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CMS/Medicare

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

  • 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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  • Latest CMS/Medicare News

  • 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 Launches New Power Wheelchair Initiative, To Split K0011 Code

    Washington The Centers for Medicare and Medicaid Services (CMS) has launched an aggressive three-pronged initiative focusing on power wheelchair coverage, payment and quality controls for suppliers. The campaign was announced by recently appointed CMS Administrator Mark McClellan on April 28, and outlined by Herbert Kuhn, director of CMS’ Center for Medicare Management, during a Senate Finance Committee hearing on power wheelchair fraud and abuse held the same day. The committee oversees the Medicare program and has been investigating the reasons for a dramatic increase in power wheelchair claims. “CMS has cracked down on fraud and abuse in the wheelchair market, including the launch of Operation Wheeler Dealer last fall in collaboration with the [Department of Health and Human Services] Office of the Inspector General,” said…
    Read More →: CMS Launches New Power Wheelchair Initiative, To Split K0011 Code

  • 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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  • Many Rivers to Cross

    The Centers for Medicare and Medicaid Services’ retraction of the DMERCs’ December Web bulletins on restrictive Medicare coverage for motorized wheelchairs and power-operated vehicles (POVs) was a great victory for the entire power wheelchair community, consumers and the HME industry. It is, however, only the first milestone that the industry, in partnership with consumers, needs to attain. Our overall objective related to powered and manual mobility is to ensure that consumers with real medical need continue to have access to mobility devices, enabling them to engage in activities of daily life within their homes. Achieving the following five goals, in conjunction with the consumers we serve, should be an industry priority at the national level. A specialist in health care legislation, regulations and government relations,…
    Read More →: Many Rivers to Cross

  • CMS Should Watch Medicaid Accounting, GAO Says

    In a March 16 report, the government’s General Accounting Office said the Centers for Medicare and Medicaid Services should closely monitor how states use the upper payment limit, a maximum price that the federal government pays as its share of Medicaid costs. The report, titled Medicaid: Improved Federal Oversight of State Financing Schemes Is Needed, says that some states use accounting techniques that inflate program costs — closer to the upper payment limit — to acquire higher program payments from the federal government. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
    Read More →: CMS Should Watch Medicaid Accounting, GAO Says

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