Cuts to oxygen rates likely lower than anticipated. The feds can't seem to make up their mind about oxygen payment rates, and that means no one will get paid starting Jan. 1.
Durable medical equipment regional carriers will hold Medicare claims for oxygen, oxygen equipment and portable oxygen equipment furnished on or after Jan.1, 2005, the Centers for Medicare & Medicaid Services says in a notice. "To ensure Medicare's payments are accurate, these claims will be held until the 2005 fee schedule amounts can be computed based on information CMS expects to receive from the [HHS Office of Inspector General] by January 15, 2005," CMS explains.
But it's probably a good sign that the OIG can't settle on a payment rate. "We believe OIG has conceded its original analysis was flawed because it failed to properly compare [Federal Employee Health Benefit Plans'] unbundled payment for oxygen equipment, supplies and contents with Medicare's single bundled equipment price, as industry groups have claimed," notes investment firm Legg Mason in a briefing.
"This is likely to result in a 2005 Medicare oxygen equipment cut closer to 5 percent than to 10 percent," Legg Mason says.
"We are very gratified that CMS and the [OIG] are willing to refine their analysis of oxygen pricing," Kay Cox, President and CEO of the American Association for Homecare, says in a release.
More information is at
www.cms.hhs.gov/suppliers/dmepos/. HCPCS codes affected include E0424, E0439, E1390, E1391, E0431 and E0434, AAH notes. It's that time of year again - time to voice your ideas on anti-kickback safe harbors and new special fraud alerts. The OIG annually solicits proposals for developing new and modifying existing kickback-related provisions.
The OIG will consider a number of factors in reviewing proposals, including the impact on: access to health care services; quality of services; patient freedom of choice and competition among health care providers; the cost to federal health care programs; potential over-utilization of the health care services; and the ability to provide services in medically underserved areas.
Comments must be received by Feb. 8, 2005. The notice in the Dec. 10 Federal Register is at
www.access.gpo.gov/su_docs/fedreg/a041210c.html.
The marching orders for the new inhalation drug dispensing fee have gone out. Starting Jan. 1, suppliers may bill G0371 for a 30-day fee of $57 or G0374 for a 90-day fee of $80, according to Dec. 10 Change Request 3620.
The fee covers "all inhalation drugs furnished through DME dispensed during a [30 or] 90 day period regardless of the number of shipments or drugs dispensed," CMS says in the transmittal.
Hospices in four states served by Palmetto GBA will be under the microscope for continuous home care hours. A new initiative from the regional home health intermediary will focus on [...]
