News
Report: Insulin cap to generate millions in savings for Medicare beneficiaries
January 26, 2023HME News Staff
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...
In brief: Viemed investment, prior auth expansion, Belluscura update
January 20, 2023HME News Staff
LAFAYETTE, La. – Viemed Healthcare has made a strategic investment in ModoHealth, a value-based care and patient management platform connecting payers, patients and post-acute providers.
ModoHealth expects to use the proceeds of the investment to fund the expansion of its proprietary patient management network, which combines clinical tools, remote patient monitoring, data analysis and patient-centric engagement.
“We are incredibly excited to partner with the team at...
ACHC publishes new analysis of quality review
January 19, 2023HME News Staff
CARY, N.C. – The Accreditation Commission for Health Care (ACHC) has published new quality review analyses in its publication the Surveyor.
The special reports include key insights and deficiencies from 2022 survey data, covering a wide range of health care environments from ambulatory surgery centers to home care agencies and sleep labs, among others. These resources help organizations benchmark performance against their peers to proactively address common issues as part of continuous...
CMS expands required list
January 17, 2023HME News Staff
WASHINGTON – CMS has added 10 more HCPCS codes to a required list for a face-to-face encounter /written order prior to delivery, according to VGM Government Relations.
The new codes include the following for back, knee and ankle/foot braces: L0631, L1843, L1932, L1940, L1951, L1960, L1970, L2005, L2036. Also included: E0748, osteogenesis stimulator, electrical, non-invasive, spinal applications.
The effective date for the news codes is April 2023.
The required...
Stark and Baird on what’s critical to a provider’s livelihood
January 13, 2023Liz Beaulieu, Editor
YARMOUTH, Maine – Medicare Advantage will be the elephant in the room in 2023, say Andrea Stark and Jeff Baird, due to the “sheer mass migration” of beneficiaries to these plans.
“Everything is centered around managed care,” said Baird, chairman of the Health Care Group at Brown & Fortunato. “It seems like, overnight, we woke up and 50% of Medicare patients are now covered by these plans.”
HME News connected with Stark, a Medicare consultant...
In brief: AAH on Medicaid, AdaptHealth on expectations, GAO on waivers
January 13, 2023HME News Staff
WASHINGTON – AAHomecare’s Payer Relations Team has begun a nationwide campaign to work with state/regional association leaders to better align state Medicaid rates with higher costs.
The association says HME providers are experiencing increasing product prices and operational costs due to the COVID-19 pandemic and supply chain issues, as well as ongoing inflation pressures.
“Our work will include requesting that rates reflect the 6.4%+ CPI-U increases granted by...
AAHomecare gets to work on Medicaid reimbursement
January 12, 2023HME News Staff
WASHINGTON – AAHomecare’s Payer Relations Team has begun a nationwide campaign to work with state/regional association leaders to better align state Medicaid rates with higher costs.
The association says HME providers are experiencing increasing product prices and operational costs due to the COVID-19 pandemic and supply chain issues, as well as ongoing inflation pressures.
“Our work will include requesting that rates reflect the 6.4%+ CPI-U increases granted by...
Telehealth use declines nationally
January 11, 2023HME News Staff
NEW YORK – Telehealth use nationally declined 3.7% in October 2022, according to FAIR Health's Monthly Telehealth Regional Tracker.
The decline was larger in the South (6.8%), Midwest (4.9%) and West (4.1%), while there was an increase (1.7%) in the Northeast. The data represent the privately insured population, including Medicare Advantage, and exclude Medicare Fee-for-Service and Medicaid.
In October, COVID-19 continued to fall among the top five telehealth diagnoses...
Industry reaches ‘inflection point’ in bid areas
January 6, 2023Liz Beaulieu, Editor
Industry scored major wins in an end-of-year spending bill
But, outside of annual updates, reimbursement relief in former competitive bidding areas has been elusive
Stakeholders are now working on a strategy for providing relief in those areas, but CMS’s plans for the next round of bidding is an obstacle
WASHINGTON – Industry stakeholders “left everything on the field” in December, paving the way for Congress to pass several HME-related provisions...
Contractors ‘flip switch’ on audits
January 6, 2023Theresa Flaherty, Managing Editor
YARMOUTH, Maine – After lying largely dormant during the public health emergency, audits are on the rise, including for respiratory claims, say industry consultants.
While audits never stopped completely during the PHE, waivers of certain coverage criteria, including for oxygen equipment and CGMs, helped lessen the burden on providers. But UPIC auditors are now increasingly targeting claims covered by those waivers, says Kelly Grahovac.
“It’s almost like they...