Tag: Andrea Stark

YARMOUTH, Maine – Medicare Advantage will be the elephant in the room in 2023, say Andrea Stark and Jeff Baird, due to the “sheer mass migration” of beneficiaries to these plans.  “Everything is centered around managed care,” said Baird, chairman of the Health Care Group at Brown & Fortunato. “It seems like, overnight, we woke up and 50% of Medicare patients are now covered by these plans.”  HME News connected with Stark, a Medicare consultant...

WASHINGTON – CMS has begun setting the stage for the end of the public health emergency and so should HME providers, say stakeholders.  The agency recently released an overview, “Creating a Roadmap for the End of the Covid-19 Public Health Emergency,” and while it doesn’t provide new information, it summarizes waivers still in place and those that have already expired.  “Eventually, the PHE is going to come to an end and suppliers need to be thinking...

BALTIMORE – With a new clarification from CMS and the DME MACs, it’s “crystal clear” that certificates of medical necessity are no longer required for oxygen claims during the public health emergency, say industry experts.  “The guidance is crystal clear and precise,” said Andrea Stark, a Medicare consultant and reimbursement specialist for MiraVista. “Providers have chased their last CMN for oxygen.”  CMS in June posted a joint...

WASHINGTON – Industry stakeholders are trying to guide what a post-PHE world for home oxygen therapy and other product categories might look like.  AAHomecare recently discussed with CMS a one-page recommended reference document for Medicare audit contractors reviewing claims for dates of service during and after the PHE. The document is a cheat sheet of sorts for the waivers that have been in place during the PHE that don’t require, for example, medical documentation or a signature.  “It...

YARMOUTH, Maine – Andrea Stark says the HME industry hasn’t experienced a coverage expansion like what’s in the new NCD for home oxygen therapy in recent history.  Stark, the head of reimbursement at MiraVista LLC, was a guest on a recent HME News in 10 podcast to talk about the ripple effects of the new NCD, which expands coverage to acute conditions and eliminates the CMN requirement, and how the DME MACs will interpret the new policy.  Caught by surprise  “CMS...

Q. How can suppliers find out when patients switch to Medicare Advantage Plans?  A. Because many patients forget to notify DME suppliers directly, denials from an inactive plan are often the first sign that a patient has changed insurance coverage. Fortunately, Medicare eligibility data is a powerful tool for identifying policy changes in advance. Search results include effective dates for plans that go into effect up to four months after the date of service queried.  A structured,...

Q. When can oxygen suppliers stop using the CMN?  A. Suppliers can stop using CMNs for oxygen setups with dates of service on and after Sept. 27, 2021. A recent change to the Home Use of Oxygen National Coverage Determination (NCD) eliminates the CMN requirement. In lieu of a CMN, suppliers need a standard written order from a treating practitioner.   To release initial claims for hypoxic patients, suppliers must confirm the medical records support the need for oxygen with test results...

Q. Can suppliers bill monthly rentals for Medicare patients with recalled Philips CPAP devices? A. Yes, so long as the patient continues to use the device. Suppliers, however, should be increasingly diligent in their monthly verification procedures because the publicity surrounding the recall may persuade regular CPAP users to stop using their machines, even those produced by Philips’ competitors. Remote monitoring is the easiest way to satisfy the requirement, but suppliers can also...

Q. Can suppliers sell new CPAPs to Medicare beneficiaries who own a recalled machine but don’t want to wait for warranty repairs?  A. Yes. When the equipment is over five years, it has exceeded its reasonable useful life. Suppliers can bill new equipment to Medicare with a new prescription.  If the patient’s equipment is less than five years old, Medicare will not pay for a new machine because the equipment remains within the useful lifetime.  Patients may want...

YARMOUTH, Maine – The contract may be running out for a demonstration that allows HME providers to try to resolve denied claims by phone, but Andrea Stark says, “We’re onto something here,” and hopes CMS will make it a permanent part of the statement of work for the QIC.  The QIC, which is run by Maximus, recently announced it is winding down the demo per a contract that ends Dec. 31, 2021.  “Clearly, DME is complicated and suppliers feel better when...