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Tag: CMS


News

CMS seeks increased transparency for MA plans 

January 29, 2024HME News Staff

WASHINGTON – CMS has released a request for information (RFI) to solicit feedback from the public on how best to enhance Medicare Advantage data capabilities and increase public transparency.  The agency says transparency is especially important now that MA plans have grown to more than 50% of Medicare enrollment, and the government is expected to pay these plans more than $7 trillion over the next decade.  “Americans with Medicare who have managed care plans called Medicare...

CMS, Medicare Advantage, Request for information, transparency


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In brief: Senators write GAO, CMS reports on spending, Quantum appears at the Met

December 15, 2023HME News Staff

WASHINGTON – U.S. Senate Majority Whip Dick Durbin, D-Ill., and U.S. Sen. Richard Blumenthal, D-Conn., have sent a letter to the Government Accountability Office (GAO) calling on the agency to update its 2011 report entitled “Medical Devices: FDA Should Enhance Its Oversight of Recalls” in the wake of the Philips Respironics recall.    The Senators sent the letter following the Pittsburgh Post-Gazette’s and ProPublica’s reporting on the recall of certain...

Accreditation Commission for Health Care (ACHC), Aeroflow, Belluscura, CMS, Health care spending, Quantum Rehab


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CMS: Medicare Advantage, drug programs to remain stable in 2024 

September 27, 2023HME News Staff

WASHINGTON – Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain stable in 2024, according to CMS.  The announcement precedes the upcoming Medicare Open Enrollment period, which begins Oct. 15, 2023, to help people with Medicare determine the best Medicare coverage option for their health care needs.  “A top priority for CMS is to protect and strengthen the Medicare program for people with Medicare,...

CMS, Medicare Advantage, Premiums, prescription drug plans


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Terri Sewell

News

Reps. Sewell, Smith launch sign-on letter to protect access to oxygen 

July 17, 2023HME News Staff

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...

CMS, Documentation, Oxygen


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News

CMS expands required list 

January 17, 2023HME News Staff

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...

CMS, Documentation


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News

In brief: Part B drug payments, Kalogon deal, new Vertess managing director

January 6, 2023HME News Staff

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)...

CMS, Home Medical Equipment (HME), Kalogon, Medicare, Merits Health Products, Vertess


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OIG to CMS: Accuracy of Part B drug payments is substantially hindered 

January 3, 2023HME News Staff

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)...

CMS, Medicare


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OIG calls out unimplemented recommendations 

December 19, 2022HME News Staff

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...

CMS, Medicare, Office of Inspector General (OIG)


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Also Noted

CMS issues corrected fee schedules

November 16, 2022HME News Staff

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...

CMS, Home Medical Equipment (HME)


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Kelly Grahovac

News

Stakeholders gear up for NSC transition

September 30, 2022Theresa Flaherty, Managing Editor

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...

CMS, National Supplier Clearinghouse, Novitas, Palmetto, Provider


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