The Centers for Medicare and Medicaid Services (“CMS”) announced today the contract suppliers for Round 2 and the national mail-order program of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (“DMEPOS”) Competitive Bidding Program. As of April 9, 2013, there are 799 suppliers that have been awarded contracts in this round, and these contracts will affect suppliers and beneficiaries in 91 competitive bidding areas. Additionally, CMS announced 18 suppliers that accepted contracts to provide mail-order diabetic testing supplies at competitively bid prices nationwide. (more…)
Posts Tagged ‘Medicare’
DMEPOS Round 2 Contract Suppliers Announced
Authored By: Kendra Conover
MedPAC Releases Report to Congress, Suggests Broad Reforms to Post-Acute Landscape
Authored By: David W. Bufford
The Medicare Payment Advisory Commission’s (“MedPAC”) March 25th Report to Congress outlines inefficiencies they believe exist in the post-acute world and lead to excessive Medicare payments to providers. MedPAC recommendations include Congress evaluate post-acute provider reimbursement and encourage use of the lowest cost mix of services necessary to achieve the best outcomes.
CMS Clarifies Delegation of Tasks by Physicians in Long-Term Care Facilities
Authored By: Todd J. Selby
The Centers for Medicare & Medicaid Services (“CMS”), in the March 8, 2013 Memorandum, issued new guidance specifying those tasks that can and cannot be delegated in skilled nursing facilities (“SNFs”) and nursing facilities (“NFs”). Physicians who improperly assign tasks to non-physician practitioners (“NPPs”) jeopardize the SNFs’ and NFs’ compliance with federal and state regulations, which potentially affects the facilities’ reimbursement.
CMS Proposes Extension on Automatic Sprinkler Requirements
Authored By: Todd J. Selby
In 2003, two fires in long-term care facilities resulted in 31 resident deaths. As a result of these two events, CMS analyzed the fire safety precautions in place in these facilities and determined that resident safety could be greatly improved by requiring that all long-term care facilities have automatic sprinkling systems installed throughout the buildings. Consequently, on August 13, 2008, CMS published a final rule that required all buildings with long-term care facilities must have automatic sprinkler systems installed throughout the facilities no later than August 13, 2013.
Two Florida Home Health Agency Owners Plead Guilty to Fraud
Authored By: Kendra Conover
On December 19, 2012 the Department of Justice announced the owners and operators of two Miami health care agencies pleaded guilty for their participation in a $48 million home health Medicare fraud scheme. According to plea documents, the owners conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. The owners and their alleged co-conspirators paid kickbacks and bribes to patient recruiters in return for these recruiters providing patients to Caring Nurse Home Health Corp. (“Caring Nurse”) and Good Quality Home Health, Inc. (“Good Quality”), as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. The owners used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, which the owners knew was in violation of federal criminal laws. (more…)
CMS Issues Advance Copy of Long-Term Care Survey Protocol
Authored By: Todd J. Selby
On September 27, 2012, CMS issued an advance copy of the State Operations Manual (“SOM”) revisions to Appendix P of the SOM, which addresses Long-Term Care Facility survey protocol. The SOM guidance also makes changes to various survey forms resulting from the new quality measures reports. (more…)
Registration Open for DMEPOS Competitive Bidding Round 1 Recompete
Authored By: Kendra Conover
Centers for Medicare & Medicaid Services (“CMS”) has announced that registration is now open to all suppliers interested in participating in the Round 1 Recompete of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) Competitive Bidding Program.
In order to submit a bid for the Round 1 Recompete, suppliers will need to first register in the Individuals Authorized Access to the CMS Computer Services (“IACS”) online application. Once suppliers are registered in IACS, suppliers will receive a user ID and password to access the online DMEPOS Bidding System (“DBidS”). Suppliers must register even if they registered during a previous round of competition (i.e., Round 1 Rebid, Round 2, or the national mail-order competition). Suppliers that do not register will not be able to bid. (more…)
Internet-Based PECOS Improvements Increase Access to Information
Authored By: Todd J. Selby
The Centers for Medicare & Medicaid Services (CMS) implemented changes to Internet-based PECOS to allow providers easier access to information. The following enhancements are now available: (more…)
White House to Reach Sequestration Decision Within 30 Days
Authored By: David W. Bufford
The 2% across-the-board cut in reimbursement for Medicare providers, the result of last summer’s “Super Committee” failure, is scheduled to take place January 1, 2013. The President recently signed legislation requiring a report detailing how the sequestration process will affect Medicare providers. Skilled nursing facilities (SNFs) have already seen significant cuts to reimbursement; an additional 2% cut will further strain operations.
Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.
Inappropriate and Questionable Billing by Medicare Home Health Agencies
Authored By: Todd J. Selby
Data collected and analyzed by the Office of Inspector General (OIG) since 2010, indicate that home health agencies (HHAs) are predisposed to commit Medicare fraud, waste and abuse. In 2010, Medicare inappropriately paid $5 million for erroneous claims submitted by HHAs. With one in four claims being suspect, the OIG established six (6) criteria that identify HHAs submitting potentially fraudulent claims and/or employing questionable billing practices. Primarily, these criteria are based on higher than average payments, visits, late episodes, therapy visits and Medicare payment amounts per beneficiary, as well as a higher than average number of beneficiaries. (more…)
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