Medicare Compliance & Reimbursement

Plus:  HHAs will enjoy a bigger-than-expected payment boost.

Medicare won't cover infrared therapy devices for treatment of diabetic and non-diabetic sensory neuropathy, wounds and ulcers, the Centers for Medicare & Medicaid Services (CMS) announced. This includes the treatment of related pain.

Non-covered therapies include monochromatic infrared energy (MIRE), according to decision memo CAG-00291N. For more info, go to www.cms.hhs.gov/coverage and click "What's New."

Medicare Pays HHAs More Next Year

Home health agencies (HHAs) will receive a 3.3-percent increase to Medicare payment rates starting Jan. 1, 2007, CMS announced Nov. 1.

That's up slightly from the 3.1-percent increase CMS suggested in its Aug. 3 proposed rule on next year's prospective payment system update.

Agencies that don't submit OASIS data will see only a 1.3-percent increase, CMS notes in a release. Rural agencies will receive an average 3.6-percent higher rate while urban agencies will see a 3.1-percent increase.

Don't Shutter Your Condo Labs Just Yet

Good news: For now, CMS won't go ahead with proposed changes to the self-referral regulations that would have made it almost impossible for you to operate a "pod lab" or "condo lab" at an off-site lab company. CMS said it needs more time to study the comments it received on this proposal and come up with a regulation later.

CMS May Be Wrong About Increasing Claims For PMDs

CMS is mistaken in its assertion that claims for power mobility devices (PMDs) are on the rise--and government data can prove the agency is in the wrong.

That's the latest volley in a battle between the power mobility industry and CMS over pending cuts in Medicare rates for PMDs, which include power wheelchairs and scooters.

A fee schedule released last month and set to go into effect Nov. 15 slashes PMD rates by as much as 41 percent, reports Michael Frisby of Restore Access to Mobility Partnership (RAMP), a coalition representing power wheelchair providers and manufacturers.

Making a case for the necessity of the cuts, CMS said that utilization has increased 2,700 percent in the last nine years. But an analysis of data from the federal government's Statistical Analysis Durable Medical Equipment Regional Carrier shows that utilization of Medicare's mobility benefit has declined significantly since 2003.

There was a 29 percent drop from 2003 to 2004, reports RAMP. In 2005, utilization increased at a rate of only 8 percent over 2004.

"It is certainly misleading for CMS to contend that some big, recent surge in utilization calls for these draconian cuts," says Invacare CEO Mal Mixon, in a statement released by RAMP.

CERT Program Certified With Clean Bill Of Health

CMS has appropriate controls in place to make sure its Comprehensive Error Rate Testing (CERT) program is coming up with accurate data, the HHS Office of Inspector General (OIG) cheered. CMS has taken steps to reduce the CERT error rate, and followed up on the recommendations in last year's OIG report.

In Other News...

• CMS is picking and choosing which seniors to auto-enroll into Part D plans next year.

Last year, the federal government supported its new prescription drug benefit by automatically enrolling dual eligible beneficiaries in private Medicare drug plans. They often ended up enrolled in an all-over managed care plan as well that restricted or underpaid home care services.

In 2007, CMS won't auto-enroll the 632,000 such benes, CMS says. But dual eligibles still may end up with a drug plan. Because many of these benes will miss the open-enrollment period of Nov. 15 to Dec. 31 to sign up, the group has an extra three months to enroll without incurring a penalty for lateness, says CMS spokesperson Kathleen Harrington.

· You can obtain a new print copy of the updated "Guidelines for Teaching Physicians, Interns, and Residents Fact Sheet" from the CMS Medicare Learning Network. Go to www.cms.hhs.gov/mlngeninfo, scroll down to "Related Links Inside CMS," and select "MLN Product Ordering Page."

· Physicians should start reporting their national provider identifiers (NPIs) on claims for any services they purchased outside their carriers' jurisdiction by May 23, CMS instructs in Transmittal 243, dated Oct. 23.