Last week, CMS posted on its website the first issue of a new educational product called the “Medicare Quarterly Compliance Newsletter.” This newsletter is intended to help physicians, providers, and suppliers avoid billing errors and other “improper activities.” CMS notes that the newsletter will “describe[] the issue, the problems that may occur as a result of the issue, the steps CMS has taken to make providers aware of the issue, and the recommendations on what providers need to do to avoid the problem.” CMS notes that the newsletter will also refer providers to other documents with more detailed information if any other documents exist.

The first issue of the newsletter addresses a variety of issues affecting a variety of provider types, including the failure of inpatient hospitals and skilled nursing facilities to submit documentation requested by Recovery Audit Contractors (RACs) and other auditors, claims for inpatient hospital services where the medical record includes incomplete documentation, claims for services that exceed what was approved for the related CPT or HCPCS code, and inpatient claims for heart failure and shock where the documentation submitted does not support an inpatient level of care. Providers that do not take heed of CMS’s counsel, however, run an increased risk of having their billing errors treated as false claims.

The newsletter notes that future issues will focus on the top issues of that particular quarter, which would include issues uncovered as a result of reviews by the GAO or OIG, as well as by CMS contractors, such as the RACs, Program Safeguard Contractors, and Medicare Administrative Contractors.