Medicare could save millions if beneficiaries with end-stage
renal disease (ESRD) used supplies from dialysis facilities rather
than from durable medical equipment providers, the Office of
Inspector General said May 16.
After studying equipment claims for home dialysis services that
took place from 1996 through mid-2001, OIG concluded that Medicare
paid $15.3 million more than was necessary for home-dialysis
supplies from DME providers. In light of these findings, the OIG
recommended that Medicare “change regulations to limit
payments for Method II CCPD kits to that of Method I.” That
means Medicare would pay DME providers no more for home-dialysis
supplies than the agency pays dialysis facilities for the same
Responding to the OIG's recommendation, CMS said a regulation
change is not necessary. The current regulation allows for
discrepancies in CCPD-supplies reimbursements, paying less for
supplies that are part of “composite” services (offered
by facilities) than for supplies provided separately. “We
agree that the statute clearly allows a higher payment limit for
CCPD supplies under [the HME-provider method]; however, the statute
does not require paying the higher limit,” CMS said.
“Therefore, we continue to believe that CMS should reimburse
suppliers consistently for the same dialysis supplies, irrespective
of the method the beneficiary chooses.”
Information about the OIG report is available at http://oig.hhs.gov/oei/reports/oei-07-01-00570.pdf.