Face-to-face rule

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

BALTIMORE – CMS issued a proposed rule this 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

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 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.