NewS iN brieF
Providers' Billing History May
Jeopardize Medicare Status
Medicare providers who have a
"pattern or practice of submitting
claims that fail to meet Medicare
requirements" may lose their
Medicare billing privileges under
final rules (bit.ly/billing-status) that
take effect Feb. 3.
The Centers for Medicare and
Medicaid Services identified five
factors that determine if a provider
has such a "pattern or practice":
* Percentage of claims denied.
* Reasons for the claim denials.
* History of final adverse actions.
* How long the billing pattern
continues.
* How long the provider has been
enrolled.
Audiologists and speech-language
pathologists who provide services to
Medicare beneficiaries are required
to enroll as Medicare providers and
bill Medicare for those services.
Medicare legislation clearly states
that claims must be submitted for
beneficiaries receiving audiology and
speech-language services.
To avoid losing Medicare provider
status, clinicians should monitor
Hospital to
Pay $70,000
to Patient
Denied
Interpreter
10
February 2015 |
their Medicare enrollment and
billing practices to make sure their
claims are accurate and review the
Medicare revalidation requirements
(on.asha.org/enrollment-revalid).
The new rules also allow
CMS to deny re-enrollment to
providers whose enrollment
has been (voluntarily or
involuntarily) terminated because
of outstanding Medicare debt and
to deny enrollment or revoke billing
privileges for providers with a federal
or state felony conviction within the
preceding 10 years.
For more information, contact
reimbursement@asha.org.
Franciscan St. James Health, a Chicago-area hospital group, must pay $70,000 to a
patient who is deaf who was denied a sign language interpreter during a four-day hospital
stay under the terms of a settlement with the U.S. Department of Justice in an Americans
With Disabilities Act complaint.
The settlement also requires St. James to provide free and timely auxiliary aids and
services, including sign language interpreters, to people who are deaf or hard of hearing;
designate an ADA administrator; use grievance resolution systems to investigate disputes
about effective communication with patients with hearing impairment; post notices
of its effective communication policy; and train hospital personnel on the effective
communication requirements of the ADA.
The settlement requires St. James to ensure effective communication for patients and
companions who are deaf or hard of hearing, in compliance with Title III of the ADA.
The settlement is part of the Justice Department's Barrier-Free Health Care Initiative to
make snsure that people with disabilities have equal access to medical services.
THe aSHa Le aDer
http://www.bit.ly/billing-statushttp://on.asha.org/enrollment-revalid
The ASHA Leader - February 2015
Table of Contents for the Digital Edition of The ASHA Leader - February 2015