Federal Reports

o We surveyed staff at Border Patrol stations and OFO ports of entry from April 22, 2020 to May 1, 2020. The 136 Border Patrol stations and 307 OFO ports of entry that responded to our survey described various actions they have taken to prevent and mitigate the pandemic’s spread among travelers, detained individuals, and staff. These actions include increased cleaning and disinfecting of common areas, and having personal protective equipment for staff, as well as supplies available to those individuals with whom they come into contact. However, facilities reported concerns with their inability to practice social distancing and the risk of exposure to COVID-19 due to the close-contact nature of their work. Regarding staffing, facilities reported decreases in current staff availability due to COVID-19, but have contingency plans in place to ensure continued operations. The facilities expressed concerns regarding staff availability, however, if there were an outbreak of COVID-19 at the facility. Overall, the majority of respondents reported that their facilities were prepared to address COVID-19

The Centers for Medicare & Medicaid Services administers the Medicare program, which includes coverage for hospital outpatient services under Part B. Under the outpatient prospective payment system, Medicare pays for hospital outpatient services on a rate-per-service basis that varies according to the assigned ambulatory payment classification. Healthcare Common Procedure Coding System codes and descriptors are used to identify and group the services within each ambulatory payment classification group. Outpatient prospective payment system provides outlier payments to hospitals to help mitigate the financial risk associated with high-cost and complex procedures, when a very costly service could present a hospital with significant financial loss. A service or group of services becomes eligible for outlier payments when the cost of the service or group of services estimated using the hospital’s most recent overall cost-to-charge ratio separately exceeds each relevant threshold. Medicare payments may not be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” Providers must furnish to the Medicare contractor sufficient information to determine whether payment is due and the amount of the payment. Upon receiving credible information of potential overpayments, providers must exercise reasonable diligence to identify overpayments (i.e., determine receipt of and quantify any overpayments) during a 6-year lookback period. Providers must report and return any identified overpayments by the later of (1) 60 days after identifying those overpayments or (2) the date that any corresponding cost report is due (if applicable). This is known as the 60-day rule. The 6-year lookback period is not limited by Office of Inspector General’s audit period or restrictions on the Government’s ability to reopen claims or cost reports. To report and return overpayments under the 60-day rule, providers can request the reopening of initial claims determinations, submit amended cost reports, or use any other appropriate reporting process. Each facility should have an established charge structure which is applied uniformly to each patient as services are furnished to the patient and which is reasonably and consistently related to the cost of providing the services. While the Medicare program cannot dictate to a provider what its charges or charge structure may be, the program may determine whether or not the charges are allowable for use in apportioning costs under the program. To promote correct coding by providers and to prevent Medicare payments for improperly coded services, Centers for Medicare & Medicaid Services developed the National Correct Coding Initiative. Medicare Administrative Contractors implemented National Correct Coding Initiative edits within their claim processing systems for dates of service on or after January 1, 1996. The National Correct Coding Initiative edits include procedure-to-procedure edits that define pairs of Healthcare Common Procedure Coding System codes and current procedural terminology codes (i.e., code pairs) that generally should not be reported together for the same beneficiary on the same date of service. Baylor Scott & White-College Station is a 142-bed acute care hospital, located in College Station, Texas. The hospital originally opened in 2013 and subsequently in 2013 merged with Baylor Health Care System.

The Office of the Inspector General conducted a review of the Watts Bar Nuclear Plant (WBN) Chemistry/Environmental (Chemistry) organization to identify factors that could impact WBN Chemistry’s organizational effectiveness. Our report identified behavioral risks that could have a negative impact on WBN Chemistry’s effectiveness, including those related to (1) interactions with certain management and (2) relationships between employees. We also identified operational risks that could hinder WBN Chemistry’s ability to execute its responsibilities and support Nuclear’s vision and core principles. These risks were comprised of (1) perceptions of inadequate qualified and/or experienced technicians and turnover in Nuclear Chemistry and (2) concerns with the technician training program. In addition, based on feedback received from other WBN organizations, we corroborated concerns about WBN Chemistry’s staffing and personnel knowledge.