Tag: Medicare

WASHINGTON – AAHomecare is calling on stakeholders to contact their members of Congress this week to ask them to prevent broadly applied “deep” Medicare cuts for 2022.  The potential cuts stem from the application of pay-as-you-go (PAYGO) legislation that was enacted in 2010.  “If not addressed, PAYGO provisions would trigger automatic cuts across a range of federal programs to cover recent deficit spending increases – in this case, red ink incurred via...

WASHINGTON – The improper payment rate for Medicare fee-for-service is 6.27% or $25.74 billion for fiscal year 2020 compared to 7.25% or $28.91 billion for fiscal year 2019, according to CMS.  The decrease was driven by reductions in the improper payment rates for home health and skilled nursing facility claims, the agency says.   Home health: There was a $5.90 billion decrease in estimated improper payments from 2016 to 2020 due to corrective actions such as policy clarification...

WASHINGTON – The majority of Medicare beneficiaries (84%) received telehealth services only from providers with whom they had an established relationship, the Office of Inspector General has found. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship compared to beneficiaries in Medicare Advantage, it found. “This pattern persisted among virtually all of the most common telehealth services,” the...

WASHINGTON – CMS has announced that a systems-wide error resulted in suppressed crossover claims to certain supplemental payers from April 8 through early May, MiraVista reports. The issue affects Medicare claims finalized between April 8 and April 25 for electronic claims, and between April 8 and May 11 for paper claims. Medicare did not send crossover claims to the following payers, according to MiraVista: Anthem BCBS (Connecticut, New Hampshire, Maine and Vermont); BCBS (Michigan and Maine);...

These were some of the reactions of industry stakeholders to the news of CMS’s proposed national coverage determination for home oxygen therapy: “Groundbreaking.” “We haven’t seen something this major happen in a long time.” “This obliterates everything that we’ve held to be immovable ground for oxygen coverage.”  If you’re like me, when you first saw the news on that Friday before a long holiday weekend (classic CMS move,...

WASHINGTON - Medicare paid a total of $17.6 million for telehealth in 2015, compared with $61,302 in 2001, according to a report from the Office of Inspector General. The OIG reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that did not have corresponding originating-site claims, and reviewed provider supporting documentation for a random sample of 100 claims. The OIG found that 69 of the 100 claims met requirements. Of those that did not, the biggest reason...

WASHINGTON ­– Total national health care spending in 2019 grew 4.6%, according to a study from the Office of the Actuary at CMS.  That’s similar to the 4.7% growth in 2018 and the average annual growth of 4.5% since 2016, according the study, which was published Dec. 16.   The share of the economy dedicated to health spending was 17.7%.  The 4.6% in growth in health expenditures was faster than the overall economic growth...

WASHINGTON - CMS announced on Oct. 8 new terms for payments issued under the Accelerated and Advance Payment (AAP) Program. Under the “Continuing Appropriations Act, 2021 and Other Extensions Act,” repayment will now begin one year from the issuance date of each provider's or supplier's accelerated or advance payment. “In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” said CMS Administrator Seema...

WASHINGTON - The owner and CEO of a telemedicine company has pleaded guilty to a $424 million conspiracy to defraud Medicare and receive illegal kickbacks in exchange for DME orders, the Department of Justice has announced.Lester Stockett, the owner of Video Doctor USA and Telemed Health Group, has pleaded guilty to one count of conspiracy to defraud the United States and pay and receive healthcare kickbacks, and one count of conspiracy to commit money laundering. In connection with his plea agreement,...

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...