IN THIS WEEK’S ISSUE:
- Catholic Health Association, VHA Update Community Benefit Reporting Guidelines
- CMS Releases New Codes for Immunosuppressive Drugs
- Cigna Reaches Settlement Agreement On Class Actions
- OIG Posts CMP Final Rule for Medicare Drug Card Program
- Quick Links
- In the HFMA Resource Center
1. CATHOLIC HEALTH ASSOCIATION, VHA UPDATE COMMUNITY BENEFIT REPORTING GUIDELINES
The Catholic Health Association of the United States (CHA) and VHA Inc. have published updated community benefit reporting guidelines that can help healthcare facilities quantify how they benefit their local communities. CHA has released several reports on standardizing community benefit reporting since 1989. The new standards reflect a consensus among some of the nation's largest healthcare providers and were developed in partnership with Lyon Software, which produces a companion software tool.
Community benefits include activities such as charity care, health education, caregiver support, subsidized programs, and improving health in communities. Generally, services that can be reported in a quantifiable inventory of community benefit result in a financial loss to the organization, can be quantified in terms of dollars spent or numbers of persons served, are not of a questionable nature that jeopardizes the credibility of the inventory, and have an explicit budget.
The guidelines also address how to report community benefit services that are not easily counted or are inadequately portrayed quantitatively.
2. CMS RELEASES NEW CODES FOR IMMUNOSUPPRESSIVE DRUGS
Effective January 1, 2005, Medicare will pay a separately billable supplying fee of $24 to a pharmacy for each filled prescription of immunosuppressive drugs, oral anticancer drugs, and oral antiemetic drugs, in accordance with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). In addition, Medicare will pay a $50 fee for the initial supplied prescription of the immunosuppressive drugs during the first month following a patient’s transplant. The codes for these supplying fees are G0370 and G0369, respectively. The implementing instructions, dated December 10, also provide for a dispensing fee of $57 to be paid to pharmacies and suppliers for each 30-day supply of inhalation drugs furnished through durable medical equipment, and $80 for each 90-day period of inhalation drugs.
3. CIGNA REACHES SETTLEMENT AGREEMENT ON CLASS ACTIONS
Cigna HealthCare has settled lawsuits brought on behalf of a nationwide class of specialty healthcare providers and certain state and national associations by agreeing to establish an $11.55 million fund to pay back claims. Additional settlement terms include:
- Enhancing the processing and adjudication of specialty provider claims
- Expanding and improving Cigna’s online referral, certification, and claims management systems for specialty care providers
- Providing via the Internet detailed information about Cigna’s specialty healthcare provider claim coding policies, fee schedules, and related payment guidelines.
- Refraining from reducing the specialty fee schedule for participating specialty providers more than once in a calendar year
- Implementing an external review process to resolve billing disputes “fairly and expeditiously”
- Establishing a specialty healthcare provider advisory committee to maintain open lines of communication between CIGNA and the providers
The settlement brings to a close all of the specialty healthcare provider claims alleged in various cases that were transferred to U.S. District Court in Miami.
In view of the fact that the total size of the class action has not been determined, Cigna is mailing a notice regarding the settlement to at least 210,000 specialty healthcare providers. The agreement must be approved by the United States District Court in Miami.
4. OIG POSTS CMP FINAL RULE FOR MEDICARE DRUG CARD PROGRAM
The OIG has published a final rule imposing civil money penalties (CMPs) against Medicare prescription drug discount card program “endorsed sponsors” that knowingly engage in false or misleading marketing practices, overcharge enrollees, or misuse their transitional assistance funds. According to the OIG, if a sponsor knowingly violates the conditions of its agreement with HHS, the sponsor can be subject to CMPs.
The sanction authority has been divided between CMS and the OIG. CMS will impose CMPs in those instances where the endorsed sponsor’s conduct constitutes noncompliance with an operational requirement not directly related to a beneficiary protection. The OIG will impose CMPs for violations that are misleading to or defraud a beneficiary and for misuse of the beneficiary’s transitional funds.
The rule was published in the December 14 Federal Register.
5. QUICK LINKS
FALL SEMIANNUAL OIG REPORT. The OIG has posted its semiannual report to Congress for April 1, through September 30, 2004. The report describes the OIG’s activities and initiatives for FY04, and reports a savings of $30 billion in taxpayer dollars.
NEW AND CLOSED CIAS AND ENFORCEMENT ACTIONS. The OIG has updated the list of corporate integrity agreements (CIAs), closed CIAs, and new enforcement actions on its web site. (The Department of Justice issues the settlement agreements and their full text is not available from the OIG site.
6. NEW IN THE RESOURCE CENTER
HFMA EXECUTIVE ROUNDTABLE: FINANCIAL INDICATORS: HOW DO YOU MEASURE SUCCESS? Read the insights shared by a group of senior financial executives regarding how they monitor the financial condition of their facilities and strive to find comparable, credible data for meaningful benchmarking.
INPATIENT PSYCIATRIC FACILITY PPS HIGHLIGHTS. Use this summary as a quick reference to the new psychiatric facility PPS final rule that goes into effect for cost reporting periods beginning on or after January 1, 2005.
Copyright 2004 Healthcare Financial Management Association, all rights reserved. HFMA Express News ISSN: 1540-0689. Volume XI, Number 52.
For customer service, send an e-mail to HFMA’s Member Service Center or call (800) 252-HFMA, and press 2.