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CMS/Medicare

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

  • 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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  • Latest CMS/Medicare News

  • DMERCs Issue Power Wheelchair Policy Clarification

    Baltimore Following the 10-point initiative called Operation Wheeler Dealer by the Centers for Medicare and Medicaid Services/Office of Inspector General to curb fraud and abuse of the Medicare power wheelchair benefit, last month the four durable medical equipment regional carriers announced a clarification of the local medical review policy for power wheelchairs and the adoption of “a consistent approach” to medical review of power wheelchair claims. The Medicare Coverage Issues Manual/60-9 states that Medicare will cover a wheelchair if the patient’s condition would otherwise confine him to a bed or chair. A power wheelchair is covered if the patient is unable to operate a wheelchair manually. According to the DMERCs’ new clarification, power wheelchairs will be covered only for “patients who are nonambulatory.” In bulletins…
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  • Scully Resigns, Joins Alston & Bird; Smith Named Acting CMS Head

    Baltimore After three years at the helm of the Centers for Medicare and Medicaid Services, Administrator Tom Scully resigned on Dec. 15 and has joined Alston & Bird’s Washington, D. C., law practice. U.S. Department of Health and Human Services Secretary Tommy Thompson named Dennis Smith, director of the agency’s Center for Medicaid and State Operations, as interim CMS administrator. At the same time, Thompson said Leslie Norwalk will remain in her position as deputy administrator and chief operating officer at CMS, and will continue to be the CMS lead in carrying out new Medicare reform legislation. Scully’s resignation became effective shortly after President Bush signed The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on Dec. 8. “Watching the President and Secretary Thompson…
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  • Happy New Year! It’s Deductible Time!

    It’s our favorite time of year, the time when we pay close attention to the “Deduct” column on our Medicare Explanations of Benefits (EOBs). Medicare applies a $100 deductible to each beneficiary in the New Year. The question I am asked the most by home medical equipment providers is, “How do I reduce my exposure to Medicare’s deductibles beginning Jan. 1?” The second question I am asked is, “Do I have to collect this money from the beneficiary?” Let’s review these two questions. There is no true science that can completely alleviate the reduction of revenue your company will experience from deductibles, but there are ways to reduce your exposure. Medicare will apply the deductible toward the first claims they receive each year for each…
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  • CMS Eases Supplier Number Moratorium

    The home care industry recently received some positive news. Thomas A. Scully, administrator of the Centers for Medicare and Medicaid Services, authorized the National Supplier Clearinghouse to begin approving applications for those providers who have submitted their enrollment application and have passed their site visit, signaling an ease in the provider-number moratorium. This development is the culmination of months of hard work by the entire home care industry, and marks a significant victory for law-abiding durable medical equipment providers and the patients we serve every day! Earlier this fall, CMS announced “Operation Wheeler Dealer” to help prevent Medicare fraud and abuse. The initiative came on the heels of an isolated Houston-based wheelchair scam, in which corrupt doctors submitted Medicare claims for power wheelchairs that were…
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  • Up, Up and Away

    With great consternation, I read the following recently: “Medicare spends $600,000 to advertise on a blimp.” Oh, yes! The Centers for Medicare and Medicaid Services is advertising the Medicare program on a blimp that flies at sporting events. According to CMS Administrator Tom Scully, the average senior has no clue what his or her Medicare benefits are. What a blanket denunciation about a major segment of our population. Nevertheless, CMS has budgeted $30 million for advertising to promote the program to its 40 million participants. How many benefits for ailing and needy seniors will be denied just to be able to cover the $30 million spent to advertise Medicare benefits on a blimp at a football game? Thirty million here, $30 million there — and…
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  • CMS Reports $11.6 Billion In Errors for 2003

    Baltimore In a mid-November announcement, the Centers for Medicare and Medicaid Services estimated its improper Medicare payments rate for 2003 at 5.8 percent, or $11.6 billion. This figure, however, excludes providers who did not respond to the agency’s error-rate survey. When these non-responders are included, the error rate becomes 9.8 percent, CMS reported. Each year, CMS measures claims found medically unnecessary, inadequately documented or improperly coded. From 1996 until last year, the study — conducted by the Department of Health and Human Services Office of Inspector General — was based on a survey of some 6,000 claims. During those years, the error rate declined from 13.8 percent in 1996 to 6.3 percent in 2001 and 2002. This year, CMS used an outside contractor to determine…
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  • CMS Finalizes Medicare Beneficiary Appeals Process

    Baltimore The Centers for Medicare and Medicaid Services has published a final rule establishing a process for beneficiaries to appeal local or national Medicare coverage determinations, along with independent review of these coverage policies. Under the final rule, CMS said that appeals of local coverage determinations (LCD) would be reviewed initially by an administrative law judge. Appeals from national coverage determinations (NCDs) and from a judge’s decision on LCDs would be reviewed by the Health and Human Services Departmental Appeals Board. The Board’s decisions could be appealed to federal court. This rule represents the final step toward formal implementation of several appeals-related provisions of the Benefits Improvement and Protection Act of 2000, CMS explained. For breaking news, go to www.homecaremonday.com, the electronic news service of…
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  • On the Web

    CMS Launches Home Health Compare Baltimore In November, the Centers for Medicare and Medicaid Services launched Home Health Compare, a database for beneficiaries featuring home health agency scores on 11 outcome measures, including, among others, dressing and bathing. CMS, which plans to update the database quarterly, compiled the data over a 12-month period ending in May of this year. For more, visit www.medicare.gov and click on “Home Health Compare.” KFF Posts Medicaid Information Washington The Henry J. Kaiser Family Foundation, a non-profit health care research organization, has developed an online database about Medicaid benefits in all 50 states, Washington, D.C., and the U.S. territories. The database, available at www.kff.org, includes information about the benefits covered by each state and payment rules, and is searchable by…
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  • First Medicare, Now Medicaid

    Facing unprecedented fiscal challenges, state Medicaid officials have been actively working to reduce the program’s growth and spending. All 50 states have implemented Medicaid cost containment measures in fiscal year 2003, according to the Kaiser Commission on Medicaid and the Uninsured. If you have not focused on your state Medicaid program, and the potential changes to it that probably are already impacting your business, don’t delay. Some notable facts about Medicaid, according to the Kaiser Commission: The Medicaid program, a state-federal government partnership, was enacted into law in 1965, in the same package of legislation that created the Medicare program. There are essentially four types of Medicaid populations: the “categorically needy,” such as those who meet the Aid to Families with Dependent Children (AFDC) requirements;…
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  • CMS Issues Home Health Market Report

    Baltimore The Centers for Medicare and Medicaid Services’ Health Care Industry Market Update, its first since June 2002, reveals that American home health spending totaled $45.3 billion in 2001, with the home health agency segment accounting for $33.2 billion. The remaining annual expenditures came from respiratory therapy at $4.5 billion; infusion therapy, $4.7 billion; and DME, $2.9 billion. Among other findings, the study calls the respiratory therapy market “very fragmented,” with more than 2,000 local providers making up half the market, but says that large respiratory and infusion therapy companies show strong operational and financial performance. Where strategic and attractively priced targets are available, these companies are actively consolidating the industry. The full report is available at www.cms.hhs.gov/reports/hcimu/default.asp. For breaking news, go to www.homecaremonday.com, the…
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