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Tag: Catheter


Cara Bachenheimer

Specialty Providers

Catheter proposal is ‘huge step forward’

June 14, 2024Theresa Flaherty, Managing Editor

WASHINGTON – CMS’s plan to “explode the codes” for intermittent urinary catheters will better reflect available technologies, says Cara Bachenheimer, who leads the Government Affairs Practice of Brown & Fortunato.  CMS in May proposed discontinuing two existing HCPCS codes for intermittent urinary catheters, A4351 and A4352, and establishing five new codes, in response to a request from AAHomecare and its manufacturer members, who comprise the Intermittent Catheter...

AAHomecare, Cara Bachenheimer, Catheter


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In brief: CMS makes advance payments, state AG sues Apria, OIG warns of cath scams 

March 13, 2024HME News Staff

WASHINGTON – CMS on March 9 made available Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions.  The payments may be granted in amounts representative of up to 30 of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider/supplier between Aug. 1, 2023, and Oct. 31, 2023, divided by three. These payments...

advance payments, Apria, Catheter, Change Healthcare, Cyberattack, Data Breach, Fraud


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OIG publishes ‘Consumer Alert’ for cath scams 

March 11, 2024HME News Staff

WASHINGTON – The Office of Inspector General is alerting the public about a fraud scheme involving urinary catheters. In a “Consumer Alert,” the agency says scammers are targeting Medicare enrollees through phone calls, Internet ads and text messages with offers of free services, medical equipment or gift cards upon confirming their personal information and eligibility for specific Medicare services. Often, the enticement for the individual is that they are “qualified”...

Catheter, Fraud, Office of Inspector General (OIG)


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In brief: AAH on cath fraud & CCS on GLP-1s

March 8, 2024HME News Staff

WASHINGTON – AAHomecare has issued a statement affirming its support for the government to implement real-time monitoring of claims to detect potential fraud and abuse, in response to news reports of potential Medicare fraud by a handful of intermittent catheter companies.  AAHomecare's statement, which was shared with CMS and Capitol Hill, also reiterates recommendations for federal government initiatives to better monitor DME supplier billing practices and trends, including:  Increased...

AAHomecare, Catheter, CCS, Diabetes, Noridian, Soleo Health


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DMEMACs clarify coverage for caths 

December 5, 2023HME News Staff

WASHINGTON – Both CGS and Noridian have clarified that a high-level spinal cord injury (T3 and above) is an example of immunosuppression, meeting criteria #2 for coverage for closed-system catheters, Coloplast has announced. In October 2021, during a DME MAC council call, it was stated, “The example of high-level spinal cord injury patients (higher than T3) will be considered for coverage when conducting medical reviews of intermittent catheterization using a sterile intermittent catheter...

Catheter, coverage criteria, spinal cord injury


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Avalon GloboCare acquires Merlin Medical Supply

September 14, 2023HME News Staff

FREEHOLD, N.J. – Avalon GloboCare, a developer of innovative precision diagnostics and provider of clinical laboratory services, has announced that Laboratory Services MSO has acquired Merlin Medical Supply, an HME company providing acute and non-acute medical supplies in Ventura County, Calif. Additionally, LSM has acquired Leading Edge Innovations, which owns the GeeWhiz External Condom Catheter, a patented, FDA-registered, in-market, male incontinence device, from the same owner.  “MMS...

Avalon GloboCare, Catheter, Merlin Medical Supply


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Bill introduced in Iowa addresses catheters made with DEHP

February 24, 2023HME News Staff

DES MOINES, Iowa – Democratic Iowa State Representative Josh Turek has introduced the Better Caths for Iowa Act (H.F. 387) to review the use and reimbursement of certain catheters under the Medicaid program, specifically urinary catheters made with the harmful chemical DEHP.   A four-time Paralympian who was born with spina bifida, Josh and his basketball team most recently brought home gold from the 2020 Tokyo Paralympics.    "Bladder cancer took the life of Dale Ericksen,...

Catheter, Iowa


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OIG report on catheters: ‘Where are they getting their information?’

Specialty Providers

OIG report on catheters: ‘Where are they getting their information?’

November 22, 2022Theresa Flaherty, Managing Editor

YARMOUTH, Maine – An Office of Inspector General report “understates” the actual cost of providing catheters, especially given the complexity of both Medicare’s documentation requirements and the needs of patients, say providers.  The report, released in September, found that Medicare payments for intermittent urinary catheters were 3.4 times supplier acquisition costs in fiscal year 2020 and recommended that CMS lower its reimbursement rates.  “I’d...

Aeroflow, Catheter, Chris Malcom, First source catheters, Mica Philips, Office of Inspector General (OIG), Report, Urology


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In brief: Philips recall, catheter payments, Pottery Barn play

September 9, 2022HME News Staff

PITTSBURGH – Philips Respironics is alerting users of certain CPAP or Bi-Level PAP therapy masks with magnetic headgear clips or straps that these devices should not be used by or near patients and their household members, caregivers and bed partners who have metallic implanted devices or metallic objects (such as metallic splinters) in the body.   The magnetic headgear clips are used to attach the headgear straps to the masks, a commonly used method in sleep therapy devices.  This...

Catheter, Mergers & Acquisitions (M&A), Philips Recall, Pottery Barn, ResMed, Responsive Respiratory


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OIG report: CMS should reduce cath payments

September 7, 2022HME News Staff

WASHINGTON – Medicare payments for intermittent urinary catheters were 3.4 times supplier acquisition costs in fiscal year 2020, according to a new analysis by the Office of Inspector General.  In total, Medicare allowed $407 million in payments for these items, while suppliers paid approximately $121 million to acquire them.   Each of the three billing categories for intermittent urinary catheters (straight tip, curved tip, and sterile kit) showed large differences between...

Catheter, Medicare, Office of Inspector General (OIG)


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