OIG Recommends ENT Pricing ‘Adjustment’

WASHINGTON — In a report released Jan. 6, the HHS Office
of Inspector General said a review of 2006 payments for enteral
nutrition during non-Part A nursing home stays exceeded prices
available to suppliers by more than 50 percent.

Medicare allowed $142 million for enteral nutrients provided
during non-Part A stays during the study period, the OIG said.

“Using the calculated average unit prices available to the
suppliers, we estimate that Medicare’s allowance for [the] two most
frequently billed enteral nutrient codes exceeded supplier prices
by approximately $61 million for non-Part A nursing home stays in
2006,” according to the report.

To control Part B expenditures for ENT, OIG recommended that CMS
adjust the Medicare fee schedule “to more accurately reflect
supplier prices.”

The report said CMS agreed with the recommendation, citing
resumption of the competitive bidding program and
resulting adjustment of the fee schedule for enteral nutrients as
its “opportunities to address enteral pricing concerns.”

The OIG also said payments for ENT could be further impacted if
Congress changed the prosthetic device benefit to restrict Part B
coverage to a beneficiary’s home, thus recognizing enteral
nutrients as food covered under nursing home room and board
payment. “Such a policy change would end Part B payments for ENT
costs in nursing homes and would affect nearly half of all current
Part B ENT payments annually,” the OIG said.

Such a change, however, would require legislative action.