Reimbursement:
Some Suppliers May Dodge Drastic FEHBP Cuts
Published on Thu Sep 30, 2004
Find out if you are exempt from cuts to oxygen, diabetes supplies, hospital beds, air mattresses, nebulizers and wheelchairs. Your location could make or break your Medicare reimbursement rates for key items in 2005.
The Centers for Medicare & Medicaid Services will make its sometimes drastic Medicare payment cuts to Federal Employee Health Benefit Plan levels on a state by state basis, CMS announced in the Sept. 22 Open Door Forum for home care providers.
Suppliers in states that already have fee schedule amounts at or below FEHBP levels won't see their rates reduced, a CMS official revealed. Suppliers in states with payment amounts above FEHBP levels reported by the HHS Office of Inspector General will see reductions down to the FEHBP median price (for specific amounts, see Eli's HCW, Vol. XIII, No. 33, p. 263). States whose payment levels are below FEHBP levels won't see their rates go up to those amounts, CMS added.
You're stuck with it: The bad news is that suppliers won't get a chance to comment on the reduced rates, which are mandated by the Medicare Modernization Act passed last December. Because a law mandates the cuts, they will go straight into the regular fee schedule to take effect Jan. 1, CMS said. "There is no rulemaking to go through" and thus no comment period, an official noted.
Suppliers should get their first look at the official rate cuts when CMS issues the fee schedule later this month, the agency said.
Industry representatives have voiced grave concerns about the OIG data CMS is basing the cuts on, especially its report on oxygen prices issued last month. CMS promises it is "reviewing" the OIG FEHBP information, especially the recent oxygen prices. But the agency's hands may be tied by the regulatory language, observers predict.
Other topics addressed in the forum include:
Wheelchair codes. After gathering input in a Sept. 1 meeting, durable medical equipment regional carrier and statistical analysis DMERC medical directors are fashioning wheelchair coding recommendations, a CMS staffer said. The DMERC/SADMERC group hopes to present the new codes to a national panel by November, and CMS aims to implement the new codes by next July.
New CMN. A new form for wheelchair certificates of medical necessity has gone to the Office of Management and Budget for approval - the final clearance step, CMS said. CMS revised the forms in light of its Operation Wheeler Dealer initiative, among other pressures. In June, a California federal court ruled that a CMN is all that is required to prove medical necessity for power wheelchairs (see Eli's HCW, Vol. XIII, No. 24, p. 187).
