Tag: CMS
Dr. Oz launches Medicare enrollment series
June 11, 2025HME News Staff
WASHINGTON – CMS Administrator Dr. Mehmet Oz, who turns 65 today, is using his own Medicare enrollment experience to help Americans better understand how to sign up for Medicare and select the coverage that best fits their needs. Through a new video and social media series, Dr. Oz is walking future enrollees through simple steps they can take to get started—beginning with Medicare.gov. “Millions of Americans become eligible for Medicare each year, and this year, I’m one of...
CMS releases final NCD for non-invasive ventilation
June 9, 2025HME News Staff
WASHINGTON – CMS has released a final national coverage determination (NCD) for non-invasive positive pressure ventilation (NIPPV) in the home for the treatment of chronic respiratory failure consequent to COPD.
The final NCD:
Provides coverage of respiratory assist devices (RADs) for the treatment of chronic respiratory failure that often accompanies COPD; and
For the first time, establishes coverage for home mechanical ventilation for patients with COPD.
For...
CMS awards RAC contracts to Cotiviti
June 4, 2025HME News Staff
WASHINGTON – CMS in April named Cotiviti GOV Services the new Recovery Audit Contractor (RAC) for Region 3, 4 and 5. These three contracts, awarded through a competitive procurement process, will support post-pay review of Medicare claims in these regions to efficiently identify and correct overpayments and underpayments made to health care providers with a focus on the quality, accuracy and transparency of reviews, the recovery of improper payments and the reduction of provider burden, Cotiviti...
CMS: Gov't must be ‘catalyst’ to digital health
May 14, 2025HME News Staff
WASHINGTON – CMS, in partnership with the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), seeks public input on how best to advance a seamless, secure and patient-centered digital health infrastructure.
The goal is to unlock the power of modern technology to help seniors and their families take control of their health and well-being, manage chronic conditions and access care more efficiently, the agency says.
“We...
Proposed rule would establish more guardrails for Medicare Advantage
December 4, 2024HME News Staff
WASHINGTON – CMS is proposing changes to the Medicare Advantage (MA) and Medicare Part D prescription drug programs to hold them more accountable for delivering high-quality care for people with Medicare.
In the Contract Year 2026 MA and Part D proposed rule, CMS proposes addressing inappropriate use of prior authorization and internal coverage criteria, including by defining the meaning of “internal coverage criteria” to clarify when MA plans can apply utilization management,...
HHS, CMS outline flexibilities in wake of cyberattack
March 5, 2024HME News Staff
WASHINGTON – The U.S. Department of Health and Human Services has outlined steps that CMS has taken to assist providers to continue serving patients in the wake of the Change Healthcare cyberattack.
Affected parties should be aware of the following flexibilities, the agencies say:
Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic...
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...
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...
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,...
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...