Baltimore After announcing its intentions earlier this year, beginning July 6 CMS slowed processing of non-HIPAA-compliant claims — paying them no earlier than 27 days after receipt — to encourage use of the standardized transactions and code sets (TCS) format. According to CMS, about 87.5 percent of all Medicare providers are currently filing electronic claims in the TCS-compliant format. But, said a CMS official at a June 23 Home Health, Hospice and DME Open Door Forum, “that’s definitely not in the ballpark of 100 percent.” In a June 30 statement, CMS Administrator Mark Mcclellan said “for those still not in compliance, there is going to be a delay in getting their money. We are hoping this will motivate more filers to get into compliance soon.”...

Washington After a three-year investigation, HHS has removed language stating obesity is not an illness from Medicare’s Coverage Issues Manual, paving the way for possible coverage of obesity treatment. In 2001, the Centers for Disease Control and Prevention asked CMS to review the issue of whether obesity should be considered an illness, but until now, the agency has denied coverage for obesity therapies. While the language change still does not define obesity as a disease, the revision does allow beneficiaries to request coverage for obesity-related treatments. “The critical issue is not the classification of obesity but whether particular items or services are reasonable and necessary,” according to CMS. “With this new policy, Medicare will be able to review scientific evidence in order to determine which...

The government’s tight scrutiny of K0011 claims in Harris County (Houston), Texas, could ease, according to Steve McAdoo, associate regional administrator for the Division of Medicare Financial Management in CMS’ Dallas regional office. “We are in discussions with Palmetto GBA (Region C DMERC) to see whether or not we feel comfortable doing a modification in the level of review going on,” McAdoo said at a CMS June 23 Home Health, Hospice and DME Open Door Forum. “There could be some changes in the not-too-distant future.” A strict 100-percent review for all power wheelchair claims submitted in the Texas county has remained in effect since last September, when CMS and the OIG launched Operation Wheeler Dealer in response to a sharp rise in power wheelchair expenditures...