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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 Issues Physican Self-Referral Regs

    The Centers for Medicare and Medicaid Services has issued the second phase of its final regulations prohibiting physicians from making referrals to entities with whom they have a financial relationship. A study by HHS’ Office of Inspector General revealed that excessive use of some services is encouraged when physicians have a financial relationship with the organizations to which they refer patients. CMS defines a financial relationship as either a compensation arrangement, an ownership or a direct or indirect investment interest. Organizations are also prohibited from billing for services provided as a result of a prohibited referral. The prohibition applies to durable medical equipment and supplies, physical therapy service and home health services, among others. For breaking news, go to www.homecaremonday.com, the electronic news service of…
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  • CMS Retracts Controversial Power Wheelchair Clarification

    Baltimore Last month, the Centers for Medicare and Medicaid Services told legislators that it is retracting the power wheelchair coverage clarification issued by the four DMERCs in Dec. (see HomeCare, January 2004). “CMS has decided to retract the Dec. 9, 2003, Durable Medical Equipment Regional Carrier (DMERC) article which was intended to reiterate our coverage policy on power wheelchairs,” wrote Carleen Talley, director of CMS’ Congressional Affairs Group, in a notification that was circulated to Capitol Hill offices. “The coverage policy remains unchanged from when it was originally put into place in 1985. CMS will continue to pay claims as it has prior to and following the issuance of the December 9, 2003, DMERC article.” The notice said the agency is taking the action “in…
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  • Latest CMS/Medicare News

  • CMS Matches Disease Management Costs

    In a recent announcement, CMS said that it will match states’ costs for operating disease management programs and has sent a letter to state Medicaid directors informing them of the program.The agency said it hopes the federal match will encourage states to adopt more disease management programs to improve health outcomes and lower the costs of managing care for patients with chronic diseases. States can pursue disease management programs under a Medicaid waiver or a state plan amendment, according to the agency. CMS is also undertaking a disease management program for Medicare. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • Greenspan: Trim Medicare

    In late February, Federal Reserve Chairman Alan Greenspan told members of the Committee on the Budget that Congress should trim Social Security and Medicare benefits instead of raising taxes to help control the nation’s budget deficit, which is expected to exceed $500 billion this year. Greenspan has said that the real strain on the economy is expected to hit when baby boomers reach retirement age and entitlement costs begin to rise. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • Bush Taps FDA Chief to Head CMS

    Washington President Bush says he will nominate Mark McClellan as administrator of the Centers for Medicare and Medicaid Services. If confirmed, McClellan will oversee the rollout of Medicare’s massive overhaul, set in motion by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. His brother, White House Press Secretary Scott McClellan, announced the nomination. Currently commissioner of the U.S. Food and Drug Administration, Mark McClellan has served as a member of the White House Council of Economic Advisers. Previously, he worked at Stanford University as an associate professor and director of the Program on Health Outcomes Research, and was also an attending physician for internal medicine at Stanford Health Services. Before taking the helm at CMS, McClellan must be confirmed by the Senate…
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  • A New Medicare Era

    The new Medicare law signed by President Bush on Dec. 8, 2003, includes a number of reforms that affect Medicare beneficiaries and the home care providers who serve them. The following highlights of portions of the law from the American Association for Homecare’s Asela Cuervo, senior vice president, and Ann Howard, director of federal policy, will give you the basics, as will AAHomecare’s accompanying summary of certain provisions. The summary chart is available in its entirety to association members at www.aahomecare.org. To view the entire law as it is written (678 pages), visit http//thomas.loc.gov. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) has two primary purposes: to provide prescription drug coverage for Medicare beneficiaries and to encourage as many beneficiaries as possible to consider…
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  • OIG Says Reimbursement for Inhalation Drugs Excessive

    Washington Medicare reimbursement for ipratropium bromide and albuterol continues to be at higher levels than that of other payers — even after 2004 reimbursement reductions. That’s according to Department of Health and Human Services’ Office of Inspector General reports titled Update: Excessive Medicare Reimbursement for Ipratropium Bromide and Update: Excessive Medicare Reimbursement for Albuterol, both released last month. The reports say that Medicare could have saved $263 million in 2002 if the federal program had used the Medicaid federal upper limit amount for albuterol reimbursements, and $386 million by reimbursing ipratropium bromide at the upper limit amount. The 2004 reimbursement reductions for the Part B drugs, to 80 percent of the Average Wholesale Price, were among the first changes to become effective under the Medicare…
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  • HIPAA TCS Compliance Reaches 58 Percent

    Baltimore As of Jan. 2, 58 percent of electronic claims Medicare received were in the transaction code set (TCS) format required by the Health Insurance Portability and Accountability Act, the Centers for Medicare and Medicaid Services said during a January home health, hospice and DME Open Door Forum. The TCS rule was set to take effect Oct. 16, 2003, but by mid-September last year, fewer than 11 percent of the electronic claims that Medicare received were HIPAA-compliant. As a result, the agency implemented a contingency plan to ease the deadline and ensure continued processing of claims. Although no new deadline has been announced, according to a CMS spokesperson at the Open Door session, “the contingency plan is only temporary,” and CMS will be ending the…
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  • Industry Standards

    One of the platforms I have preached for many years is that there are far too few standards for products offered to Medicare beneficiaries. The price CMS pays to DME dealers usually is the same for a quality walker as it is for a cheap knockoff. Invariably, the knockoff may look the same as the quality unit, but that is normally as far as it goes. The knockoffs often break down, and many do not have the same life expectancy as the quality items. Can you compare a walker that may cost the dealer $50 (or more) with one that is sold to him for $15 or less? We need standards, and they should be strict and enforceable. To push for standards, I recommend that…
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  • CBO Predicts Spiraling Costs For Medicare and Medicaid

    Washington Federal costs for Medicare and Medicaid could spiral to more than 21 percent of the gross domestic product by 2050, according to a recent Congressional Budget Office long-term budget forecast. In 2003, Medicare and Medicaid spending equaled only 3.9 percent of the nation’s GDP. “As health care costs continue to grow faster than the economy and the baby boom generation nears eligibility for Social Security and Medicare, the United States faces inevitable decisions about the fundamentals of its tax and spending policies,” the forecast said. Unless taxation reaches “unprecedented” levels, the forecast continued, “current spending policies will probably be financially unsustainable over the next 50 years.” The report analyzed the long-term effects of several options to reduce spending, including competition and reducing provider payments….
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  • Spread the Word

    In early December, the durable medical equipment regional carriers posted Web bulletins clarifying existing Medicare coverage policy for motorized wheelchairs and power-operated vehicles (POVs). Part of the Centers for Medicare and Medicare Services’ Operation Wheeler Dealer initiative, the so-called clarifications actually provide a more restrictive definition of the circumstances under which Medicare will provide coverage for a motorized wheelchair. The bulletins state that these medical review guidelines will be applied not only to new reviews but also to any provider-specific reviews the DMERCs are currently conducting. The attempt to apply these medical review guidelines retroactively is unfair and contrary to Medicare law and regulation. While the industry must fully support CMS and DMERC activities to eliminate fraud from Medicare, these policy changes will have absolutely…
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  • NSC Issues 760 New Supplier Numbers

    Baltimore Continuing an ease of its supplier-number moratorium, the National Supplier Clearinghouse has issued 760 new supplier numbers, the Centers for Medicare and Medicaid Services announced at a December Open Door forum. However, the agency added that new applicants will continue to experience delays as the NSC continues to aggressively scrutinize its applications. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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