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CMS/Medicare

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

  • CMS Permits At-Home Oxygen Testing Device

    Baltimore CMS is allowing at-home oxygen testing using a specific product, a development that could help clear logjams at the nation’s Independent Diagnostic Testing Facilities (IDTFs). In an April 23 letter to Brighton, Mich.-based Oximetry Co., LLC, John Warren, a health insurance specialist at CMS’ Division of Medical Review, said: “Medicare covers home oxygen therapy for a beneficiary when a qualified provider or supplier of laboratory services performs a blood gas study that was ordered by a physician; and that study indicates that the patient’s blood oxygen levels meet Medicare criteria. “The Program Integrity Group [at CMS] has determined that the Power-Ox system does not violate any portion of the Local Medical Review Policy or National Coverage Determination for home oxygen therapy. Test results obtained…
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  • CMS Introduces New Wheelchair Cushion Codes

    Baltimore Last month, CMS sent out a change-request transmittal to its contractors spelling out 20 new codes for wheelchair cushions — and eliminating, among others, the broad E0192 code. To become effective July 1, the new codes include cushion depth and height parameters, wheelchair cushions for general use, skin protection, positioning and seat backs, along with new codes for mounting hardware. 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

  • CMS Considers Home Sleep Testing Coverage

    Baltimore CMS is reviewing its national coverage of obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy. Current policy requires a sleep test, or polysomnography, to be performed in a facility-based sleep-study laboratory, but the agency is considering changes to accept the use of portable multi-channel home sleep test devices. According to Dr. Terence Davidson of the University of California San Diego, sleep-disordered breathing (SDB) “is grossly under-diagnosed in large part due to a limited number of sleep diagnostic facilities.” Davidson submitted a letter to CMS requesting the policy change. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • GAO Recommends Clarification of Medicare Supplier Standards

    Washington Fraudulent DME suppliers should not be able to enter the Medicare business in the first place, and vague supplier standards are partly to blame. So said the General Accounting Office’s (GAO) Leslie Aronovitz, director of health care program administration and integrity issues, in testimony at a late April Senate Finance Committee hearing on power wheelchair fraud and abuse. “The standards NSC uses to evaluate suppliers are not explicit,” Aronovitz said. “Officials at CMS and NSC told us that some of Medicare’s supplier standards lack specificity as criteria for NSC to use in determining the legitimacy of a supplier.” For example, Standard No. 4 requires that a supplier “fills orders, fabricates, or fits items from its own inventory or by contracting with other companies for…
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  • Noteworthy

    ‘Homebound’ Demo to Launch in October CMS will launch a two-year, three-state demonstration project Oct. 4 to clarify what defines a “homebound” patient under Medicare’s home health benefit, the agency announced. The MMA-mandated project will determine if a broader definition of “homebound” will result in higher costs for Medicare. It will be limited to no more than 15,000 beneficiaries with permanent, disabling conditions requiring daily living assistance and skilled nursing for the rest of their lives. CMS has not yet announced in which three states the project will take place. Enteral Nutrition Reimbursements Excessive, OIG Says A recent report from the HHS OIG found that Medicare reimbursements for enteral nutrition formulas are excessive. Medicare’s reimbursement for Category I formulas exceeded median contract prices available from…
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  • CMS Moves in the Right Direction

    The Centers for Medicare and Medicaid Services (CMS) announced its three-pronged initiative to address power wheelchair issues at the Senate Finance Committee’s April 28 hearing on Medicare coverage and payment for power wheelchairs. Overall, CMS’ initiative is a significant step in the right direction to address perceived and real issues in this area. There are, however, several recommendations to improve and refine CMS’ initiatives that will yield improved results. RAMP’s 10-Point Plan Consistent with CMS’ initiative, the industry coalition RAMP, the Restore Access to Mobility Partnership, has recommended a 10-point plan to help CMS fight fraud without harming the people who require power wheelchairs to increase their mobility. The coalition has developed this plan and is actively lobbying CMS and members of Congress for CMS…
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  • CMS Considers Changes To Wheelchair Coverage Policy

    Washington This year, HME industry advocates and the Centers for Medicare and Medicaid Services (CMS) have volleyed back and forth in a K0011 coverage debate that may end with vigilant payment oversight, pricing changes or even changes to national coverage policy for wheelchairs. Since a DMERC clarification of power wheelchair policy was issued in December, industry stakeholders have spoken out against CMS’ strict interpretation of policy language, voicing concerns regarding beneficiary access to medically necessary power equipment and provider payments. Although CMS retracted the clarification in mid-March, some advocates say access questions remain. At a March 31 Open Door session on the issue, CMS officials said the agency cannot give a more specific definition of its policy language. “Being more specific than the national policy,…
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  • Trustees Say Medicare Could Go Broke Sooner Than They Thought

    Washington By 2019, the Medicare trust fund could go broke. According to the annual report released in late March by the Social Security and Medicare Boards of Trustees, Medicare’s insolvency date is now seven years sooner than the trustees projected last year. The bleak financial situation stems from medical advances that allow people to live longer, more productive lives. “But the result of these very happy trends, unfortunately, is a rate of growth of medical costs that will continue to far outstrip that of the economy,” the trustees said, adding that “legislative action to remedy this situation will be required shortly.” According to the report, the new Medicare prescription drug law also raises “serious doubt about the sustainability of Medicare under current financing arrangements.” The…
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  • CMS Prepares to Form DME Advisory Committee

    Baltimore The wheels may be starting to turn toward competitive bidding. At a Home Health, Hospice and DME Open Door Forum in late March, CMS announced it is preparing for the formation of a DME advisory committee to advise the agency on quality standards, financial standards, data collection strategies and, ultimately, the logistics behind implementation of competitive bidding as required under the Medicare Modernization Act (MMA). “We’re just getting started now,” a CMS official told HomeCare. “The committee … has to be there at the start of the process. I would hope we would have internal decision-making done … by late summer. [But that is] pure speculation.” MMA creates an Advisory and Oversight Committee to advise the Secretary of Health and Human Services on development…
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  • CMS to Slow Non-TCS-Compliant Claims

    The Centers for Medicare and Medicaid Services recently announced that beginning July 1 it will slow processing of non-compliant claims — paying them no earlier than 27 days after receipt — to encourage use of the standardized transactions and code sets (TCS) format. Compliant claims could be paid as early as 14 days after receipt. Shortly before the original TCS-compliance deadline, which was scheduled Oct. 16 last year, CMS enacted a contingency plan allowing providers to submit non-compliant claims as long as they demonstrated a “good faith effort” toward compliance. Last month, CMS announced that 69 percent of electronic Medicare claims from all health care providers are now in the TCS format. In February, however, 82 percent of HME providers who responded to a HomeCare…
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  • What Medicare Law?

    A majority of Americans over age 65 do not understand Medicare reform, a Kaiser Family Foundation survey reports. Further, the survey shows 68 percent of seniors, or about 7 in 10, do not know that the new prescription drug law was passed by Congress and signed into law in December. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • Scully: Educate Congress, CMS To Avoid Another Hit in 2005

    Rancho Bernardo, Calif. Speaking at the American Association for Homecare’s Leadership Conference Feb. 27, Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, told attendees the road ahead could be tough for HME. But, he said, with a focused message to Congress and an educational effort directed at CMS, the industry should be able to avoid “a double-whammy” when lawmakers tackle the nation’s budget deficit. “I know you have had a little bit of a rough year, and I think I’m probably about as popular with this group as Ralph Nader would be at a Corvair convention,” quipped Scully, who worked to get Medicare reform through Congress. “The bill passed, and despite a lot of people’s views that they’re going to get…
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