Tag: Andrea Stark
CMS piles on prior auth requirements
February 7, 2024Liz Beaulieu, Editor
YARMOUTH, Maine – A rule finalized in January is CMS’s latest bid to fine-tune the prior authorization process for Medicare Advantage plans and other payers to increase efficiency and transparency.
The agency in January finalized a rule requiring MA plans and other payers like Medicaid and Medicaid managed care to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. For some payers, CMS says, this cuts the current...
Market changes likely to drive increase in audit activity
December 1, 2023Liz Beaulieu, Editor
YARMOUTH, Maine – The end of Medicare’s competitive bidding program for knee and back braces on Dec. 31 could open the door to increased audit activity for orthotics in 2024, industry consultants predict.
“We’ve already seen the Supplemental Medical Review Contractor (SMRC) add braces back onto their project list and the Recovery Audit Contractor (RAC) still has them on their approved list,” said Kelly Grahovac, general manager of the van Halem Group. “But...
Andrea Stark on re-engineering Medicare Advantage
September 8, 2023Liz Beaulieu, Editor
YARMOUTH, Maine – There will be overdue changes to Medicare Advantage in the next year that will make them “a lot more friendly” to HME providers, says Andrea Stark.
Stark, a Medicare consultant and reimbursement specialist with MiraVista, joined the HME News in 10 podcast in August to take a deep dive into the “state of the state” of Medicare Advantage and what’s in store for these plans.
Here’s an excerpt:
‘State of the...
Medicaid disenrollment highlights need for increased automation
August 11, 2023Liz Beaulieu, Editor
WASHINGTON – HME providers might feel like they’ve been “whipsawed” by the current Medicaid disenrollment, but there are tools and processes they can implement to continue business as usual, say industry stakeholders.
As of Aug. 1, 2023, states have disenrolled at least 3.8 million Medicaid recipients based on the most current data from 41 states and the District of Columbia, according to Kaiser Family Foundation (KFF).
“There’s a lot of whipsawing...
SCMESA’s Bobby Horton passes
July 6, 2023HME News Staff
WEST COLUMBIA, S.C. – Bobby Horton, executive director of the South Carolina Medical Equipment Services Association (SCMESA), passed June 29. Horton, 87, advocated for suppliers at both the state and federal level, and was instrumental in getting prescribed equipment and supplies exempted from the state sales tax in 2013, says Andrea Stark, who described him as a friend and mentor to many. “Bobby was an expert at cultivating relationships,” said Stark, a Medicare consultant and...
How to prepare for Medicaid dis-enrollment
June 8, 2023Andrea Stark
Continuous Medicaid enrollment established under the Families First Coronavirus Response Act (FFCRA) ended on March 31, 2023. I am sure I am not the first to tell you about the millions of Medicaid beneficiaries that will lose coverage in the coming months. Nonetheless, I hope I can offer a few insights to better prepare you for the ramifications of so many patients potentially changing coverage in a short period of time.
In exchange for a 6.2% Federal Medical Assistance Percentage (FMAP)...
Home oxygen therapy: Stakeholders welcome ‘much-needed’ guidance
March 3, 2023Theresa Flaherty, Managing Editor
WASHINGTON – An updated FAQ published by the DME MACs in February, by and large, addresses concerns around the new local coverage determination for home oxygen therapy and serves as a good reference point as HME providers navigate a new era for the benefit, stakeholders say.
The FAQ, published Feb. 21 and updated Feb. 23, addresses 25 questions related to continued need, the new N modifiers and more.
“Full stop, it was a much-needed thing,” said Andrea Stark, a...
Post-PHE: Grandfathering patients, continuing telehealth and using EUA devices
February 10, 2023Liz Beaulieu, Editor
YARMOUTH, Maine – Now that there’s an end date, industry watchers are waiting for CMS to publish guidance on patients who providers set up during the public health emergency and who they will bill for beyond the PHE.
President Joe Biden announced in February that the PHE will end May 11, 2023.
“We need to be grandfathered in,” said Jeff Baird, chair of the Health Care Group at Brown & Fortunato during a Feb. 2 webcast. “We don’t want post-PHE...
Stark and Baird on what’s critical to a provider’s livelihood
January 13, 2023Liz Beaulieu, Editor
YARMOUTH, Maine – Medicare Advantage will be the elephant in the room in 2023, say Andrea Stark and Jeff Baird, due to the “sheer mass migration” of beneficiaries to these plans.
“Everything is centered around managed care,” said Baird, chairman of the Health Care Group at Brown & Fortunato. “It seems like, overnight, we woke up and 50% of Medicare patients are now covered by these plans.”
HME News connected with Stark, a Medicare consultant...
Providers should prepare to move on from PHE
September 9, 2022Theresa Flaherty, Managing Editor
WASHINGTON – CMS has begun setting the stage for the end of the public health emergency and so should HME providers, say stakeholders.
The agency recently released an overview, “Creating a Roadmap for the End of the Covid-19 Public Health Emergency,” and while it doesn’t provide new information, it summarizes waivers still in place and those that have already expired.
“Eventually, the PHE is going to come to an end and suppliers need to be thinking...