Tag: reimbursement

WASHINGTON – CMS has announced a 0.6% CPI-U adjustment to the 2021 DMEPOS fee schedule for products previously subject to competitive bidding provided in bid areas, AAHomecare reports. The adjustment for suppliers in rural and other non-bid areas in expected to be even less, the association says. “A less-than-1% price increase for 2021 is another example of a Medicare reimbursement methodology for HME that is not connected to the economic reality suppliers face,”...

WASHINGTON - Medicare pays more for non-invasive ventilators than certain other payers, according to a new report from the Office of Inspector General.The OIG estimates that Medicare and beneficiaries could have saved $86.6 million if Medicare-allowed charges were comparable with payment rates of select non-Medicare payers for HCPCS code E0466.Medicare paid $424.4 million for non-invasive vents in 2018, a 52% increase compared to 2016, the OIG found.The agency believes Medicare pays more for non-invasive...

WASHINGTON - In a hard-fought win, industry stakeholders have succeeded in getting Congress to suspend competitive bidding pricing for accessories for complex manual wheelchairs.Both the House of Representatives and the Senate last week passed H.R. 1865, a year-end spending bill that includes language requiring CMS to stop applying bid pricing to these accessories for 18 months starting Jan. 1, 2020.“This really has been a four-year battle that involved getting resolutions for complex power...

WASHINGTON - CMS is proposing a rule to establish methodologies to modernize pricing of new DMEPOS items and services, the agency announced July 29.“The proposed rule would provide greater transparency for innovators regarding how CMS determines if new items and services are comparable to older items and services for Medicare pricing,” CMS states. “The proposed rule also promotes competition and innovation in DMEPOS by setting Medicare payment for new items based on commercial pricing...

NASHVILLE, Tenn. - National Seating & Mobility has launched an automated expected reimbursement system. The new system uses required payer and client benefits information to provide a real-time expected reimbursement for equipment being ordered, eliminating the need for manual calculations. “This automated, real-time information gives our funding specialists the ability to focus on moving the order forward more efficiently,” said Bill Mixon, NSM CEO. “It also increases the accuracy...

ATLANTA - HME industry stakeholders have succeeded in steering Georgia away from basing its Medicaid reimbursement on competitive bidding-based Medicare reimbursement, AAHomecare reported this week.Initially, the Georgia Department of Community Health indicated that it would just adopt Medicare reimbursement, because an aggregate pricing approach would create a $10 million shortfall. But after the Georgia Association for Medical Equipment Suppliers intervened and provided further analysis, the agency...

WASHINGTON - CMS wants state Medicaid programs to submit their DME fee schedules using a new spreadsheet to make sure they're not paying too much for equipment, according to a notice in the Federal Register.CMS says the spreadsheet will help the agency comply with a provision in the 21st Century Cures Act that requires it to cap Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018.“We would require the minimal amount of information be collected from states to comply...

WASHINGTON - Reps. Pat Tiberi, R-Ohio, and Bill Pascrell, D-N.J., have introduced a bill that would create a “temporary transitional payment” for home infusion drugs beginning Jan. 1, 2019.The bill, H.R. 3163, would address a payment gap created by two provisions in last year's 21st Century Cures Act. The first provision requires Medicare to pay for services associated with providing Part B home infusion drugs, but not until 2021. Meanwhile, a second provision cut payments for those drugs...

WASHINGTON - With only days to spare, stakeholders have succeeded in getting CMS to refrain from cutting reimbursement for accessories for complex rehab power wheelchairs.The agency announced late on Friday that it would not apply competitive bidding pricing to accessories on July 1, 2017.“This speaks well of the CRT community, including the consumers,” said Don Clayback, executive director of NCART, who was on the Hill the week of June 19. “It has been a year and a half of very...

WASHINGTON - The medical directors at jurisdictions B and C have agreed to do an “immediate review” of payments for custom seats (E2609) and custom backs (E2617), following their decision to change payments from individually priced to flat allowable, according to NCART. “In the interim, they are holding the processing of any claims that include E2609 and E2617 until they have determined any needed changes,” stated Don Clayback, executive director of NCART, in an email to members...