Insurers would have to accept any medical provider who meets contract terms into their network under a bill moving forward in the Mississippi House. The House Insurance Committee voted 7-6 Thursday to approve House Bill 553, with four members present but not voting....
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Reimbursement
Proposed Medicare Changes Threaten Nation’s Most Vulnerable
Despite the fact that Medicare's per capita cost increases are at historic lows, policymakers continue to look for ways to put new constraints on program spending. There's nothing inherently wrong with that. In fact, given the rapid growth in the beneficiary...
H.R. 1717 GAINS TWO MORE CO-SPONSORS
H.R. 1717, a bill that would replace competitive bidding with the industry’s market pricing program, continues to draw support. This week, two more lawmakers co-sponsored the legislation, which was introduced by Rep. Tom Price (R-Ga.)into the House as the Medicare...
PECOS Ordering Referring Physician Data Problem Fixed
On January 15, CGS notified providers of an issue related to the ordering/referring physician data in the DME MAC claim system. CMS provided a corrected file to the DME MACs in order to resolve the issue and that file has been loaded into CGS’ system. With the...
New HCPCS Code (K0900) for Custom DME
According to Joint DME MAC A, a new HCPCS code, K0900, has been created for use with custom fabricated durable medical equipment other than wheelchairs. 42 CFR §414.224(a) describes the requirements for custom fabricated, stating in order to be considered a customized...
Congress Braves First Steps in Medicare Reform
Seniors beware: Congress is considering changes to what Medicare will pay for, and what's coming out of your pocket. Congress is getting serious about changes to Medicare, even if that means cutting coverage to services that senior citizens have long enjoyed. At issue...
HME News: Audits take their toll on finances, according to poll
If you use accounts receivable (A/R) to paint a picture of the financial health of HME providers, what you see doesn’t look very good, according to the results of the latest HME Newspoll. A majority of the 46 respondents to the poll—55%—said the portion of their A/R...
Medicare Changes Coming When Ron Wyden Takes Over Top Senate Finance Post
Medicare changes that would overhaul the way the national health care program cares for seniors with chronic conditions highlight a Medicare reform bill introduced this week by Oregon Democratic Senator Ron Wyden. Wyden, who has long been an advocate for changes to...
Agency Announces Medicare appeals at ALJ on two year backlog
Medicare appeals at the administrative law judge level will be suspended for two years due to backlog, agency announces Long-term care providers filing to have a Medicare claims appeal heard by an administrative law judge will not have the case assigned to a judge for...
NC doctors file suit against state over Medicaid payments
A group of North Carolina doctors filed a class action lawsuit today seeking millions from the state over severely delayed Medicaid reimbursements. The suit says medical providers have been shorted about $500 million since July. That's when a new system for Medicaid's...
New RAC Audits Posted
New RAC Audits Posted Region A Performant Recovery, the recovery audit contractor (RAC), posted a complex review for automatic external defibrillators on December 26 that will specifically look at claims billed without an indication supporting medical necessity as...
HME News: Orthotics codes become more difficult to bill
The 2014 Medicare DMEPOS fee schedule could create billing confusion for orthotics providers. The recently released schedule applies the same payment amounts to 23 orthotics codes, regardless of whether they are classified as off-the-shelf (OTS) orthotics or require...