• HME providers pitch in to help during recent weather crises

    Editor’s Note:  For more on heroism by home care providers, see CRE’s Competitive Bidding blog here.

    From: Home Care Magazine

    WASHINGTON, July 3, 2012—HME providers worked alongside first responders to ensure the safety of the elderly and disabled during the recent extreme weather and power outages that struck much of the nation, the American Association for Homecare reported.

    One provider that helped out was Home MediService, which is based in Havre de Grace, Md. It serves about 1,500 oxygen patients in Maryland, Delaware and Pennsylvania. Power outages can be deadly for people who rely on oxygen concentrators or ventilators, both of which require electricity. A storm ravaged the Mid-Atlantic on June 29 and caused massive power outages.

  • CMS Major Proposed Rule: Face-to-Face Encounters as a Condition for Payment

    Attached below is an Advance copy of a CMS Federal Register notice announcing a proposed rule that would impact the DME industry.  Specifically, the proposed rule’s provisions include implementation of “provisions of the Affordable Care Act by establishing a face-to-face encounter as a condition of payment for certain durable medical equipment (DME) items.”

    CMS’ Summary of the proposed rule states:

  • DME Providers among first responders in emergency situations

    Editor’s Note:  DME providers have a long track record of taking care of their patients, providing life-sustaining services, in emergencies.  CMS’s competitive bidding program refuses to recognize the value of these essential services, threatening the care, and the lives, of Medicare beneficiaries.

    From: HME News

    WASHINGTON – Providers have worked hard this week to ensure patients have what they need amid extreme weather events around the country.

    Among the top concerns: power outages, especially for oxygen and ventilator patients.

    Provider Joel McGrain told AAHomecare this week that massive outages called by a storm that hit the Mid-Atlantic led to dozens of calls.

  • 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

  • CMS’ Blum Promoted To Principal Deputy Administrator

    From: Inside Health Policy

    CMS’ Medicare chief Jonathan Blum has been promoted to principal deputy administrator of CMS, Acting Administrator Marilyn Tavenner announced in an email obtained by Inside Health Policy. Blum will also continue his duties as Medicare director, Tavenner said.

    In the email Tavenner noted that Blum, who joined CMS in March 2009, “has been instrumental in our efforts to implement the Affordable Care Act and strengthen Medicare by providing beneficiaries with access to new preventive benefits and lower cost prescription drugs as well as launching accountable care organizations and linking payment to quality.”

  • It Pays to Appeal! 43% of All RAC Audits Overturned

    From: Mira Vista

    CMS has released updated appeals data for claims reviewed by Recovery Audit Contractors during fiscal year (FY) 2011. Recovery audit contractors (RACs) are paid on a contingency fee basis for each identified improper payment. Fees paid to a RAC are retracted in cases where a denial is later overturned upon appeal.


    In FY 2011, RACs identified 903,372 overpayments. Less than 7% of those overpayments (56,620) were appealed at any level. Of those claims appealed, over 43% (24,548) resulted in a favorable decision, and a total of $37.9-million was returned to providers. Automated audits accounted for the majority of overturned overpayment determinations. However, appealed complex reviews resulted in the largest dollar amounts being returned to providers.