CMS: Data shows payment amounts not an issue

Providers are accepting assignment, so the reimbursement must be adequate, agency reasons
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Wednesday, May 18, 2016

WASHINGTON – CMS announced this week that it believes reimbursement cuts implemented Jan. 1 in non-competitive bidding areas have not had a negative effect on beneficiary access.

CMS compared the rate of assignment of claims for DMEPOS items for the first four months of 2015, which were paid at the unadjusted fee schedule rates, to the rate of assignment of claims for the same items for the first four months of 2016, which were paid at the new partially adjusted rates. 

“The monitoring data shows that suppliers in all areas where the adjusted DMEPOS fee schedule rates have been implemented have continued to accept these adjusted rates as payment in full, suggesting that the adjusted fee schedule rates continue to be more than adequate in covering the costs of furnishing the DMEPOS items in all areas,” the agency stated.

On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the current fee schedule and adjusted rates from its competitive bidding program. On July 1, it will base pricing 100% on adjusted rates.

Overall, there was no change in the rate of assignment for the first four months in 2016 (99.88%) compared to the first four months in 2015 (99.87%). There was also no change in the rate of assignment in rural areas in 2016 (99.9%) compared to 2015 (99.9%). The rate of assignment in non-contiguous areas changed slightly in 2016 (99.81%) compared to 2015 (99.90%).

“CMS believes that the fee schedule adjustments implemented in January have not had a negative impact on beneficiary access to quality items and services,” stated the agency.

CMS says it will continue to monitor data.