Tag: Medicare
William Felix on recognizing innovation, while protecting Medicare
October 18, 2024Theresa Flaherty, Managing Editor
YARMOUTH, Maine – Dr. William Felix has worn many hats throughout his career, including chief medical officer for Medicare DMEPOS and medical director of the Pricing, Data Analysis and Coding division at Palmetto GBA, but one constant is his passion for getting innovative technology into the hands of patients.
“The sooner the patient or the beneficiary can have their hands on this technology that can improve their quality of life, along with a healthy lifestyle, and their lives...
AAH comments on NIV NCA
October 17, 2024HME News Staff
WASHINGTON – AAHomecare has submitted comments in response to the opening of a national coverage analysis for the use of noninvasive positive pressure ventilation in the home for the treatment of chronic respiratory failure consequent to COPD. In its comments, the association strongly urged the agency to establish clear and subjective medical need criteria for coverage. “When medical professionals prescribe this therapy for their patients, it is important that the clinician community...
OIG: More oversight needed of remote patient monitoring
September 25, 2024HME News Staff
WASHINGTON – CMS needs to provide more oversight of remote patient monitoring to ensure it is being used and billed properly, says a new report from the Office of Inspector General.
From 2019 to 2022, use of remote patient monitoring increased dramatically, from about 55,000 enrollees to 570,000. In 2022, payments for these services by traditional Medicare and Medicare Advantage were more than $300 million, compared to just $15 million in 2019.
However, the OIG found 43% of...
CMS seeks input on NIV
September 12, 2024HME News Staff
WASHINGTON – CMS is soliciting public comment on a request for reconsideration of NCD 280.1 to establish coverage policies for the use of noninvasive home mechanical ventilators and respiratory assist devices for Medicare beneficiaries with COPD.
The scope of the agency’s national coverage analysis (NCA) is limited to noninvasive positive pressure ventilation in the home for the treatment of chronic respiratory failure consequent to COPD and will focus on clinical indications...
Election coverage: Poll lays out hot button issues
August 23, 2024Liz Beaulieu, Editor
YARMOUTH, Maine – At the top of the list of priorities for Medicare under a new administration are fair reimbursement, fraud prevention and streamlined documentation, say respondents to a recent HME Newspoll.
“The top priority for Medicare is to implement fair, market-based reimbursement rates,” wrote Craig Rae of Penrod Medical Equipment in Salisbury, N.C. “DME providers are dealing with a harsh reality that either CMS doesn’t understand or doesn’t want...
CMS report: Health spending will rise
June 17, 2024HME News Staff
WASHINGTON – CMS's Office of the Actuary projects that average annual growth in national health expenditures (5.6%) will outpace average annual growth in GDP (4.3%), resulting in an increase in the health spending share of GDP from 17.3% in 2022 to 19.7% in 2032.
The NHE estimates discussed in the office’s new report contain expected effects from the Inflation Reduction Act of 2022 (IRA), including anticipated effects associated with the law’s provisions regarding the...
OIG: Medicare remains vulnerable to orthotics fraud
May 30, 2024HME News Staff
WASHINGTON – The Office of Inspector General says there are still issues related to CMS’s oversight of off-the-shelf braces, including providers that ordered braces for enrollees for whom there was no history of a treating relationship.
The OIG also found new suppliers located in geographic areas with known Medicare fraud; Medicare paid more than private payers for OTS braces; and suppliers used prohibited solicitation to contact enrollees.
“These issues continue...
CMS proposes policies to support underserved communities
April 11, 2024HME News Staff
WASHINGTON – CMS has issued a proposed rule to improve the health of Medicare beneficiaries by addressing social determinants of health, strengthening emergency preparedness, and improving maternal health.
The fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) rule builds on the Biden-Harris Administration’s work to support historically underserved and under-resourced communities and promote...
Uncertainty surrounds reimbursement relief
March 19, 2024HME News Staff
WASHINGTON – Industry stakeholders are on the hunt for another vehicle for their legislation to extend the 75/25 blended Medicare reimbursement rate in non-rural areas through 2024.
AAHomecare reports that its lobbyists and HME advocates on the Hill have indicated that reimbursement relief will not be included in a second segment of appropriations language that must pass Congress by March 22 to prevent another government shutdown.
“We will continue to look for other...
Georgia man pleads guilty to $127M fraud scheme
December 21, 2023HME News Staff
NEWARK, N.J. – Nicco Romanowski, of Roswell, Ga., pleaded guilty to conspiracy to violate the federal anti-kickback statute and conspiracy to commit health care fraud. From June 2017 through May 2019, Romanowski participated in a scheme with DME companies, telemedicine companies and doctors to submit false claims to health care benefit programs, including Medicare and Tricare. In total, Romanowski and his conspirators caused the submission of false and fraudulent claims to health care benefit...