OIG’s 2007 Work Plan Includes Focus on DME

Washington

In a 94-page document, the HHS Office of Inspector General outlined its work plan for 2007 and said it will look into a number of ”vulnerabilities” in Medicare and Medicaid programs related to DME. After its investigations, the OIG will make recommendations for improvements.

The OIG said it will examine the following areas this year:

• DME payments for beneficiaries receiving home health services. The OIG will determine whether the items furnished were reasonable and necessary for the beneficiaries’ conditions.
• Medicare payments for therapeutic footwear.
• Medicare payments for DME claims with ZX, KX, and KS modifiers. Reviews by CMS’ regional carriers of suppliers who had used these modifiers found there was little or no documentation to support the claims.
• Medical necessity of DME. The OIG will determine the appropriateness of Medicare payments for items such as power wheelchairs, wound care equipment and orthotics.
• Medicare pricing of equipment and supplies. The OIG will compare Medicare payment rates for certain medical equipment and supplies with the rates of other federal and state health care programs, as well as with wholesale and retail prices. Its review will cover such items as wheelchairs, parenteral nutrition, wound care equipment and supplies, and oxygen equipment and supplies.
• Billing for DME in hurricane-affected areas.