December 1, 2023

OIG Issues Remote Patient Monitoring (RPM) Alert

The Office of Inspector General (OIG) is alerting the public about a fraud scheme involving monthly billing for remote patient monitoring. Please educate staff and patients with this important information.

Legitimate RPM involves using medical devices such as scales, glucose monitors, blood pressure cuffs, cardiac rhythm devices, and other equipment to remotely monitor for anomalies in patients with chronic medical conditions. This new treatment is beneficial for those whose condition might deteriorate quickly, where monitoring can reduce complications, hospitalizations or death.

However, the OIG has found unscrupulous companies are signing up Medicare enrollees for this service, regardless of medical necessity. Most often, the monthly monitoring never happens, but the enrollee is billed monthly anyway.

• Scammers target Medicare enrollees through calls, texts, and Internet ads
• Scammers steal Medicare numbers and other personal information
• Scammers then bill Medicare for services that are unnecessary or never provided

Report Fraud

• HHS.GOV
• 1-800-447-8477
• TTY: 1-800-377-4950
• Report Fraud to the FTC

Learn More

December 1, 2023

American Institute of Healthcare Compliance – Evaluation and Management (E/M) Visits

Beginning January 1, 2024, the Centers for Medicare and Medicaid (CMS) is finalizing implementation of a separate add-on payment for healthcare common procedure coding system (HCPCS) code G2211.

• This add-on code will better recognize the resource costs associated with evaluation and management visits for primary care and longitudinal care.
• Generally, it will be applicable for outpatient and office visits as an additional payment, recognizing the inherent costs involved when clinicians are the continuing focal point for all needed services, or are part of ongoing care related to a patient’s single, serious condition or a complex condition.

Split (or shared) Evaluation and Management (e/M) visits

Split (or shared) E/M visits refer to visits provided in part by physicians and in part by other nonphysician practitioners in hospitals and other institutional settings.

• For CY 2024, CMS is finalizing a revision to the definition of “substantive portion” of a split (or shared) visit to include the revisions to the Current Procedural Terminology (CPT) guidelines, such that for Medicare billing purposes, the “substantive portion” means more than half of the total time spent by the physician or nonphysician practitioner performing the split (or shared) visit, or a substantive part of the medical decision making.
• This responds to public comments asking that it be allowed that either time or medical decision making to serve as the substantive portion of a split (or shared) visit.

Click here for more PFS information from CMS

Click here for the November press release which provides a summary of changes

November 22, 2023

Inflation Reduction Act – Funding and Tax Credits for Rural Health Organizations

On Friday October 20^th, Assistant Secretary for Health, Admiral Rachel Levine announced that OCCHE will be launching a “catalytic program” early in 2024 to support health care providers and especially safety net organizations in taking advantage of the tax credits, grants and other supports made available by the historic Inflation Reduction Act (IRA). This legislation creates unprecedented opportunities for health sector organizations to make investments in clean energy, building efficiency, infrastructure resilience and more.

OCCHE’s planned initiative will occur through collaboration with federal partners including the Environmental Protection Agency and Department of Energy and will feature national webinars as well as breakout sessions by provider type to help organizations’ assess their needs and opportunities.

Sign Up for the November 30 information session in which you will learn more details on this initiative.

When: November 30, 11:00 a.m. CT

Sign Up Now