Tag: Coverage
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...
Diabetes & CGMs: ‘A rapid-fire changing environment’
March 17, 2023Theresa Flaherty, Managing Editor
WASHINGTON – Industry stakeholders say Medicare’s newly expanded coverage guidelines for continuous glucose monitors (CGMs) are a big win, but there’s still work to do to process that and other changes made to the benefit in the past few months.
CMS in March published an updated LCD and policy article that, among other things, expands coverage for CGMs to beneficiaries with Type 2 diabetes and allows follow-up visits to be conducted via telehealth.
“Medicare...
CMS reviews NIV therapy for chronic respiratory failure
June 24, 2020HME News Staff
WASHINGTON - CMS on July 22 will conduct a virtual Medicare Evidence Development & Coverage Advisory Committee meeting to review the evidence specific to the home use of non-invasive ventilators by patients with chronic respiratory failure consequent to COPD. The agency seeks the committee's recommendations on the characteristics that define patient selection and usage criteria, and concomitant services, as well as the equipment parameters necessary to best achieve positive patient health outcomes...
CMS makes change to multi-function vents permanent
June 9, 2020HME News Staff
WASHINGTON - Starting April 20, CMS permanently suspended claims editing for multi-function ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime, according to a revised MLN Matters article.Effective immediately, DME suppliers may provide and bill for multi-function vents described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage criteria for a vent.Ventec Life Systems, which makes the VOCSN multi-function...
CMS allows upgrades to multi-function vents
April 7, 2020HME News Staff
WASHINGTON - CMS has allowed for expanded use of multi-function ventilators (E0467), according to an MLN Matters article.“Effective immediately, you may provide and bill for multi-function ventilators described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage for a ventilator,” the article states.Previously, to meet the medical necessity coverage for multi-function vents, CMS required beneficiaries to need a ventilator and at least one of the four additional...
CMS opens access to respiratory therapy
March 31, 2020HME News Staff
WASHINGTON - Medicare will cover respiratory related devices and equipment for any medical reason determined by clinicians during the coronavirus pandemic, CMS announced last night.Previously, Medicare only covered them under certain circumstances.“Clinicians now have maximum flexibility in determining patient needs for respiratory related device and equipment and the flexibility for more patients to manage their treatments at the home,” the agency states. “The current NCDs and...
Inspire touts coverage win
August 27, 2019HME News Staff
MINNEAPOLIS - Two Medicare Administrative Contractors, Noridian and Palmetto, have published draft local coverage determinations that propose coverage for Inspire Medical Systems' obstructive sleep apnea therapy, according to the company. Both draft LCDs state that for individuals with OSA who are treated with hypoglossal nerve stimulation, the evidence is sufficient to determine that neurostimulation technology results in a meaningful improvement in the net health outcomes when used as outlined....
Inspire racks up more coverage by private payers
April 26, 2019HME News Staff
MINNEAPOLIS - Inspire Medical Systems has added 10.4 million covered lives with several new coverage policies. Two new Blue Cross Blue Shield Association plans, including Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program, and BCBS of Tennessee have issued positive coverage policies for the Inspire therapy. Additionally, Medical Mutual of Ohio has issued positive coverage. There have now been 18 positive coverage policies issued by BCBSA healthcare plans, covering...
What's up with this 'What's Covered' app?
January 31, 2019Liz Beaulieu, Editor
CMS this week has made much ado about its new “What's Covered” app that allows beneficiaries to see whether Medicare covers a specific medical item or service, which of course includes HME.
The launch of the app paralleled the agency's CMS Quality Conference, or #CMSQualCon19 as it's known on twitter. CMS's coverage of the event on the social media platform has included photos of attendees, including these patient advocates, giving the app a whirl.
Screen...
Don't expect CMS to remain silent on vents, Stark says
July 1, 2016Liz Beaulieu, Editor
COLUMBIA, S.C. - CMS is not done tinkering with coverage guidelines for vents, predicts consultant Andrea Stark.Discussing the National Association for Medical Direction of Respiratory Care's recent request that CMS reconsider its national coverage determination for vents, Stark said during a recent webcast: “CMS is not obligated to agree or institute any changes. However, in light of many 'quiet' changes behind the scenes, we do not expect CMS to remain silent on ventilators.”NAMDRC's...