CMS Needs to Address Flaws in Reimbursement and Documentation policies
Medicare is denying too many DMEPOS claims due to technical problems with documentation according to a report by the inspector general of the U.S. Department of Health and Human Services (HHS). With this, the American Association for Homecare, headed by its president Tyler Wilson, is bringing attention to the report. The documentation process for Medicare reimbursements must be addressed in a substantial way, says Wilson. In an article published by AAHomecare, Wilson further added that the claim denials are killing providers’ legitimate businesses.
The extent of flaws in CMS’ reimbursement and documentation policies was highlighted by AAHomecare using the HHS Office of Inspector General’s report. Currently, CMS is denyingreimbursement claimsfor home medical equipment unless certain guidelines are met.
CMS to Change Certain Re-supply Requirements
According to industry stakeholders, CMS is planning to change the requirements for certain respiratory supply re-orders, which could have a direct impact on the way providers do business. The biggest change is disallowing item replacement unless beneficiary’s current item does not work. As stated in CMS’ published notice on June 8, for items needing periodic replacement like PAP, providers need to determine whether the items are no longer functional before they can provide replacements.
The change opposes CMS’s local coverage determination (LCD) for PAP, which favors replacement of supplies like cushions, headgear, tubing and filters every three months. Additionally, stakeholders are concerned that if providers need to wait for an item to be non-functional before replacing it, this will affect compliance which could also affect patient’s health as well as providers’ reimbursement.
Flaws in the Surety Bond Program Need Correction
The Centers for Medicare and Medicaid Services (CMS) have received comments and recommendations from AAHomecare, VGM and other stakeholders in the homecare community concerning problems and unintended consequences with the Medicare DMEPOS surety bond program. AAHomecare and VGM members got notices from surety companies that surety bonds were triggered by the DME MACs to collect overpayments for as little as $16.
Comments made by the group highlighted concerns for surety bonds which could become difficult to overwrite, thus endangering surety companies’ businesses and the supply of bonds. Included in the stakeholders’ recommendations is the need for better notices for HME providers when surety bond is about to be triggered.
Inadequacies of Medicaid Integrity Programs Outlined by OIG Testimony Before Congressional Subcommittee
Regional Inspector General of the Office of Inspector General (OIG) Ann Maxwell testified before the U.S. House of Representatives Committee on Oversight and Reform: Subcommittee on Government Organization, Efficiency and Financial Management. She said that there is more that needs to be done with the OIG assessment of the Medicaid program to protect its integrity.
The testimony’s focus was on two national Medicaid integrity programs: the Centers for Medicare and Medicaid Services’ (CMS) National Medicaid Audit Program, and the Medicare-Medicaid Data Match Program (Medi-Medi). As outlined in the testimony, the OIG assessment of the programs indicates that not one of the programs is effectively accomplishing its mission.
Overpayments in an amount to prevent a negative return on investment were not identified by the National Medicaid Audit program, says OIG. In fiscal year 2010, an amount of $32.1 million was paid by CMS, while the Audit MICs identified only $6.9 million in the first six months of the year. A negative return on investment was yielded by the Medi-Medi Program, recovering $57.8 million in 2007 and 2008, while CMS spent $60 million on the program during the same period.
Study Links Insomnia to Risk of Injury
According to the National Sleep Foundation, more than one third of the American adult population is experiencing symptoms of insomnia, and some adults have symptoms serious enough to be considered chronic. As already known, insomnia puts sufferers at risk for other serious health problems. In a recent large-scale study, the link between insomnia and the risk of injury was being investigated both in the workplace and outside it. Data from the American Insomnia Survey, which consisted of interview details regarding insomnia and related health problems, were used by researchers. A collection of self-reported information on accidents and injuries that respondents had experienced in the previous 12 months were also analyzed.
The study found that people with insomnia reported more workplace injuries and non-workplace injuries compared to respondents without insomnia. Researchers also found that people that have health problems in addition to their insomnia have more chances of experiencing some type of injury.
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