OIG outlines work plan

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Tuesday, February 4, 2014

WASHINGTON – The Office of Inspector General (OIG) has several new HME-related projects in the works for 2014, including a review of the reasonableness of the Medicare fee schedule.

In its recently released 2014 Work Plan, the OIG says it will review the reasonableness of the Medicare fee schedule for certain HME, including commode chairs, folding walkers and transcutaneous electrical nerve stimulators. It will compare what Medicare pays for those items with what non-Medicare payers, such as private insurance companies and Veterans Affairs, pay.

Other new HME-related projects in the work plan:

•    a review of the potential savings that can be achieved by Medicare if certain power mobility devices (PMDs) are rented over a 13-month period rather than acquired through a lump-sum purchase;

•    a review of the market share of different types of diabetic testing strips immediately following the implementation of the national mail-order program;

•    a review of Medicare Part B payments for PMDs to determine whether or not the requirements for a face-to-face examination were met; and

•    a review of Medicare Part B payments for nebulizer machines and related drugs to determine whether or not claims were medically necessary and met requirements.

The OIG also lists in the work plan several HME-related projects in progress, including:

•    a review of the reasonableness of Medicare reimbursement rates for parenteral nutrition compared to amounts paid by other payers;

•    a review of the process CMS used to conduct competitive bidding and to make subsequent pricing determinations as part of Round 1 and Round 2 of the program;

•    a review of Medicare Part B payments for suppliers of PMDs to determine whether or not such payments met requirements;

•    a review of Medicare Part B payments for claims for lower limb prosthetics to determine whether the requirements of CMS’s Benefits Policy Manual were met;

•    a review of claims for frequently replaced supplies for CPAP and RAD devices to determine whether or not medical necessity, frequency and other Medicare requirements are met;

•    a review of Medicare Part B payments for home blood glucose test strips and lancet supplies to determine their appropriateness; and

•    a review of Medicare’s claims processing edits designed to prevent payment to multiple suppliers of home blood glucose test strips and lancets to determine whether or not they are effective in preventing inappropriate payments.