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CMS/Medicare

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

  • 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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  • Gallup Sues CMS Administrator

    Washington Gallup Organization, a nationally known polling company, April 8 filed suit against Tom Scully, administrator of the Centers for Medicare and Medicaid Services, for allegedly interfering in the government’s contracting process. Filed in the U.S. District Court for the District of Columbia, the lawsuit alleges that Scully “engaged in a willful and malicious campaign to violate [Gallup’s] constitutional rights of free speech, free association and due process; federal law; and the rules and regulations of the Department of Health and Human Services, of which CMS is a part.” The lawsuit stems from a survey of hospital performance data — a survey that CMS and the U.S. Agency for Healthcare Research and Quality are overseeing. When Gallup’s managing partner for health care programs, Robert Nielsen,…
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  • Latest CMS/Medicare News

  • 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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  • Medicare Funds Are Shrinking Quickly

    Washington By 2026, Medicare Part A will be insolvent, and the government’s expenditures for Medicare Part B will outweigh premiums by a ratio of four to one, according to a sobering report from Medicare’s Boards of Trustees. Each year, the trustees for Medicare’s Hospital Insurance and Supplementary Medical Insurance Trust Funds report to the U.S. Congress on the financial status of the funds. The HI fund lost ground this year, as hospital admissions increased and the Bureau of Economic Analysis predicted lower taxable wages, the trustees said. Similarly, the outlook for the SMI fund worsened, due to the rapid growth of Medicare Part B spending and the passage of reimbursement increases for physicians. “Over the next 10 years, the average annual increase in [SMI] benefit…
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  • Balancing Act

    Last year, the four durable medical equipment regional carriers issued supplier-manual updates requiring home medical equipment suppliers, in certain circumstances such as pre-and post-pay audits, to submit physician progress notes to substantiate medical necessity for a particular claim. Then, in December, the Centers for Medicare and Medicaid Services, in its certificate of medical necessity submission to the White House’s Office of Management and Budget, reported “suppliers and physicians will complete these [CMN] forms and as needed supply additional routine supporting documentation necessary to process claims.” To put it plainly, CMS and the DMERCs have placed the burden on DME suppliers to provide to the DMERCs copies of physician progress notes to determine whether the medical necessity criteria were met for a particular claim. The CMN…
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  • GAO Paints Grim Medicare Picture

    Washington The nation’s two largest health insurers — Medicare and Medicaid — are in dire straits, in part because the government pays too much for Part B equipment and services, according to a Jan. 30 report from the U.S. General Accounting Office. Pointing to disparities between what Medicare pays for medical equipment and what other government agencies and private insurers pay, the report argues the need for a more-flexible reimbursement structure. “To lower unreasonably high payment rates, [the Centers for Medicare and Medicaid Services today] must follow a lengthy and complicated regulatory process for making payment adjustments,” the GAO said. But that process will change as of Feb. 11, 2003, when a rule outlining CMS’ expedited payment-adjustment authority — the “inherent reasonableness” rule — becomes…
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  • Scully: Spending Report Signals Need for Medicare Reform

    Baltimore Not only is health care spending growing, but it is growing at an accelerated rate, according to a Jan. 8 report from the Centers for Medicare and Medicaid Services. Americans and the federal government spent $1.4 trillion on health care during 2001, an 8.7 percent increase, compared to spending during 2000. Public health care spending — which accounted for nearly half of the total — jumped 9.4 percent, as Medicare reimbursements increased and Medicaid rosters grew. “Legislation [including the Benefits Improvement Protection Act of 2000] added $7.5 billion to total Medicare spending in 2001,” the report said. Increasing at its fastest rate since 1993 — 10.8 percent — Medicaid spending soared to $224.3 billion during 2001. The report attributed this growth to an 8.5…
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  • IR 101

    The Centers for Medicare and Medicaid Services Dec. 13, 2002, issued a long-awaited interim final rule concerning the application of “inherent reasonableness” to certain Medicare Part B items and services. This expedited IR authority could have an immediate and potentially devastating impact on home medical equipment providers, because the durable medical equipment regional carriers now have the ability to reduce payments for durable medical equipment, prosthetics and orthotics at a faster pace. Effective Feb. 11, 2003, the regulations explain the process whereby CMS and Medicare carriers — including the DMERCs — will reduce or increase payment amounts when the federal government believes the existing payment amounts are either grossly excessive or grossly deficient. CMS issued the rule as an “interim final rule,” because the agency…
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  • Medicare Publishes IR Rule, Providers Fear Cuts

    Baltimore A debate that began nearly two decades ago entered its final stages last month, when the Centers for Medicare and Medicaid Services granted
    Read More →: Medicare Publishes IR Rule, Providers Fear Cuts

  • New Senate Leader Could Bring Changes, AAHomecare Says

    Washington Unable to atone for comments many perceived as racist, Sen. Trent Lott, R-Miss., stepped down from his position as Senate Majority Leader last
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