OIG: Medicare pays too much for non-invasive vents

Agency recommends CMS include E0466 in bid program ‘as soon as possible’
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Tuesday, September 22, 2020

WASHINGTON – Medicare pays more for non-invasive ventilators than certain other payers, according to a new report from the Office of Inspector General.

The OIG estimates that Medicare and beneficiaries could have saved $86.6 million if Medicare-allowed charges were comparable with payment rates of select non-Medicare payers for HCPCS code E0466.

Medicare paid $424.4 million for non-invasive vents in 2018, a 52% increase compared to 2016, the OIG found.

The agency believes Medicare pays more for non-invasive vents than select non-Medicare payers because CMS does not routinely evaluate the pricing trends or payment rates of those payers. Instead, CMS uses statutorily mandated fee schedule payments and applies an economic update factor to them.

The OIG recommends that CMS review Medicare-allowed charges for non-invasive vents and add E0466 to the competitive bidding program as soon as possible.

In response, CMS confirmed that it has been evaluating non-invasive vents for potential inclusion in the bid program and noted that it had included the product category in Round 2021 but removed it in April due to the COVID-19 pandemic.

The agency said it will consider whether to include non-invasive vents in future rounds of the program.