a list of numerous documents that you should have available for this as well as site visits.  I recommend maintaining all the important records in a three ring binder to be handy for site inspectors.

If you need help getting this done, we can help with this project.  We will register you, save all log in data for you, save the existing PECOS record, make necessary updates based on the documents provided, save revised document, print all certification forms to PDF.  All documents will be password protected and returned to you by email for $289.00 per provider number.  We can overnight the certification pages and a CD with all documents back to you for an extra $30.00 for all provider records being returned.  Please contact us so that we may sign a confidentiality contract.

PECOS  CHECKLIST

  • Sale purchase agreement, if applicable
    • Asset acquisitions require a new provider number
    • Also note, Home Health Agencies with a provider number less than 36 months old will require a new provider number also
    • Were the state and local agencies informed of the acquisition?
  • State Licensure such as pharmacy license, DME/HME License, typically health care business line specific, if applicable
  • Local- state licenses such as occupancy or business licenses
  • Copy accredit certificate (DME, HHA,
  • IRS 147C letter
  • NPI letter/email
  • Any Adverse Action
  • Director of Nursing/Administrator license
  • Medical MalPractice Insurance Certificate
  • Liability Insurance Certificate must have correct location address on it for minimum $300K
  • HHA: Documentation to demonstrate capitalization requirements
  • Board of Directors, Owners with 5% or more, Manager (w-2), clinical provider Information:
    • Full Name
    • Social Security Number
    • Date of Birth
    • In some states, like FL &CA, finger print cards are required for the mentioned
  • If owned by another company or venture capital company:
    • Need the company(ies) TID#
    • Corporate Business Address
  • If complex ownership, please provide an organizational chart of ownership even if handwritten.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.