Centers for Medicare & Medicaid Services

CMS issues hospital inpatient PPS proposed rule for FY 2017. The Centers for Medicare & Medicaid Services on April 18 issued its hospital inpatient prospective payment system (PPS) proposed rule for FY 2017.
The proposed rule includes:

• an increase in rates by 0.85% from FY 2016, after accounting for inflation and other adjustments required by law
• adjustments to reverse the effects of the 0.2% cut instituted when implementing the “two-midnight” rule in FY 2014
• an initial market-basket update of 2.8% for hospitals that were “meaningful users” of electronic health records in 2015 and submitted data on quality measures, less a productivity cut of 0.5% and an additional market-basket cut of 0.75%, as mandated by the Affordable Care Act (ACA)
  a 1.5% cut to fulfill the requirement of the American Taxpayer Relief Act of 2012 that CMS recoup the effect of documentation and coding changes from FY 2010-2012
• a reduction in overall Medicare Disproportionate Share Hospital payments by $134 million in FY 2017 from 2016, as mandated by the ACA
• a new scoring methodology for the FY 2018 Hospital-Acquired Condition Reduction Program in which hospitals would be scored based on how their measured performance compares to the national mean, rather than their performance decile
• a reduction to a hospital’s base operating DRG payment to account for excess readmissions associated with applicable conditions that include total hip arthroplasty/total knee arthroplasty and coronary artery bypass graft (CABG) surgery
• Updates to the Hospital Value-Based Purchasing program including the addition of a 30-day mortality measure after CABG surgery beginning in FY 2022.

CMS will accept comments on the proposed rule until June 17, 2016.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-18-2.html

CMS issues final rule on Medicare overpayments. The Centers for Medicare & Medicaid Services (CMS) on February 11 released its final rule for reporting and repaying Medicare overpayments, as required by the Affordable Care Act.

The rule requires providers and suppliers to report and return any overpayments they identify within 6 years of receipt, down from 10 years that was in the proposed rule.

Once overpayment is identified, providers have 60 days to return the overpayments.

Failing to report overpayments can result in liability under the False Claims Act, which means the provider could face financial penalties or be excluded from billing CMS programs.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-02789.pdf