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CMS/Medicare

News and analysis of CMS rules, Medicare policy and reimbursement changes affecting HME providers and home health agencies.

  • Preventing Medicare Fraud and Abuse

    Recently, the Centers for Medicare and Medicaid Services announced a 10-point plan targeting Medicare fraud and abuse in the power mobility sector. The impetus for this aggressive crackdown was a Houston-based wheelchair scam involving unscrupulous doctors and providers who billed Medicare for power wheelchairs that were either never delivered or substituted with a less expensive model. The scam cost taxpayers millions of dollars, and AAHomecare and durable medical equipment providers applauded CMS for taking action to prevent this type of fraudulent activity from occurring in the future. But, because the new CMS initiative is untested, we need to be diligent in alerting CMS to our concerns and monitoring the effect that it has on the vast majority of law-abiding DME providers and the patients they…
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  • CMS Changes to Online Manuals

    Baltimore The Centers for Medicare and Medicaid Services announced Sept. 12 it will change from a paper-based to a Web-based system for Medicare manual instructions. All of CMS’ program instructions will now be available online at www.cms.hhs.gov/manuals, which links to the agency’s “CMS Manual System.” The new online system will be organized by functional area — claims processing, entitlement, etc. — which CMS says will “eliminate significant redundancy within the manuals.” The agency said it would no longer publish paper program memoranda after Sept. 30. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • Latest CMS/Medicare News

  • Medicare Implements HIPAA Contingency Plan

    Baltimore To avoid what one Medicare spokesman called a possible “health care system collapse,” the Centers for Medicare and Medicaid Services will implement a contingency plan that bends a rule the agency itself set in stone more than three years ago. The “transaction and code set” or TCS rule, which federal lawmakers described in the Health Insurance Portability and Accountability Act of 1996, requires that all health care transactions take place electronically and use the same code sets by Oct. 16, 2003. But by mid-September, fewer than 11 percent of the electronic claims that Medicare received were HIPAA-compliant, CMS said, and the threat of a massive backlog forced an agency decision to put the contingency plan in place on the deadline date. The plan will…
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  • Proposed Medicare Cuts Ignore Service

    Baltimore Bi-level respiratory-assist devices with backup, designed to treat patients with severe respiratory conditions, should fall under Medicare’s capped rental reimbursement policy — not under the government’s policy for items requiring “frequent servicing,” the Centers for Medicare and Medicaid Services said. Attempting to rectify what CMS called the “erroneous” classification of these items, the agency published a proposed rule Aug. 22 in the Federal Register. The move essentially would cut Medicare reimbursements for bi-level respiratory-assist devices with backup by approximately 13 percent, CMS explained. However, device manufacturers and home medical equipment providers argued at a 1999 public meeting that these devices merit reimbursement under the “frequent servicing” classification, because ensuring patients’ compliance requires frequent visits from respiratory therapists. CMS disagreed. “No information was presented at…
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  • Sound the Alarm

    The Centers for Medicare and Medicaid Services’ “Operation Wheeler Dealer” hit the trade press and even the mainstream press in early September. If there is any good news hidden in this massive motorized wheelchair scandal, it is that this represents a needed wake-up call for both the home medical equipment industry and the federal government. Both parties need to do a better job to ensure that scam artists cannot so easily rip off the Medicare rogram and pollute our industry. While we can and should fault the regulators who failed to notice the dramatic increase in new supplier numbers coming out of Harris County, Texas, and the unbelievable rise in claims for motorized wheelchairs coming out of the same area in a year, that is…
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  • Doc Says Expand Medicare Coverage

    Boston An article in the Aug. 13 edition of the Journal of the American Medical Association proposed extending Medicare to cover uninsured people age 55 and older. Expanding Medicare eligibility in this way would serve a “very vulnerable population” that wants to protect its health but does not have the resources to do so, said author Michael McWilliams, a medical resident at Boston’s Brigham and Women’s Hospital. By 2015, Americans aged 55 to 64 will make up nearly 20 percent of the U.S. population, the article predicted. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • GAO Report Echoes Home Care Industry

    Washington For the first time in recent history, a federal budget-watching office took the proverbial words out of the home care industry’s mouth. In an August report, the U.S. General Accounting Office said “Medicare might not be paying home care agencies enough for some non-routine medical supplies,” such as wound care dressings and catheters. “Although Medicare’s home health payment includes the average costs of non-routine medical supplies, adjusted payments may not reflect variation in supply costs across types of patients,” the GAO said, recommending that CMS investigate the possible underpayments. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • Q & A With Tom Scully

    He’s Medicare’s defender and its toughest critic. He roots for beneficiaries but works to contain costs. He wants to stop fraud. He would like to see
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  • Scully Acted Improperly, GAO Says

    Washington For the second time this year, Tom Scully, administrator of the Centers for Medicare and Medicaid Services, found himself under the microscope for allegedly compromising Medicare’s contract-procurement process. This time, the U.S. General Accounting Office stepped in to investigate and found that Scully’s actions regarding a nursing home survey contract were “improper.” The GAO’s report, which focused on a September 2002 contract CMS awarded the RAND Corporation, found that Scully undermined the integrity of the contracting process by excluding RAND’s subcontractor — the University of Wisconsin’s Center for Health Systems Research & Analysis — from the contract. While Scully insisted that he based his decision to exclude the Center on the Center’s poor performance on past and ongoing CMS contracts, the GAO found no…
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  • Medicare Proposes Changes to Enrollment Policy

    Baltimore To weed out unqualified Medicare providers, the Centers for Medicare and Medicaid Services April 25 proposed changes to the provider-enrollment policy. The new policy will be simpler and clearer, according to Tommy Thompson, secretary of the U.S. Department of Health and Human Services. Under the proposed policy, there would be a different provider-enrollment form for each provider group, instead of one generic form for all providers. CMS would deactivate any suppliers that did not bill Medicare for two consecutive quarters. Currently, CMS deactivates providers that have not billed Medicare for four consecutive quarters. Other proposed changes include a requirement that Medicare providers re-certify the accuracy of their enrollment information every three years; a requirement that applicants meet all federal, state and local licensure laws;…
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  • AAHomecare Task Force Submits Code Applications to CMS

    Alexandria, Va. In its ongoing effort to clarify and expand Medicare’s and Medicaid’s coding system for rehab and assistive technology products, AAHomecare’s Re/hab and Assistive Technology Council Coding Task Force last month submitted more than 20 code applications to the Centers for Medicare and Medicaid Services. The task force, which consists of rehab suppliers and manufacturers, has worked for more than two years to develop consensus proposals for codes in the categories of alternative positioning, ambulatory products, bath safety, configured seating, manual wheelchairs and wheelchair accessories. Its mission —” to identify coding deficiencies in the current Medicare [HCFA Common Procedure Coding System] with respect to rehab products” — is critical in light of upcoming regulatory deadlines, AAHomecare said. “All private and public payers must use…
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  • National NewsWire

    Noteworthy CMS Granting Appeals Extensions: The Baltimore-based Centers for Medicare and Medicaid Services April 15 began granting extensions of up to 60 days in the 120-day filing deadline for appeals of Part B claims for which initial determinations were made on or after Oct. 1, 2002. The appeal request must include a credible explanation of why the provider needed additional time to gather the necessary supporting records for the claim. HomeCare Honored for News Coverage: HomeCare magazine was honored recently as one of three finalists in its class for the 2003 Jesse H. Neal National Business Journalism Award for Best New Coverage. Presented by American Business Media, the Neal Awards are the nation’s most prestigious business-to-business editorial awards. This year’s panel of judges selected HomeCare…
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