WASHINGTON--In its Work Plan for 2009, issued earlier this month, HHS' Office of Inspector General said it will take on a number of DME investigations.
Among them, the OIG will focus on payments for CPAP; enteral nutrition provided to patients in nursing homes; blood glucose test strips and lancets; pressure-reducing support surfaces; negative pressure wound therapy pumps; DME items and supplies provided to patients in nursing homes; power wheelchairs; and repair and service of capped rental DME.
Citing its reasons for choosing these particular targets, the OIG said:
--CPAP: “Previous OIG work revealed cases in which Medicare paid for CPAP devices that were not used by or delivered to beneficiaries. We will determine whether Medicare payments for CPAP devices were supported, billed, and paid in accordance with Medicare requirements.”
--Enteral nutrition for nursing home patients: “We will review Part B ENT, commonly called tube feeding, to determine the appropriateness of payments for associated services. This review will specifically assess the medical necessity, adequacy of documentation, and coding accuracy of claims submitted for Medicare beneficiaries during a nursing home stay that is not covered under the Part A SNF benefit.”
--Diabetes supplies: “The Local Medical Review Policies (LMRP) or local coverage determinations, whichever are applicable, issued by the four DME MACs require that the physician’s order for each item billed to Medicare include certain elements and be retained by the supplier to support billing for those services. Further, the LMRP require that suppliers add a modifier to identify when the patient is insulin-treated or noninsulin-treated. The amount of supplies allowable for Medicare reimbursement differs depending on the applicable modifier. We will determine the appropriateness of Medicare Part B payments to DME suppliers for home blood glucose test strips and lancet supplies.”
--Pressure-reducing support surfaces: “In 2006, Medicare-allowed charges for support surfaces reached $164 million. We will conduct a medical review of claims to determine the appropriateness of payments for support surfaces.”
--Negative pressure wound therapy pumps: “A previous OIG review found that 24 percent of pump claims did not meet Medicare coverage criteria. Between 2001 and 2006, Medicare payment for the pump rose 692 percent. We will assess the range of supplier purchase prices for the pump to determine how Medicare reimbursement compares to the median supplier purchase price.”
--DME for nursing home patients: “A previous OIG report found that $210 million was potentially inappropriately paid for DME for beneficiaries residing in nursing homes. We will review Medicare claims data to determine the extent of inappropriate Medicare Part B DME payments made on behalf of Medicare beneficiaries during nursing home stays not covered by Medicare Part A.”
--Power wheelchairs: “In 2003, Medicare payments for power wheelchairs peaked at $1.2 billion. In 2004, as a result of expanded CMS program integrity initiatives, power wheelchair spending decreased to $850 million. However, Medicare payments for power wheelchairs increased again in 2005 to approximately $920 million. We will determine the appropriateness of Medicare payments for power wheelchairs.”
--Service and repair of capped rental DME: “For capped rental DME furnished on or after Jan. 1, 2006, Medicare requires suppliers to transfer the title of DME to the beneficiary after Medicare pays 13 months’ rent under a capped rental arrangement. After that time, Medicare continues to pay for reasonable and necessary repairs to the equipment. Previous OIG work found that Medicare paid substantially more for maintenance on rented equipment than repairs on purchased equipment. We will examine servicing records from suppliers and interview beneficiaries regarding their experiences with capped rental DME to determine if Medicare made proper payments for maintenance and repair services.”
For a PDF of the 115-page OIG work plan, which also includes investigative projects involving hospitals, home health agencies, hospice, physicians and other medical professionals, click here.