Tag: Catheter
In brief: Diabetes drugs, catheter investigation, Henry Schein reorg, CHME Pharmacy
February 26, 2025HME News Staff
WASHINGTON – Medicare Part D spending for 10 selected diabetes drugs totaled more than $35.8 billion in 2023, a 364% increase from 2019, according to a new data brief from the Department of Health and Human Services Office of Inspector General.
Meanwhile, the number of Medicare Part D enrollees increased from 44.9 million to 50.5 million, a 12% increase.
“Certain diabetes drugs initially approved by the Food and Drug Administration to help control blood sugar levels...
OIG investigates catheter billing
February 24, 2025HME News Staff
WASHINGTON – The Office of Inspector General estimates that Medicare improperly paid $35.1 million for catheters and kits from July 2021 through July 2022.
The agency paid a total of $303.3 million for catheters and kits during that time period.
The OIG found that:
Payments for 88 of 105 sample items met requirements. (It did not review 2 of 105 sample items and treated them as non-errors because after it had selected its sample, we determined that Medicare contractors...
In brief: Medicare spending, OIG savings, telehealth flexibility, cath reviews
December 11, 2024HME News Staff
WASHINGTON – Medicare spent 27% more, on average, for people who were covered by traditional Medicare after disenrolling from Medicare Advantage than for people who were continuously covered by traditional Medicare, after adjusting for differences in health status and other characteristics, according to a new analysis by the Kaiser Family Foundation.
This is a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022.
Other highlights...
Noridian to review cath claims
December 9, 2024HME News Staff
WASHINGTON – Noridian Healthcare Solutions, as the Supplemental Medicare Review Contractor (SMRC), is conducting post-payment review of intermittent urinary catheter claims billed with dates of service from Jan. 1, 2022, through Dec. 31, 2023. It’s reviewing HCPCS codes A4351, A4352 and A4353. Noridian noted that in February 2024, the Washington Post published an article alerting readers of an investigation into utilization for intermittent urinary catheters. As a result of the investigation,...
HR HealthCare launches patient services division
October 25, 2024HME News Staff
YORK, Pa. – HR HealthCare has appointed two senior leaders for a newly created Patient Services division. Dallas Donald has joined the company as vice president of patient services and will be responsible for the division’s day-to-day operations and essential functions, including customer service, medical records, billing and compliance. Melissa Georgeoff has joined as chief contracting officer and will be responsible for the national expansion of the company’s contracting efforts....
In brief: Wheelchair bill, RPM monitoring, catheter billing
September 27, 2024HME News Staff
WASHINGTON – Sens. Marsha Blackburn, R-Tenn., and Tammy Duckworth, D-Ill., have introduced legislation that would improve access to titanium and carbon fiber manual wheelchairs for Medicare beneficiaries.
S. 5154, which would create two new HCPCS codes for complex rehab technology manual wheelchairs and would allow for upgrades, is a companion bill to H.R. 5371.
“The Senate bill drops at an opportune time for mobility stakeholders and disability advocates to ask their...
CMS issues final rule on catheter billing
September 26, 2024HME News Staff
WASHINGTON – CMS has issued a final rule that addresses suspicious billing activity within the Medicare Shared Savings Program that resulted in an increase in DMEPOS billing for certain intermittent urinary catheter supplies. The rule, “Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023” (CMS-1799-F) is part of a larger strategy to address significant,...
In brief: AdaptHealth leadership, Philips vents, catheter billing
July 3, 2024HME News Staff
PLYMOUTH MEETING, Pa. – Josh Barnes will step down as president of AdaptHealth on Aug. 31 and from the board of directors on Dec. 31, the company has announced.
“Founding Adapt and helping it become the leading provider of HME is a source of immense pride,” said Parnes. “With Suzanne (Foster) as CEO, I am confident the company is in excellent hands and will continue to innovate, grow and deliver patient-focused best-in class care.”
AdaptHealth also...
CMS seeks to exclude cath codes from program
July 1, 2024HME News Staff
WASHINGTON – CMS has published a proposed rule to address significant, anomalous and highly suspect (SAHS) billing activity within the Medicare Shared Savings Program in response to an observed increase in DMEPOS billing for selected intermittent urinary catheter supplies in calendar year 2023.
The agency says SAHS billing activity for codes A4352 and A4353, if not addressed, could adversely impact the accuracy, fairness and integrity of the program’s financial calculations.
In...
Catheter proposal is ‘huge step forward’
June 14, 2024Theresa Flaherty, Managing Editor
WASHINGTON – CMS’s plan to “explode the codes” for intermittent urinary catheters will better reflect available technologies, says Cara Bachenheimer, who leads the Government Affairs Practice of Brown & Fortunato.
CMS in May proposed discontinuing two existing HCPCS codes for intermittent urinary catheters, A4351 and A4352, and establishing five new codes, in response to a request from AAHomecare and its manufacturer members, who comprise the Intermittent Catheter...