Bid News Blog

This news site presents breaking news on the CMS competitive bidding programs. It is interactive and readers are encouraged to post stories in their names or anonymously
July 31, 2012

Surviving an Audit

From: Home Care Magazine

When faced with a Medicare audit, documentation can save the day

by Wayne H. van Halem

I’m often asked about how to avoid a Medicare audit. There is only one response I can think of, and that is to quit billing Medicare. Since that’s not a reasonable response, I suggest instead that you take the time to prepare for the inevitable audit. Whether it’s a widespread prepayment review or a provider-focused post-payment review, suppliers must take steps to ensure that they respond quickly and accurately. Your only defense in an audit is documentation, so for the purposes of this article we will focus on that very important element.

July 30, 2012

Regulatory Overhaul Implies 30% Downside For ResMed Stock

Editor’s Note:  Shareholders are increasingly like to join Medicare beneficiaries in paying the price for CMS’ ill-considered, unsustainable “competitive” bidding program.

From:  PropThink Press Release

Short interest in ResMed Inc. (NYSE:RMD) is at its highest point this year, signaling that investors are growing increasingly bearish on the company’s valuation and are betting on a decline in the price per share. This marks the biggest bet bears have made against the company since ResMed traded at a new 52-week high last July. Shares of the company then slid more than 27%, marking a 52-week low, just four weeks later (as depicted, below).

July 23, 2012

CRE Statement on “Inherent Reasonableness” for Retail Pharmacy Diabetic Supplies

The Center for Regulatory Effectiveness’ Statement, delivered at today’s CMS Public Meeting on:  “Inherent Reasonableness of Medicare Fee Schedule Amounts for Non-Mail Order (Retail) Diabetic Testing Supplies,” is attached in pdf here and reprinted below.  The Federal Register notice for the meeting is attached here.  Comments are due to CMS by July 30th although the date may be extended.

Statement of the:

Center for Regulatory Effectiveness

before the Centers for Medicare and Medicaid Services

Public Meeting Regarding Inherent Reasonableness of Medicare Fee Schedule Amounts for Non-Mail Order (Retail) Diabetic Testing Supplies

July 23, 2012


July 17, 2012

Face-to-face target: DME costing more than $1K

Editor’s Note:  For more on the proposed rule, please see CRE’s Competitive Bidding blog here.

From: Home Care Magazine

BALTIMORE – CMS issued a proposed rule last week that details its plans to require a face-to-face evaluation within 90 days of a written order for certain high-cost durable medical equipment.

The rule gives four criteria that would subject items to the requirement:

1.) items that currently require a written order prior to delivery;

2.) items that cost more than $1,000;

3.) items that we, based on our experience and recommendations from the DME MACs, believe are particularly susceptible to fraud; and

July 11, 2012

CMS May Have Underrated Conflicts of Interest With Medicare Contractors

Editor’s Note: For more information about the HHS Inspector General report and its implications for comptitive bidding, please see CRE’s Competitive Bidding blog here.

From: Becker’s Hospital Review

Written by Molly Gamble

A new report from the Office of Inspector General has found weaknesses in the conflict-of-interest reporting program for companies that submit proposals for Medicare Zone Program Integrity Contractors and subcontractors.

CMS uses ZPICs to perform integrity activities to prevent fraud, waste and abuse in Medicare. This fraud-fighting ZPIC program performs the majority of integrity work for CMS, making potential conflicts of interest especially risky to the program’s objectivity. CMS hires contractors to conduct daily ZPIC operations, and those contractors can refer suspected cases of fraud to the OIG.

July 9, 2012

Barry Johnson named executive director of TAHCS

From: Home Care Magazine

DALLAS, Texas, July 3, 2012—Kevin Hill, president of the Texas Alliance for Home Care Services (TAHCS), has named Barry Johnson executive director of the organization. He is the immediate past president of TAHCS and also serves as the legislative director. Johnson is expected to continue his position as legislative director. He is a founding member of TAHCS and serves as an at-large member of the board of directors.

July 5, 2012

CMS Plans July 23 Meeting On Using IR For Diabetic Test Strips

Editor’s Note:  To Register to attend the CMS public meeting, click here.   The Federal Register notice with additional information about registering to attend the conference and for submitting oral and written comments to the record, is attached below.  For more information about CMS plans to use its “inherent reasonableness authority” cut payments for diabetic test strips, please see CRE’s DME Competitive Bidding Interactive Public Docket here

CMS Plans July 23 Meeting On Using IR For Diabetic Test Strips

July 3, 2012

Medicare targets non-mail order diabetes supply payments

From: Home Care Magazine

WASHINGTON, June 22, 2012—The Centers for Medicare & Medicaid Services (CMS) has scheduled a public meeting for July 23 to discuss adjustments in Medicare payments for non-mail order diabetes supplies through a controversial “inherent reasonableness” process.

The process is being triggered by competitive bidding prices on mail-order diabetes supplies that were about half that paid by Medicare at retail stores. Essentially, CMS now wants to set prices for non-mail order diabetes supplies indirectly through the competitive bidding process.