Tag: RAD
NIV reconsideration: Try-and-fail recommendation causes concerns
September 27, 2024Theresa Flaherty, Managing Editor
WASHINGTON – Industry stakeholders are concerned that a recommendation to require COPD patients to try and fail on respiratory assist devices before they can qualify for non-invasive ventilators will impede access for patients.
The recommendation is part of a request to reconsider the national coverage determination for the use of non-invasive ventilators and respiratory assist devices for Medicare beneficiaries with COPD.
It would be better to first deal with existing issues...
OIG: Bid program did not impede access
June 9, 2017HME News Staff
WASHINGTON - Most Medicare beneficiaries continued to have access to CPAP/RAD devices after Round 2 of the competitive bidding program began, according to a new report from the Office of Inspector General.For CPAP/RAD supplies, however, Medicare payments stopped for 46% of beneficiaries in Round 2 CBAs, compared to 33% in non-bid areas.“The decline may or may not indicate disruptions in receiving needed supplies,” the OIG stated. “For example, the decline may indicate that the program...
CMS publishes further guidance on CPAP accessories
September 1, 2016HME News Staff
WASHINGTON - CMS recently published change request 9741, providing further guidance to the DME MACs on medical reviews of claims for replacement accessories for beneficiary-owned CPAP and RAD devices. CMS has clarified that medical necessity is assumed to be established when Medicare initially pays for the base DME item. This guidance only applies to base items that were paid by Medicare for the entire 13 months. For replacement accessories claims, contractors will only review the continued medical...
CMS shifts gears on documentation requirements for CPAP accessories
August 9, 2016HME News Staff
WASHINGTON - CMS will now assume that medical necessity has been established for replacement of essential accessories for beneficiary-owned CPAP device and RAD.This does not mean that CMS or its contractors can't determine that payments for the equipment were inappropriate based on additional information or investigations related to audits, the agency stated in a bulletin.“This assumption is merely made so that initial claims for essential accessories used with a beneficiary-owned CPAP device...