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Tag: fee schedule


Also Noted

MCOs and Medicaid: Call for support in NY 

March 2, 2021HME News Staff

ALBANY, N.Y. – AAHomecare is calling on providers in New York to help build support for two new bills in the state legislature that would require Medicaid managed care organizations to reimburse for DME and complex rehab at no less than 100% of the published Medicaid fee schedule for the same services and supplies. A.5368 was introduced in the State Assembly on Feb. 16 and S.5118 was introduced in the State Senate on Feb. 24. “This legislation is critically needed to ensure...

complex rehab, dme, fee schedule, managed care organizations, medicaid


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Also Noted

AAH roundup: Proposed rule, Stand Up, TRICARE

November 10, 2020HME News Staff

AAHomecare has published key takeaways from CMS's recent proposed rule outlining changes to the fee schedule methodology starting April 1, 2021, or immediately after the public health emergency, whichever is laterAAHomecare's Stand Up for Homecare, held during last week's Medtrade Virtual Conference, raised $6,500 toward the association's commitment to support ITEM Coalition. The coalition is a policy steering group for more than 80 patient advocacy organizations that have been strong allies on...

aahomecare, competitive bidding, fee schedule, stand up for homecare, TRICARE


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CMS releases 2019 fee schedule adjustments

December 14, 2018HME News Staff

WASHINGTON - CMS's 2019 fee schedule provides a “modest” 2.5% CPI-U increase to single payment amounts for DME in former competitive bidding areas, according to AAHomecare.The fee schedule also provides a 2.5% increase to SPAs for diabetes supplies as part of the mail-order program.It provides a 2.3% increase to current rates for DME not included in the bid program.As previously determined, by a final rule, DME in rural/non-contiguous areas will be paid a 50/50 blended reimbursement rate.“While...

CPI-U, fee schedule


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Rural rates for oxygen dip below bid rates

December 23, 2016Theresa Flaherty, Managing Editor

WASHINGTON - Industry stakeholders are trying to figure out why the recently released 2017 DMEPOS fee schedule appears to apply a “double dip” cut to rural rates for oxygen concentrators, lowering them to below competitive bidding rates.To determine the fee schedule, CMS reduces payments for oxygen concentrators by a certain percentage to maintain budget neutrality in the face of increased utilization for oxygen generating portable equipment.“This comes as somewhat of a surprise...

aahomecare, fee schedule, oxygen reimbursement


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Also Noted

CMS revises enrollment app, fee schedule

September 9, 2016HME News Staff

WASHINGTON - CMS has revised the 855S enrollment application and the July 2016 DMEPOS fee schedule, it announced in a Sept. 8 MLN Connects e-newsletter. The agency plans to publish a revised 855S this fall and providers must begin using it Jan. 1, 2017. Until then, CMS will accept both the current and the revised form. The agency has also revised the fee schedule for 66 codes. For most codes, the revised payment amounts for July 2016 are higher than the original payment amounts, according to AAHomecare.

enrollment, fee schedule


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CMS releases updated fee schedule

December 10, 2015HME News Staff

WASHINGTON - After finding several errors in its revised 2016 DMEPOS fee schedule, CMS has posted an updated version to its website, AAHomecare has announced.The fee schedule maps out adjusted payment amounts for 11 product categories as part of the national roll out of competitive bid pricing on Jan. 1.The first version of the revised fee schedule was released on Nov. 23.CMS has developed payment amounts for non-bid areas by using the average pricing in the competitive bidding areas in the...

fee schedule, national roll out


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Specialty Providers

Orthotics codes become trickier to bill

January 3, 2014Theresa Flaherty, Managing Editor

BALTIMORE - The 2014 Medicare DMEPOS fee schedule could create billing confusion for orthotics providers.The recently released schedule applies the same payment amounts to 23 orthotics codes, regardless of whether they are classified as off-the-shelf (OTS) orthotics or require some customization.“There is no difference in the reimbursement, but they do make a distinction in the description of the code,” said Ryan Ball, director of state policy for VGM & Associates. “Whether you...

coding, customized, fee schedule, off the shelf, orthotics


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Indiana: Medicaid rethinks manually priced products

November 23, 2010Liz Beaulieu, Editor

INDIANAPOLIS - The state's Medicaid program is on a mission to limit the number of HME products that aren't part of the fee schedule and are manually priced. Earlier this year, Medicaid notified HME providers that they had to include cost invoices with claims for manually priced products beginning Oct. 1. The reason: The state wants to see if it can save money and time by creating a fee schedule for inexpensive, routinely dispensed products. "The encouraging part is that they understand that complex...

fee schedule, manually priced HME


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