Tag: Catheter
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...
In brief: CMS makes advance payments, state AG sues Apria, OIG warns of cath scams
March 13, 2024HME News Staff
WASHINGTON – CMS on March 9 made available Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions.
The payments may be granted in amounts representative of up to 30 of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider/supplier between Aug. 1, 2023, and Oct. 31, 2023, divided by three. These payments...
OIG publishes ‘Consumer Alert’ for cath scams
March 11, 2024HME News Staff
WASHINGTON – The Office of Inspector General is alerting the public about a fraud scheme involving urinary catheters. In a “Consumer Alert,” the agency says scammers are targeting Medicare enrollees through phone calls, Internet ads and text messages with offers of free services, medical equipment or gift cards upon confirming their personal information and eligibility for specific Medicare services. Often, the enticement for the individual is that they are “qualified”...