(November 1, 2018)—The Centers for Medicare & Medicaid Services’ Market Saturation and Utilization Data Tool is one of many tools used to monitor and manage market saturation as a means to help prevent potential fraud, waste and abuse. It also assists health care providers in making informed decisions about their service locations and the beneficiary population they serve.
CMS
(October 24, 2018)—Former commissioner of Maine Department of Health and Human and Services (DHHS), Mary Mayhew, has been tapped by the Trump administration as the deputy administrator for the Center for Medicaid and CHIP Services.
WASHINGTON, D.C. (October 23, 2018)—Citing “strong support from the supplier community” as well as initial success in DME MAC Jurisdictions C and D, CMS announced expansion of the Telephone Discussions & Re-Openings Demonstration into Jurisdictions A and B, starting November 1, 2018.
WASHINGTON, D.C. (October 17, 2018)—Industry stakeholders are rolling out a new resource to help suppliers prepare for the next round of the Medicare competitive bidding program for HME.
Evolving market requires focus on local market dynamics
WASHINGTON, D.C. (October 4, 2018)—In June 2018, the Office of Inspector General for the Department of Health & Human Services reported that most Medicare claims for replacement positive airway pressure device supplies did not comply with Medicare requirements. A sample of 110 claims were reviewed, and 86 did not meet the requirements, totaling $13,414 in overpayments.
WASHINGTON, D.C (September 26, 2018)—On September 13, 2018, Representatives Sam Johnson (R-Texas) and John Larson (D-Connecticut) introduced the Homecare for Seniors Act (HR 6813) in the House of Representatives. The act amends the Internal Revenue Code to allow seniors to use funds from health savings accounts for qualified homecare services.
Answers from Industry Experts
ATLANTA (September 6, 2018)—On January 1, 2019, any willing provider will be able to participate in the Medicare program, regardless of prior bidding “wins” or losses. What should providers do? Educational advisory board (EAB) members at Medtrade will outline all of the options, possible action, and consequences in a new educational track dubbed “The New Competitive Bidding.”
SPARTANBURG, S.C. (September 3, 2018)—QS/1, a pharmacy management system provider, has been selected to participate in the Surescripts Early Adopter program for the new National Council for Prescription Drug Program’s (NCPDP) SCRIPT standard version 2017071. The Centers for Medicare & Medicaid Services (CMS) is working to implement the standard in early 2020.
WASHINGTON, D.C. (August 30, 2018)—The Centers for Medicare & Medicaid Services (CMS) released an evaluation report for the first performance year of the Innovation Center’s Next Generation Accountable Care Organization (ACO) Model showing promising early results.
WASHINGTON, D.C. (August 23, 2018)—The Centers for Medicare & Medicaid Services (CMS) awarded $8.6 million in funding to 30 states and the District of Columbia to provide state insurance regulators with the opportunity to enhance states’ ability to strengthen their respective health insurance markets through innovative measures that support market reforms and consumer protections under the Patient Protection and Affordable Care Act (PPACA).
WASHINGTON, D.C. (August 10, 2018)—The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule to overhaul the Medicare Shared Savings Program. The program was established under the Affordable Care Act and launched in 2012. The majority of Medicare’s Accountable Care Organizations (ACOs) operate under the program.
WASHINGTON, D.C. (August 3, 2018)—On August 1, the Centers for Medicare & Medicaid Services (CMS) finalized regulations first proposed in late April regarding the FY2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements (CMS-1692-F).
(July 24, 2018)—In a July 19 blog post, the Centers for Medicare & Medicaid Services announced the creation of the CMS Chief Health Informatics Officer (CHIO). The goal of the CHIO’s role is to drive health IT and data sharing to enhance health care delivery, improve health outcomes, drive down costs and empower patients, according to CMS. The role will be filled with a leader in the health care IT space and serve on CMS Administrator Seema Verma’s leadership team.
WASHINGTON, D.C. (July 11, 2018)—The Centers for Medicare & Medicaid Services (CMS) took steps toward changing Medicare’s DME fee schedule payments, proposing market-oriented reforms to the durable medical equipment prosthetics, orthotics and supplies (DMEPOS) competitive bidding program (CBP).
By Liz Carey
In its July 11, 2018, proposed rule, the Centers for Medicare & Medicaid Services (CMS) pitched new lead item pricing as a measure to improve the competitive bidding program, saying the change would greatly reduce the complexity of the bidding process and the burden on suppliers since they would no longer have to submit bids for numerous items in a product category.
WASHINGTON, D.C. (July 11, 2018)—The Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicaid Provider Reassignment regulation that would eliminate a state’s ability to divert Medicaid payments away from providers, with the exception of payment arrangements explicitly authorized by statute.
Opportunities for improvement exist
