CMS Eyes Controversial Authority To Cut Retail Diabetes Test Supplies Payments
From: Inside Health Policy
CMS is considering invoking a rarely used and controversial payment adjustment mechanism called “inherent reasonableness” to lower Medicare reimbursements for retail diabetic testing supplies instead of putting these supplies in the competitive bidding program, and plans to discuss the option with stakeholders at a public meeting on July 23. The agency’s inherent reasonableness authority, finalized in 2005, creates a process for CMS to establish equitable payment for certain Medicare Part B services if the existing payment amounts are deemed to be grossly deficient or excessive.
CMS: Accessories not part of PMD demo
From: HME News
by: Elizabeth Deprey
BALTIMORE – Providers want to know how you determine the medical necessity of a power wheelchair when you don’t consider the accessories added to meet a patient’s needs?
CMS had no answer to that question during last week’s Open Door Forum for the PMD demonstration except to say that accessories will not be included in the prior authorization process.
“The accessories cost much more than the base,” Wayne Levesque of Mobility Medical told CMS officials during the forum. “From my standpoint, if you’re not considering the accessories, the prior authorization doesn’t do me much good.”
CMS Requests OMB Approval for Fraud Measurement Pilot, Exemption From Public Access Requirements
In a Notice to be published in tomorrow’s Federal Register, attached below, CMS is requesting OMB approval under the Paperwork Reduction Act (PRA) for a “Probable Fraud Measurement Pilot.” According to CMS,
The probable fraud measurement pilot would establish a baseline estimate of probable fraud in payments for home health care services in the fee-for-service Medicare program. CMS and its agents will collect information from home health agencies, the referring physicians and Medicare beneficiaries selected in a national random sample of home health claims. The pilot will rely on the information collected along with a summary of the service history of the HHA, the referring provider, and the beneficiary to estimate the percentage of total payments that are associated with probable fraud and the percentage of all claims that are associated with probable fraud for Medicare fee-for-service home health.
Concerns Over CMS’ Medicare Integrity Contractors Escalate As Lawmakers Seek GAO Probe
From: Inside Health Policy
A bipartisan group of key legislators has asked Congress’ investigative arm to probe the effectiveness of CMS contractors’ myriad Medicare program integrity audits, citing the need for a coherent strategic plan if the program is to be successful at tracking down improper payments while not unnecessarily burdensome for providers. Providers have long complained that multiple audit programs are defective, redundant and pull staff and providers away from patient care, and HHS’ Office of Inspector General has also raised concerns about the contractors’ effectiveness.
IR makes a comeback?
From: HME News
CMS proposes using inherent reasonableness to set payment amounts for non-mail-order diabetes supplies
WASHINGTON – CMS announced late on Friday that it plans to host a public meeting next month to consult with stakeholders on adjusting Medicare payment amounts for non-mail order diabetes supplies.
CMS already has a national competitive bidding program in place to set payment amounts for mail-order diabetes supplies. But rather than add non-mail order supplies to the mix, the agency is considering using inherent reasonableness (IR) to set payment amounts for these products in the short term.
A show issue, a Special Report and lots of bad news
From: HME News
by: Liz Beaulieu
It’s that time of year when the editorial team here at HME News starts gearing up for Medtrade, Oct. 16-18 in Atlanta. See, our September issue is the pre-show issue and our October issue is the show issue/Show Daily Day 1.
To put all of this in perspective: Right now, we’re already working on our August issue. That’s right, the end of summer is already upon HME News when it has just begun for everyone else!
Health cuts could prove disastrous
From: My San Antonio
Kathleen Weir Vale
As a lifelong provider of home medical equipment and services in the San Antonio area, I recently shared some of my concerns about Medicare with Marjorie McColl Petty, regional director of the Department of Health and Human Services (HHS). Here are the points I made:
For three generations, since 1941, Hope Medical has been serving Texans. Our patients, mostly the elderly, use Medicare, Medicaid, and private insurance. We employ 49 people in San Antonio and Corpus Christi.
Medicare’s War on Seniors
is CMS leading a major Medicare program into disaster? That’s not a rhetorical question. The agency is nationally expanding a program for acquiring life-sustaining home medical equipment (oxygen, mobility equipment, diabetes test supplies, etc.) that is heading for failure because of basic design errors by the agency.
A senior Congressional Budget Office official has already issued a warning about the CMS program by stating, “I think there is a high probability of failure in the near future. There is near certainty of failure sometime down the road.”
CMS: Meeting of the Medicare Economic Index Technical Advisory Panel—June 25, 2012
Attached below is an advance copy of a CMS Federal Register notice announcing a public meeting of an advisory committee. “The purpose of the Panel is to review all aspects of the Medicare Economic Index (MEI). This second meeting will focus on MEI price-measurement proxies and the index’s productivity adjustment.”
VGM: Competitive bidding ‘business killer’
From: Cedar Valley Business
WATERLOO — Opponents of the Medicare Competitive Bidding Program for durable medical equipment say it’s no bargain for patients in immediate need of oxygen, a wheelchair or other life-sustaining apparatus.
They also say it’s poison for the related industry.
Competitive bidding is on its way to a national rollout, and it likely will be a common topic of conversation at VGM Group’s annual Heartland Conference. The event is scheduled Monday through Thursday at the Five Sullivan Brothers Convention Center in Waterloo.