Tag: CMS
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,...
HHS, CMS outline flexibilities in wake of cyberattack
March 5, 2024HME News Staff
WASHINGTON – The U.S. Department of Health and Human Services has outlined steps that CMS has taken to assist providers to continue serving patients in the wake of the Change Healthcare cyberattack.
Affected parties should be aware of the following flexibilities, the agencies say:
Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic...
CMS seeks increased transparency for MA plans
January 29, 2024HME News Staff
WASHINGTON – CMS has released a request for information (RFI) to solicit feedback from the public on how best to enhance Medicare Advantage data capabilities and increase public transparency.
The agency says transparency is especially important now that MA plans have grown to more than 50% of Medicare enrollment, and the government is expected to pay these plans more than $7 trillion over the next decade.
“Americans with Medicare who have managed care plans called Medicare...
In brief: Senators write GAO, CMS reports on spending, Quantum appears at the Met
December 15, 2023HME News Staff
WASHINGTON – U.S. Senate Majority Whip Dick Durbin, D-Ill., and U.S. Sen. Richard Blumenthal, D-Conn., have sent a letter to the Government Accountability Office (GAO) calling on the agency to update its 2011 report entitled “Medical Devices: FDA Should Enhance Its Oversight of Recalls” in the wake of the Philips Respironics recall.
The Senators sent the letter following the Pittsburgh Post-Gazette’s and ProPublica’s reporting on the recall of certain...
CMS: Medicare Advantage, drug programs to remain stable in 2024
September 27, 2023HME News Staff
WASHINGTON – Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain stable in 2024, according to CMS.
The announcement precedes the upcoming Medicare Open Enrollment period, which begins Oct. 15, 2023, to help people with Medicare determine the best Medicare coverage option for their health care needs.
“A top priority for CMS is to protect and strengthen the Medicare program for people with Medicare,...
Reps. Sewell, Smith launch sign-on letter to protect access to oxygen
July 17, 2023HME News Staff
WASHINGTON – Reps. Terri Sewell, D-Ala., and Adrian Smith, R-Neb., are collecting signatures for a sign-on letter asking CMS to accept the standard written order as the only necessary documentation to establish medical necessity for audits of home oxygen, sleep and non-invasive ventilation claims submitted during the public health emergency, according to AAHomecare.
The letter asks CMS to protect patient access by instructing contractors to use CMS’s widely accepted...
CMS expands required list
January 17, 2023HME News Staff
WASHINGTON – CMS has added 10 more HCPCS codes to a required list for a face-to-face encounter /written order prior to delivery, according to VGM Government Relations.
The new codes include the following for back, knee and ankle/foot braces: L0631, L1843, L1932, L1940, L1951, L1960, L1970, L2005, L2036. Also included: E0748, osteogenesis stimulator, electrical, non-invasive, spinal applications.
The effective date for the news codes is April 2023.
The required...
In brief: Part B drug payments, Kalogon deal, new Vertess managing director
January 6, 2023HME News Staff
WASHINGTON – CMS should bolster its oversight of manufacturer-submitted average sales price (ASP) data to ensure accurate Part B drug payments, according to a new report from the Office of Inspector General.
Due to invalid or missing ASP data, CMS could not calculate an ASP-based payment amount for 8% of drug codes at least once between 2016-20, the OIG found.
“CMS was unable to calculate an ASP-based payment amount for several reasons, including that (1)...
OIG to CMS: Accuracy of Part B drug payments is substantially hindered
January 3, 2023HME News Staff
WASHINGTON – CMS should bolster its oversight of manufacturer-submitted average sales price (ASP) data to ensure accurate Part B drug payments, according to a new report from the Office of Inspector General.
Due to invalid or missing ASP data, CMS could not calculate an ASP-based payment amount for 8% of drug codes at least once between 2016-20, the OIG found.
“CMS was unable to calculate an ASP-based payment amount for several reasons, including that (1)...
OIG calls out unimplemented recommendations
December 19, 2022HME News Staff
WASHINGTON – The Office of Inspector General has published its annual “Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste and Abuse in HHS Programs” and DME makes more than one appearance.
This year, the OIG’s recommendations focus on the top 25 unimplemented recommendations that, in its view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented.
Recommendations...