In brief: CMS reshuffles PAOC, OIG sets agenda

Sunday, October 5, 2008

BALTIMORE - CMS effectively disbanded the Program Advisory and Oversight Committee (PAOC) last week, and began seeking nominations for 10 to 12 new individuals to serve on the committee. Seth Johnson, vice president of government affairs for Pride Mobility, and 20 other PAOC members received letters Sept. 29 thanking them for their service. "I am not sure why CMS would do this," said Johnson, who had been operating under the assumption that he would serve out his term, set to expire Dec. 31, 2009. The letter gave the impression that even if he received a nomination, it was doubtful he would be reappointed, Johnson said. PAOC advises CMS on issues related to national competitive bidding. The Medicare Improvements for Patients and Providers Act (MIPPA), passed in July, extended PAOC committee terms by two years to Dec. 31, 2011. There was nothing in the act that required dissolving the current committee, Johnson said. Nomination categories include: beneficiary/consumer representatives; physicians and other practitioners; suppliers; professional standards organizations; financial standards specialists (economist/certified public accountant); and association representatives. CMS may consider nominees for additional categories if it finds that their expertise will help to ensure the successful implementation of the program. Nominations are due Nov. 3. For information, visit

OIG has eye on DME
WASHINGTON - The Office of Inspector General (OIG) released its 2009 Fiscal Year Work Plan last week and it includes 20 DME investigations. Top targets include CPAP devices, power wheelchairs, diabetes supplies and negative pressure wound therapy pumps. The work plan is a projection of the various investigations the OIG expects to take on in the next fiscal year. The DME projects include: Medicare payments for power wheelchairs. The OIG states: "In 2003, Medicare payments for power wheelchairs peaked at $1.2 billion. In 2004, as a result of expanded CMS program integrity initiatives, power wheelchair spending decreased to $850 million. However, Medicare payments for power wheelchairs increased again in 2005 to approximately $920 million. We will determine the appropriateness of Medicare payments for power wheelchairs."

Oxygen cap remains nebulous
BALTIOMORE. - Members of AAHomecare's Regulatory Committee met with CMS officials last week to share their concerns about the 36-month cap on Medicare oxygen reimbursement. CMS officials told committee members and AAHomecare staff that they couldn't provide a timeline for releasing additional information, because they're still in the process of developing policy, according to the association. But CMS staff asked questions related to the services and costs of providing oxygen and how those services and costs may change after the cap. Committee members and AAHomecare staff lobbied CMS officials for ongoing maintenance on a semi-annual basis and payments for unscheduled service. As the Jan. 1 cap approaches, AAHomecare urges patients and providers to report problems and concerns to members of Congress.

CMS seeks improved accuracy
BALTIMORE - CMS last week began publishing most of the edits used in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments. CMS established the MUE program Jan. 1, 2007, to reduce payment errors for Medicare Part B claims. Eventually, the MUE program will contain edits for about 9,700 HCPCS/CPT codes that have been assigned unit values for MUEs. Although the Oct. 1, 2008, publication will contain most MUEs, additional ones will be published on Jan. 1, 2009. MUEs are cumulative for each quarter. Claims processing contractors use the edits to assure that providers and suppliers do not report excessive services. The edits are applied during the electronic processing of all claims. The edits will be published on the CMS Web site at

CMS clarifies exemptions
BALTIMORE - Pharmacists and pharmacies must become accredited, CMS announced in a clarification issued last week. The agency of Sept. 3 announced a list of DMEPOS providers who were exempt from meeting the quality standards for accreditation. Pharmacies that provide DME, such as diabetes supplies or enteral/parenteral nutrition, must become accredited by Sept. 30, 2009. For more information about DMEPOS Accreditation, please visit the web page at

RecoverCare boosts patient handling offerings
RADNOR, Pa. - RecoverCare, a manufacturer of bariatric, wound care and safe patient handling products and services, has acquired a majority interest in T.H.E. Medical, it announced last week. The Barrie, Ontario-based T.H.E. Medical manufactures safe patient handling and transfer equipment and services to the long-term care, acute care and long-term acute care markets. Although it's based in Canada, T.H.E. Medical generates 80% of its revenues in the United States. RecoverCare plans to use its five regional centers, 80-plus service and inventory depots and a direct sales force of 80 to further increase T.H.E. Medical's presence across the United States. T.H.E. Medical has a 60,000-square-foot manufacturing and sales facility and 70 employees.

Nebulizer mask gets thumbs up
RESEARCH TRIANGLE PARK, N.C. - The FDA has given Teleflex Medical the OK to market the Hudson RCI Neb-U-Mask, a respiratory device that allows delivery of both aerosolized medication and a high concentration of medical gases to treat acute asthma exacerbations, the manufacturer announced last week. During an acute asthma attack, a patient may be given oxygen or heliox with pharmacologic therapies; the challenge, according to a press release, has been the lack of a device that allows the simultaneous delivery of medications and gases. The Neb-U-Mask is available in both adult and pediatric versions.

Search function removed temporarily
BALTIMORE - The "Doing Business As (DBA)" search function on the National Provider Identifier (NPI) registry has been temporarily removed form the site's search page for enhancements. CMS expects to have the function back up and running by Oct. 10.