Tag: Bundled Payments

WASHINGTON - A bipartisan group in the House of Representatives is circulating a congressional sign-on letter that asks CMS to delay a CPAP bundling pilot program from the next round of competitive bidding.The letter states a number reasons for delaying the program, including the lack of evidence that it will save money or enhance care, and CMS's lack of authorization to test alternative payment models as part of its competitive bidding program.“Instead, we encourage the agency to work with...

LAS VEGAS - CMS's plan to use bundled payments isn't popular, but the initiative could, ultimately, help HME providers show their worth as cost-savers, says Emmet Seibels, who spoke at Medtrade Spring last week.“DME gets seen as a cost,” said Seibel, president of Verus Healthcare, a healthcare supply company based in Franklin, Tenn. “DME produces great results. We need to flip the perception of DME from a cost center.”CMS in October released a final rule detailing its plans...

Dear Ms. Tavenner: I write this letter based on my experience as the executive director of the American Sleep Apnea Association from May 2004 to March 2014. The opinions and recommendations expressed here are my own and not those held by the association.During my tenure at the association, significant changes have come about in health care, in general, and for obstructive sleep apnea (OSA) in particular. The decision to allow for physician payment for prescription of positive airway pressure (PAP)...

WASHINGTON - Industry stakeholders say a large number of providers answered the call to submit comments by Sept. 2 on a proposed rule to, among other things, expand the competitive bidding program nationwide.More than 4,000 comments were submitted on the overall rule, and stakeholders believe a good number of them pertained to the bid expansion and another HME provision to create bundled monthly payments.“The feedback we've gotten from providers spoke to rural healthcare access,” said...

YARMOUTH, Maine - Mobility providers aren't lining up to support a CMS proposal to describe, and pay for, standard manual and standard power wheelchairs each under a single code. Ninety-five percent of the 98 respondents to a recent HME NewsPoll say they don't like the plan. There are too many differences between wheelchairs—combining them under a single code would encourage the use of cheap products with few options, they say.“There are too many variations based on the individual...

WASHINGTON - The devil's in the details, and the lack of details in CMS's proposal to implement bundled monthly payments for standard manual and power wheelchairs has stakeholders on edge.“There are so many more questions that this proposal raises than it answers, and that should probably be more troubling than anything else,” said Cara Bachenheimer, senior vice president of government relations for Invacare.CMS states in a proposed rule published in the Federal Register on July 11: “We...

WASHINGTON - CMS's plan to expand competitive bidding pricing and implement bundled monthly payments for certain HME is a mixed bag of positives and negatives, industry stakeholders say.Biggest loser: rural areasIn a July 11 proposed rule, the agency outlines plans to apply competitive bidding prices in non-bid areas by using regional prices limited by a national ceiling (110% of the average of regional prices) and the floor (90% of the average of regional prices).“Until they calculate the...

WASHINGTON - CMS on July 2 issued a proposed rule outlining how it plans to expand competitive bidding pricing nationwide and bundle payments for certain DME.CMS proposes expanding competitive bidding pricing by:. Adjusting fee schedule amounts for states in different regions of the country based on competitive bidding pricing from competitions in these regions. The regional prices would be limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional...

YARMOUTH, Maine - Bundling payments for certain DME would create a bundle of problems for providers and beneficiaries alike, according to a recent HME NewsPoll. “Bundling would vastly complicate all aspects (ordering, supplying, billing) because customers' needs vary so much,” said Janet Poole, a billing supervisor with New Hampshire Pharmacy and Medical Equipment in Washington, D.C.  “How could a fair price be determined?”CMS is seeking comments on a proposal to...

BALTIMORE - The costs for providing enteral nutrition fluctuate so wildly, that bidding the product category as a bundled service would be a stab in the dark, say providers.“The more complicated the bid, the more unrealistic the price,” said Jeff Rose, vice president at Health System Services in Niagara Falls, N.Y.In an advance notice of proposed rulemaking published Feb. 24, CMS said it was seeking comments on whether it should simplify payment rules under competitive bidding for enteral...