Tag: Medicare
Proposed rule would establish more guardrails for Medicare Advantage
December 4, 2024HME News Staff
WASHINGTON – CMS is proposing changes to the Medicare Advantage (MA) and Medicare Part D prescription drug programs to hold them more accountable for delivering high-quality care for people with Medicare.
In the Contract Year 2026 MA and Part D proposed rule, CMS proposes addressing inappropriate use of prior authorization and internal coverage criteria, including by defining the meaning of “internal coverage criteria” to clarify when MA plans can apply utilization management,...
OIG: Medicare overpaid hospitals for hospice patients
November 21, 2024HME News Staff
WASHINGTON – Medicare improperly paid acute-care hospitals an estimated $190 million over five years for outpatient services provided to hospice patients, according to a new report from the Office of Inspector General.
For 30 of 100 sample items, payments to acute-care hospitals for outpatient services provided to hospice enrollees complied with Medicare requirements. For the remaining 70 items, however, payments did not comply with the requirements.
Specifically, the OIG...
CMS: Shared Savings Program reaps savings
October 30, 2024HME News Staff
WASHINGTON – CMS says the Medicare Shared Savings Program yielded more than $2.1 billion in net savings in 2023 — the largest savings in the program’s history. “Accountable Care Organizations in the Medicare Shared Savings Program continue to deliver high-quality health care for people with Medicare and meaningful savings for the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “CMS continues to improve the Medicare Shared Savings Program for the...
Pharmacist sentenced for Medicare, Medicaid fraud
October 25, 2024HME News Staff
LONDON, Ky. – Stephanie Collins, a former pharmacist, has been sentenced to 20 months for her role in a scheme to defraud Medicare and Medicaid by billing for medications that she never dispensed to her customers. According to her plea agreement, Collins operated as a registered pharmacist and operated Stephanie’s Down Home Pharmacy, a retail pharmacy located in Corbin, Ky. The pharmacy sought reimbursement from Medicare and Kentucky Medicaid for drugs and other medical products...
William Felix on recognizing innovation, while protecting Medicare
October 18, 2024Theresa Flaherty, Managing Editor
YARMOUTH, Maine – Dr. William Felix has worn many hats throughout his career, including chief medical officer for Medicare DMEPOS and medical director of the Pricing, Data Analysis and Coding division at Palmetto GBA, but one constant is his passion for getting innovative technology into the hands of patients.
“The sooner the patient or the beneficiary can have their hands on this technology that can improve their quality of life, along with a healthy lifestyle, and their lives...
AAH comments on NIV NCA
October 17, 2024HME News Staff
WASHINGTON – AAHomecare has submitted comments in response to the opening of a national coverage analysis for the use of noninvasive positive pressure ventilation in the home for the treatment of chronic respiratory failure consequent to COPD. In its comments, the association strongly urged the agency to establish clear and subjective medical need criteria for coverage. “When medical professionals prescribe this therapy for their patients, it is important that the clinician community...
OIG: More oversight needed of remote patient monitoring
September 25, 2024HME News Staff
WASHINGTON – CMS needs to provide more oversight of remote patient monitoring to ensure it is being used and billed properly, says a new report from the Office of Inspector General.
From 2019 to 2022, use of remote patient monitoring increased dramatically, from about 55,000 enrollees to 570,000. In 2022, payments for these services by traditional Medicare and Medicare Advantage were more than $300 million, compared to just $15 million in 2019.
However, the OIG found 43% of...
CMS seeks input on NIV
September 12, 2024HME News Staff
WASHINGTON – CMS is soliciting public comment on a request for reconsideration of NCD 280.1 to establish coverage policies for the use of noninvasive home mechanical ventilators and respiratory assist devices for Medicare beneficiaries with COPD.
The scope of the agency’s national coverage analysis (NCA) is limited to noninvasive positive pressure ventilation in the home for the treatment of chronic respiratory failure consequent to COPD and will focus on clinical indications...
Election coverage: Poll lays out hot button issues
August 23, 2024Liz Beaulieu, Editor
YARMOUTH, Maine – At the top of the list of priorities for Medicare under a new administration are fair reimbursement, fraud prevention and streamlined documentation, say respondents to a recent HME Newspoll.
“The top priority for Medicare is to implement fair, market-based reimbursement rates,” wrote Craig Rae of Penrod Medical Equipment in Salisbury, N.C. “DME providers are dealing with a harsh reality that either CMS doesn’t understand or doesn’t want...
CMS report: Health spending will rise
June 17, 2024HME News Staff
WASHINGTON – CMS's Office of the Actuary projects that average annual growth in national health expenditures (5.6%) will outpace average annual growth in GDP (4.3%), resulting in an increase in the health spending share of GDP from 17.3% in 2022 to 19.7% in 2032.
The NHE estimates discussed in the office’s new report contain expected effects from the Inflation Reduction Act of 2022 (IRA), including anticipated effects associated with the law’s provisions regarding the...