Tag: Coverage

WASHINGTON - Starting April 20, CMS permanently suspended claims editing for multi-function ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime, according to a revised MLN Matters article.Effective immediately, DME suppliers may provide and bill for multi-function vents described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage criteria for a vent.Ventec Life Systems, which makes the VOCSN multi-function...

WASHINGTON - CMS has allowed for expanded use of multi-function ventilators (E0467), according to an MLN Matters article.“Effective immediately, you may provide and bill for multi-function ventilators described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage for a ventilator,” the article states.Previously, to meet the medical necessity coverage for multi-function vents, CMS required beneficiaries to need a ventilator and at least one of the four additional...

WASHINGTON - Medicare will cover respiratory related devices and equipment for any medical reason determined by clinicians during the coronavirus pandemic, CMS announced last night.Previously, Medicare only covered them under certain circumstances.“Clinicians now have maximum flexibility in determining patient needs for respiratory related device and equipment and the flexibility for more patients to manage their treatments at the home,” the agency states. “The current NCDs and...

MINNEAPOLIS - Two Medicare Administrative Contractors, Noridian and Palmetto, have published draft local coverage determinations that propose coverage for Inspire Medical Systems' obstructive sleep apnea therapy, according to the company. Both draft LCDs state that for individuals with OSA who are treated with hypoglossal nerve stimulation, the evidence is sufficient to determine that neurostimulation technology results in a meaningful improvement in the net health outcomes when used as outlined....

MINNEAPOLIS - Inspire Medical Systems has added 10.4 million covered lives with several new coverage policies. Two new Blue Cross Blue Shield Association plans, including Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program, and BCBS of Tennessee have issued positive coverage policies for the Inspire therapy. Additionally, Medical Mutual of Ohio has issued positive coverage. There have now been 18 positive coverage policies issued by BCBSA healthcare plans, covering...

CMS this week has made much ado about its new “What's Covered” app that allows beneficiaries to see whether Medicare covers a specific medical item or service, which of course includes HME. The launch of the app paralleled the agency's CMS Quality Conference, or #CMSQualCon19 as it's known on twitter. CMS's coverage of the event on the social media platform has included photos of attendees, including these patient advocates, giving the app a whirl. Screen Shot 2019-01-30 at 12.33.28...

WASHINGTON - Medicare made a clerical error when it said it considered wheelchair trays, tables or similar products convenience items. The agency said claims for E0950 would be denied as statutorily non-covered, no benefit, according to an LCD and policy article revision posted by the DME MACs on March 16. The article was corrected on March 30. The change was set to take effect retroactively on Jan. 1, 2017. Concerns with the change included the medical necessity of these items and the timing. “They...

COLUMBIA, S.C. - CMS is not done tinkering with coverage guidelines for vents, predicts consultant Andrea Stark.Discussing the National Association for Medical Direction of Respiratory Care's recent request that CMS reconsider its national coverage determination for vents, Stark said during a recent webcast: “CMS is not obligated to agree or institute any changes. However, in light of many 'quiet' changes behind the scenes, we do not expect CMS to remain silent on ventilators.”NAMDRC's...

WASHINGTON - In highly anticipated clarifications on coding and coverage requirements for ventilators, the DME MACs have acknowledged that coverage for the product category isn't quite black and white.While the National Coverage Determination stipulates that vents are covered for neuromuscular diseases, thoracic restrictive diseases and chronic respiratory failure, the DME MACs acknowledge that these disease groups overlap conditions described in the local coverage determination for respiratory assist...

WASHINGTON - Rep. Renee Ellmers, R-N.C., has introduced a bill that would halt CMS's plans to make dramatic changes to coverage for prosthetic devices.H.R. 5045, the “Preserving Access to Modern Prosthetic Limbs Act of 2016,” would “impose a moratorium on the implementation of a proposed Medicare local coverage determination on lower limb prostheses,” according to a bulletin from the American Orthotics and Prosthetics Association.The bill would restrict CMS from implementing...