Tag: Medicare

WASHINGTON – If the Inflation Reduction Act’s provision capping the cost of insulin at $35 for a month’s supply had been in place in 2020, 1.5 million Medicare beneficiaries across the country would have saved an average of $500, according to a new report from the U.S. Department of Health and Human Services.  Starting July 1, under Medicare Part B, beneficiary cost sharing will be limited to $35 for a month’s supply of insulin, which will result in an estimated $27...

WASHINGTON – The standard monthly premium for Medicare Part B beneficiaries will be $164.90 for 2023, a decrease of $5.20 compared to 2022.   The annual deductible for all Medicare Part B beneficiaries will be $226 in 2023, a decrease of $7 compared to 2022, according to information released Sept. 27 by CMS.  The 2022 premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm. Lower-than-projected spending on both Aduhelm and other Part...

WASHINGTON – Medicare payments for intermittent urinary catheters were 3.4 times supplier acquisition costs in fiscal year 2020, according to a new analysis by the Office of Inspector General.  In total, Medicare allowed $407 million in payments for these items, while suppliers paid approximately $121 million to acquire them.   Each of the three billing categories for intermittent urinary catheters (straight tip, curved tip, and sterile kit) showed large differences between...

WASHINGTON – CMS will host a virtual listening session with health care providers on Sept. 13 to gather information on their experiences during public health emergencies outside of the COVID-19 pandemic. Topics of discussion will include What have been your facility's experiences in developing and implementing emergency preparedness plans under the CMS regulations, and do the current CMS emergency preparedness regulations create any unintended barriers in your work? This session is the...

WASHINGTON – AAHomecare is calling on stakeholders to contact their members of Congress this week to ask them to prevent broadly applied “deep” Medicare cuts for 2022.  The potential cuts stem from the application of pay-as-you-go (PAYGO) legislation that was enacted in 2010.  “If not addressed, PAYGO provisions would trigger automatic cuts across a range of federal programs to cover recent deficit spending increases – in this case, red ink incurred via...

WASHINGTON – The improper payment rate for Medicare fee-for-service is 6.27% or $25.74 billion for fiscal year 2020 compared to 7.25% or $28.91 billion for fiscal year 2019, according to CMS.  The decrease was driven by reductions in the improper payment rates for home health and skilled nursing facility claims, the agency says.   Home health: There was a $5.90 billion decrease in estimated improper payments from 2016 to 2020 due to corrective actions such as policy clarification...

WASHINGTON – The majority of Medicare beneficiaries (84%) received telehealth services only from providers with whom they had an established relationship, the Office of Inspector General has found. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship compared to beneficiaries in Medicare Advantage, it found. “This pattern persisted among virtually all of the most common telehealth services,” the...

WASHINGTON – CMS has announced that a systems-wide error resulted in suppressed crossover claims to certain supplemental payers from April 8 through early May, MiraVista reports. The issue affects Medicare claims finalized between April 8 and April 25 for electronic claims, and between April 8 and May 11 for paper claims. Medicare did not send crossover claims to the following payers, according to MiraVista: Anthem BCBS (Connecticut, New Hampshire, Maine and Vermont); BCBS (Michigan and Maine);...

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 - Medicare paid a total of $17.6 million for telehealth in 2015, compared with $61,302 in 2001, according to a report from the Office of Inspector General. The OIG reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that did not have corresponding originating-site claims, and reviewed provider supporting documentation for a random sample of 100 claims. The OIG found that 69 of the 100 claims met requirements. Of those that did not, the biggest reason...