Tag: Reimbursement
New York Medicaid increases access to standing frames
March 10, 2025HME News Staff
NEW YORK – HME stakeholders in New York have worked with the state’s Medicaid program to secure reimbursement increases for standing frame / table systems that support children with neuromuscular conditions that impair their ability to stand independently. Reimbursement for E0638 is now $3,264.65, up from $1,285.95; and reimbursement for E0641 is $3,526.92, up from $1,680.52. “New York’s children with profound medical needs now have access to the most medically appropriate...
Bill’s sponsors on Medicare cut: ‘The future of private practice is in dire straights’
February 3, 2025HME News Staff
WASHINGTON – A bipartisan group of 10 lawmakers in the House of Representatives has introduced a bill to stop the 2.83% cut in Medicare payments to stabilize physician practices and protect access to care.
The “Medicare Patient Access and Practice Stabilization Act,” introduced by Reps. Greg Murphy, M.D., R-N.C., and Jimmy Panetta, D-Calif., along with eight other House members, would prospectively cancel the 2.83% cut that went into effect Jan. 1.
“Physicians...
NCPA joins price-fixing lawsuit
January 27, 2025HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association has joined a class action lawsuit against GoodRx, as well as CVS Caremark, Express Scripts, MedImpact Healthcare Systems and Navitus Health Solutions, that accuses them of colluding in a scheme to fix reimbursement rates to independent pharmacies. The lawsuit, brought by Community Care Rx, an independent pharmacy in Michigan, alleges that GoodRx and several PBMs are violating federal antitrust law by sharing competitively sensitive...
Patient advocacy groups press leadership on reimbursement relief
December 4, 2024HME News Staff
WASHINGTON – More than 30 leading patient advocacy organizations have weighed in with congressional leadership to support including provisions from H.R. 5555 and S. 1294 in any legislative package that moves before the end of the year, AAHomecare reports.
In a Dec. 2 letter from the ITEM Coalition, the groups assert that the expiration of 75/25 blended Medicare reimbursement rates on Jan. 1, 2024, has resulted in a “crushing blow to DMEPOS suppliers and providers, threatening...
Report makes case for ‘fully funding’ DME
September 24, 2024HME News Staff
WATERLOO, Iowa – The cost of treating injuries and illnesses due to lack of DME far exceeds the cost of providing the necessary equipment, according to a new report from Leitten Consulting.
For example, every dollar spent on mobility equipment can save Medicare $62.53 in treatment costs, the report found.
“An ounce of prevention is now worth several pounds of cure,” said Brian Leitten, CEO of Leitten Consulting, which specializes in health care policy analysis...
Pacific Therapy Access rebrands, adds DME division
August 13, 2024HME News Staff
DALLAS – Pacific Therapy Access, a provider of reimbursement strategies, prior authorization and health insurance appeals services, has rebranded to Walnut Hill Medical and added DME, health economics and market access divisions. "We are thrilled to embark on this new chapter as Walnut Hill Medical," said Chris Hanna, CEO of Walnut Hill Medical. "This transformation represents our ongoing commitment to excellence and innovation in health care solutions. Our expanded services...
CMS to implement small increase for seat elevation systems
July 2, 2024HME News Staff
WASHINGTON – CMS has agreed to increase reimbursement for seat elevation systems for power wheelchairs by $13.62 to $2,013.96, according to NCART. The agency will implement the change and provide instructions on submitting previously submitted claims for adjustment as part of its July DMEPOS fee schedule update, the organization says. Reimbursement of $2,000 for the new code E2298 went into effect April 1, 2024. On an interim basis prior to April 1, providers were being paid about $2,800, on...
Reimbursement: Understand new flexibility
March 13, 2024Noel Neil
Q. Can I apply the same new guidance for PAP masks to other accessories?
A. In February 2024, the DME MACs published a Dear Physician Letter (DPL) clarifying Medicare’s stance of masks for PAP and RAD devices. The DPL specifically addressed the PAP and RAD device masks, but does the same flexibility apply to other accessories such as tubing, cushions or pillows?
The letter indicates:
In order to promote patient adherence to PAP or RAD therapy, the treating practitioner...
Lack of reimbursement relief starts to set in
February 9, 2024Theresa Flaherty, Managing Editor
WASHINGTON – With Medicare reimbursement decreases in non-rural areas now in effect, including 32% for oxygen and 37% for manual wheelchairs, HME providers are faced with making potentially difficult business decisions if relief doesn’t come their way soon, say industry stakeholders.
Congress in January passed a stripped down, short-term government funding measure without including any significant health care extenders, including a provision to extend a 75/25 blended rate in...
Reimbursement: Document qualifying test result
February 7, 2024Noel Neil
Q. What do I need to document in the medical record to meet current oxygen policy requirements?
A. The current oxygen policy requires the practitioner to order and evaluate the results of a qualifying blood gas study performed at the time of need. I believe this requirement stems from the national coverage determination (NCD) but Medicare confirmed that the practitioner does not necessarily have to document that “I personally reviewed the qualify test result.”
However,...