Tag: CMS

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...

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 – CMS has published an adjusted fee schedule for oxygen therapy for April 2021 that doesn’t include a percentage reduction to meet the budget neutrality requirement. The adjustments result in an increase in fee schedule amounts ranging from $6.72 to $8.19 in former competitive bidding areas; $5.17 to $5.43 in other non-rural areas; and $4.14 to $6.82 in non-contiguous and rural areas, according to the VGM Group. The fee schedule amounts are not retroactive –...

WASHINGTON - Liz Richter has been named acting administrator of CMS and Norris Cochran has been named acting secretary of the Department of Health and Human Services.  Richter is an agency veteran who has worked at CMS since 1990, most recently as deputy center director for the Center for Medicare. She began in the Bureau of Policy Development working on inpatient hospital payment policy. She subsequently worked on a variety of Medicare payment issues. She has...

DUBLIN – The biggest barrier to CGMs and other innovative diabetes technology is cost, says Medtronic, and that’s why the company recently launched a CGM Access Discount Program for certain users.  “Our goal is to make therapy available to everyone and we hear cost is one of the top reasons they can’t go on CGMs or fall off (using CGMs),” says Krista Sugerman, vice president of global customer engagement for Medtronic. “We try to...

WASHINGTON ­– Non-competitive bidding areas will see a slight decrease in Medicare reimbursement, based on the 2021 fee schedule CMS released earlier this week.  Rural areas will see a decrease of about 0.2% and non-rural areas will see a decrease of about 0.5%, according to an analysis of the top 25 HCPCS codes by AAHomecare.  CMS will continue to apply the CARES Act relief rates in rural and non-rural areas, resulting...

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 has published a proposed rule that seeks to codify in regulations the definition of “reasonable and necessary” with modifications, including adding a reference to Medicare patients and a reference to commercial health insurer coverage policies. CMS proposes that an item or service would be considered “reasonable and necessary” if it is safe and effective; not experimental or investigational; and appropriate for Medicare patients, including the duration and...

WASHINGTON - CMS is proposing to allow home health agencies to continue to report the costs of telehealth as allowable administrative costs on line 5 of the home health agency cost report, according to a proposed rule. The agency proposes modifying the instructions regarding line 5 to reflect broader use of telecommunications technology. Additionally, CMS proposes to include not only remote patient monitoring but also other communications or monitoring services, consistent with the plan of care for...

WASHINGTON - CMS has created the Office of Burden Reduction and Health Informatics to unify the agency's efforts to reduce regulatory and administrative burdens.The new office is an outgrowth of the agency's Patients over Paperwork Initiative, part of its efforts to implement President Trump's 2017 executive order to “Cut the Red Tape” and eliminate duplicative, unnecessary and costly requirements and regulations.“The Office of Burden Reduction and Health Informatics will ensure...