Tag: CMS

WASHINGTON – Reps. Terri Sewell, D-Ala., and Adrian Smith, R-Neb., are collecting signatures for a sign-on letter asking CMS to accept the standard written order as the only necessary documentation to establish medical necessity for audits of home oxygen, sleep and non-invasive ventilation claims submitted during the public health emergency, according to AAHomecare.  The letter asks CMS to protect patient access by instructing contractors to use CMS’s widely accepted...

WASHINGTON – CMS has added 10 more HCPCS codes to a required list for a face-to-face encounter /written order prior to delivery, according to VGM Government Relations.  The new codes include the following for back, knee and ankle/foot braces: L0631, L1843, L1932, L1940, L1951, L1960, L1970, L2005, L2036. Also included: E0748, osteogenesis stimulator, electrical, non-invasive, spinal applications.  The effective date for the news codes is April 2023.  The required...

WASHINGTON – CMS should bolster its oversight of manufacturer-submitted average sales price (ASP) data to ensure accurate Part B drug payments, according to a new report from the Office of Inspector General.   Due to invalid or missing ASP data, CMS could not calculate an ASP-based payment amount for 8% of drug codes at least once between 2016-20, the OIG found.  “CMS was unable to calculate an ASP-based payment amount for several reasons, including that (1)...

WASHINGTON – CMS should bolster its oversight of manufacturer-submitted average sales price (ASP) data to ensure accurate Part B drug payments, according to a new report from the Office of Inspector General.   Due to invalid or missing ASP data, CMS could not calculate an ASP-based payment amount for 8% of drug codes at least once between 2016-20, the OIG found.  “CMS was unable to calculate an ASP-based payment amount for several reasons, including that (1)...

WASHINGTON – The Office of Inspector General has published its annual “Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste and Abuse in HHS Programs” and DME makes more than one appearance.  This year, the OIG’s recommendations focus on the top 25 unimplemented recommendations that, in its view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented.  Recommendations...

WASHINGTON – CMS has identified errors in the fee schedule amounts for certain items furnished in non-contiguous areas and has released revised public use fee schedule files. Most of the corrections to the fee schedule amounts were minor, resulting in an estimated aggregate underpayment of about $3,200 dollars in 2022 with percentage fee adjustments ranging from 0.5% to 5.1% for certain items. Fewer than 3,000 claims are affected by these errors and will be automatically reprocessed by the...

WASHINGTON – It should be business as usual for providers when CMS winds down the National Supplier Clearinghouse on Nov. 6, but industry stakeholders caution a wait-and-see approach.  Agency officials announced during a Sept. 21 Open Door Forum that it’s transitioning from the NSC to two National Provider Enrollment Contractors: Palmetto GBA, for the western half of the country (NPEC West) and Novitas for the eastern half (NPEC East).   While stakeholders are familiar...

WASHINGTON – The standard monthly premium for Medicare Part B beneficiaries will be $164.90 for 2023, a decrease of $5.20 compared to 2022.   The annual deductible for all Medicare Part B beneficiaries will be $226 in 2023, a decrease of $7 compared to 2022, according to information released Sept. 27 by CMS.  The 2022 premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm. Lower-than-projected spending on both Aduhelm and other Part...

WASHINGTON – The National Suppliers Clearinghouse will no longer process new DMEPOS provider enrollment applications starting Oct. 29, CMS officials announced during a Sept. 21 Open Door Forum. After that date, Palmetto will process applications for the west half of the country and Novitas for the east half. At this time, suppliers don’t need to take any action, but they should continue working with the NSC, officials said. Any in-process applications will automatically be transferred...

WASHINGTON – Eight drug codes met CMS’s price substitution criteria in the first quarter of 2022 by exceeding the 5% threshold for two consecutive quarters or three of the previous four quarters, according to a new Office of Inspector General report. The OIG is providing the eight drug codes to CMS for its review. The OIG says CMS should review the information to pursue price substitutions that would limit excessive payments for Part B drugs. To conduct the study, the OIG obtained average...