Tag: Local Coverage Determination (LCD)
In brief: Fraud bill, LCD for prostheses, diamond anniversary
January 26, 2024HME News Staff
WASHINGTON – Sens. Mike Braun, R-Ind., and Bill Cassidy, R-La., have introduced legislation to target irregular billing for certain DME and other diagnostic products in the Medicare program.
The “Medicare Transaction Fraud Prevention Act” directs CMS to create a two-year pilot to oversee Medicare-covered purchasing of DME and other diagnostic testing related products for the 5% of beneficiaries that already receive electronic notices.
The bill, which would ask...
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...
DME MACs provide additional guidance
February 21, 2023HME News Staff
WASHINGTON – The DME MACs have published an updated FAQ to provide additional guidance related to the new local coverage determination for home oxygen therapy.
The FAQ comprises 25 questions related to continued need, the new N modifiers and more.
AAHomecare highlighted the following questions in a bulletin:
1. Is an initial F2F evaluation required?
Answer: While there’s no formal requirement in the NCD or LCD, good medical practice would dictate...
Oxygen LCD needs some ‘finer points’
December 2, 2022Theresa Flaherty, Managing Editor
Stakeholders have been eagerly awaiting the LCD and policy article, following a proposed national coverage determination for oxygen published in July 2021 and a final NCD in September 2021.
As with any change this significant, the devil is in the details, and stakeholders are calling some parts of the LCD and policy article “muddied.”
At the end of the day, stakeholders say providers need clear documentation from physicians and treating practitioners.
WASHINGTON...
AAH responds to proposed LCD for CGMs
November 21, 2022HME News Staff
WASHINGTON – AAHomecare strongly supported CMS’s proposed local coverage determination for continuous glucose monitors in recent submitted comments. The proposed LCD would, among other things, remove the requirement for multiple administration of insulin and frequent self-adjustments, and allow for telehealth visits in place of in-person visits. The association, however, has concerns about the ability of DMEPOS providers to collect documentation from prescriber medical records that’s...
CMS publishes LCD for oxygen
November 18, 2022HME News Staff
WASHINGTON – CMS has published a new local coverage and policy article for oxygen and oxygen equipment, AAHomecare reports.
Here is a link to the LCD: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33797
Here is a link to the policy article: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52514
The new LCD goes into effect Jan. 1.
CMS is not required to provide a comment period, because the LCD contains what...
CMS proposes modifications to CGM coverage
October 10, 2022HME News Staff
WASHINGTON – CMS has published a proposed LCD that modifies the coverage criteria for continuous glucose monitors (CGMs) based on the best available evidence.
The agency seeks to modify criteria to allow coverage of a CGM for beneficiaries with diabetes mellitus who are insulin treated or have a history of problematic hypoglycemia. Problematic hypoglycemia is defined as:
recurrent level 2 hypoglycemic events (
DME MACs to retire LCDs for nutrition
October 13, 2020HME News Staff
ALEXANDRIA, Va. - The DME MACs will retire their local coverage determinations for parenteral nutrition and enteral nutrition effective Nov. 12, according to the National Home Infusion Association. The NHIA commends the move, saying the LCDs for parenteral nutrition and enteral nutrition “cause delays in access to care for Medicare beneficiaries with gastrointestinal disabilities and are administratively burdensome for hospitals, physicians and home infusion pharmacies,” the association...
Medicare keeps coverage for wheelchair trays
March 28, 2017HME News Staff
WASHINGTON - Medicare made a clerical error when it said it considered wheelchair trays, tables or similar products convenience items. The agency said claims for E0950 would be denied as statutorily non-covered, no benefit, according to an LCD and policy article revision posted by the DME MACs on March 16. The article was corrected on March 30. The change was set to take effect retroactively on Jan. 1, 2017. Concerns with the change included the medical necessity of these items and the timing. “They...
Bill would formalize LCD process
October 14, 2016Liz Beaulieu, Editor
WASHINGTON - A bill recently introduced in the Senate that seeks to improve how the Medicare Administrative Contractors develop local coverage determinations is more of a message bill when it comes to HME, stakeholders say.
The bill, which would, among other things, require the MACs to disclose their rationale for LCDs, is geared more toward other Part B services, not DMEPOS, AAHomecare's Kim Brummett says.
“There would be some (positive) ramification for DMEPOS,” said Brummett,...