ATLANTA (November 23, 2021)—PruittHealth, Inc. and affiliated entities have agreed to pay $4.2 million to resolve allegations that they submitted claims for home health services that were not covered by the Medicare and Medicaid programs, and that they failed to refund overpayments that they had received from Medicare and Medicaid in a timely manner.
reimbursement
Answers to 5 pressing questions about Medicare Advantage
WASHINGTON, D.C. (October 8, 2021)—The Centers for Medicare & Medicaid Services (CMS) has posted the annual update of the Post-Acute Care and Hospice Provider Public Use File (PAC PUF) with data for 2019. The PAC PUF now has data available for years 2013-2019.
Home may be the new hospital
BATON ROUGE, La. (August 24, 2021)—Louisiana home medical equipment (HME) providers now have more protection against payment caps for home ventilation services.
Guide your MA & MCO customers so you can be reimbursed properly
ARLINGTON, Va. (June 1, 2021)—Home medical equipment (HME) suppliers in rural and other non-bid areas received significant support in the April 2020 Cares Act through measures that extended the 50/50 blended rate for rural suppliers through the COVID-19 public health emergency (PHE), and for the first time provided a 75/25 rate (a blend using 75% current adjusted rates and 25% unadjusted rates) for suppliers in other non-bid areas for the duration of the PHE.
ATLANTA (May 7, 2021)—Brightree announced its Brightree Patient Collections (BPC) solution has been selected as the winner of the “Best New Technology Solution for Healthcare Payment” award in the fifth annual MedTech Breakthrough Awards program conducted by MedTech Breakthrough, an independent market intelligence organization that recognizes the top companies, technologies and products in the global health and medical technology market.
WASHINGTON, D.C. (April 9, 2021)—For a short period early in the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) expanded its Accelerated and Advanced Payments (AAP) Program to Medicare providers and suppliers, including DME and home health suppliers. The expanded program was available for suppliers starting March 28, 2020, and the suspension of the program was announced a month later in April.
WASHINGTON, D.C. (March 23, 2021)—The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12085—Correction to Period Sequence Edits on Home Health Claims.
How HME providers can handle virtual reimbursement, Medicare Advantage plans & more
WASHINGTON, D.C. (March 3, 2021)—The Centers for Medicare & Medicaid Services (CMS) has published the Revised January 2021 DMEPOS Fee Schedule. In the announcement, CMS stated that errors were identified in the original fee schedule that was published on Dec. 11, 2020 and this new fee schedule includes adjustments to 919 HCPCS codes.
WASHINGTON, D.C. (January 22, 2021)—A definition of “reasonable and necessary” was included of the recently finalized rule, Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of ‘‘Reasonable and Necessary’’.
How PDAC handles new codes
BALTIMORE (December 15, 2020)—The American Academy of Home Care Medicine (Academy) has expressed concerns that the Medicare cuts beginning in 2021 threaten care for patients receiving primary care in their homes when they are being encouraged to stay home to stay safe. The Academy strongly disagrees with the Centers for Medicare & Medicaid Services’ decision in the CY 2021 Medicare Physician Fee Schedule Final Rule to cut payments for home-based primary care (HBPC) visits by 8%-10%.
RICHMOND, Va. (November 20, 2020)—Governor Ralph Northam has signed Virginia’s 2021-2022 budget containing an amendment requiring Medicaid Managed Care Organizations (MCOs) to reimburse home medical equipment (HME) providers at a minimum of 90% of the State’s Medicaid fee schedule effective July 1, 2021.
OVERLAND PARK, Kan. (August 25, 2020)—eSolutions, a health care technology company, is adding an enhancement to its Durable Medical Equipment (DME) Eligibility platform that allows DME providers to check for same or similar equipment items on multiple patients at once. This new enhancement, called Same or Similar Batch, verifies all Medicare HCPCS codes, including A, L and V codes, for same or similar equipment items.
SPARTANBURG, S.C. (July 13, 2020)—RedSail Technologies, LLC, is partnering with OmniSYS, LLC, to deliver clinical solutions to community and long-term care pharmacies. This collaboration will offer enhanced clinical services and provide untapped revenue streams that will help set pharmacies apart from the competition.