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Stakeholders eye upcoming payment rule

‘What will be the formula in non-bid areas?’
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09/13/2019

WASHINGTON – Industry stakeholders are stepping back to take a larger view of payment issues for HME, with the bid window for Round 2021 closing on Thursday.

Auditors avoid appeals process, make ‘major’ requests

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09/13/2019

YARMOUTH, Maine – If you’re an HME provider trying to appeal a denial by a managed care payer, it’s probably not going very smoothly, reports consultant Wayne van Halem.

In brief: Invacare sticks to target, Quality Biomedical takes on investor

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09/13/2019

ELYRIA, Ohio – Invacare reaffirmed its long-term target of $85 million to $105 million adjusted EBITDA run-rate by the fourth quarter of 2020 at the Baird Global Healthcare Conference in New York on Sept. 4.

Guilty plea entered for $424M fraud scheme

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09/10/2019

WASHINGTON – The owner and CEO of a telemedicine company has pleaded guilty to a $424 million conspiracy to defraud Medicare and receive illegal kickbacks in exchange for DME orders, the Department of Justice has announced.

Providers feel burned in California

Under a proposal, Medi-Cal reimbursement for an oxygen concentrator would drop to $55.19
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09/06/2019

SACRAMENTO, Calif. – California’s Medicaid program, Medi-Cal, may find itself in a bind for HME providers if a drastic reimbursement cut goes through as planned, say industry stakeholders.

In brief: CMS ‘locks door to vault,’ stakeholders raise alarm on proposal to weaken Medicaid oversight

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09/06/2019

WASHINGTON – CMS has issued a final rule that creates several new revocation and denial authorities to bolster the agency’s efforts to stop waste, fraud and abuse in Medicare, Medicaid and CHIP.

CMS adds clarification to calculator

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09/06/2019

WASHINGTON – CMS has added a clarifying note on the lead-item pricing calculator for 14 non-lead item codes.

The codes, several of which are included in two categories in Round 2021 of the competitive bidding program, are:

CMS ‘locks door to vault’

New 'affiliations' authority allows CMS to identify individuals and organizations that pose an undue risk of fraud, waste and abuse based on their relationships with other previously sanctioned entities
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09/06/2019

WASHINGTON – CMS has issued a final rule that creates several new revocation and denial authorities to bolster the agency’s efforts to stop waste, fraud and abuse in Medicare, Medi

Stakeholders raise alarms on two CMS proposals

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09/05/2019

WASHINGTON – Industry stakeholders urge providers to comment on a proposal that would rescind certain Medicaid regulations regarding a state’s obligation to assess and monitor beneficiary access when requesting approval to reduce or restructure payment rates.

MAMES launches new networking committee

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09/03/2019

DULUTH, Minn. – Midwest Association for Medical Equipment & Supplies (MAMES) members looking to talk shop with fellow providers can now join the newly minted Provider, Owner, Executive Management (POEM) Committee.

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