Durable Medical Equipment

News & Analysis as of

CMS Releases CY 2015 ESRD PPS and DMEPOS Proposed Rule

On July 2, 2014, CMS released the CY 2015 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Proposed Rule. ...more

Commission-Based Sales Agreements for Medical Supplies and Equipment: More Whistleblower Activity on the Horizon? - A Wide Range...

The common industry practice of compensating independent contractor sales representatives on a "percentage of sales" commission basis may be creating an enhanced risk of False Claims Act liability for illegal kickbacks in...more

CMS Proposes Rule to Expand Authorization Program, Solicits Comments on Implementation

On May 28, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) published a proposed rule to establish a prior authorization process for certain durable medical equipment,...more

CMS's Focus on DMEPOS Fraud and Abuse Risks Continues

The focus by the Centers for Medicare & Medicaid Services (CMS) on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) as an area rife with unnecessary utilization and a high improper payment rates...more

Health Headlines: Also in the News - May 2014

CMS Releases Proposed Rule on Prior Authorizations for DMEPOS Items – On May 22, 2014, CMS released a Proposed Rule setting out a prior authorization process for certain types durable medical equipment, prosthetics,...more

Be Aware of the New Fingerprint-Based Background Check Requirement for Certain Medicare Suppliers and Providers

The Center for Medicare & Medicaid Services ("CMS") recently posted on its website an article indicating that, as part of enhanced screening provisions in the Affordable Care Act, it will phase in a new fingerprint-based...more

Chance to Comment on Future of DMEPOS Payments

CMS recently took the unusual step of issuing an Advance Notice of Proposed Rulemaking (ANPR) regarding changes to Medicare payment methodologies for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)...more

DMEPOS Competitive Bidding Program: CMS Begins to Move Toward Nationwide Implementation and Seeks Public Comments Regarding...

The Centers for Medicare & Medicaid Services ("CMS") recently announced that the agency is seeking public comments as it moves toward nationwide implementation of the Medicare Durable Equipment, Prosthetics, Orthotics, and...more

CMS Publishes DMEPOS Advance Notice of Proposed Rulemaking

On February 26, 2014, CMS published an Advance Notice of Proposed Rulemaking related to proposed changes to the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Medicare reimbursement methodologies. ...more

Health Care Reform Implementation Update - February 26, 2014

Though Congress was in recess this past week, congressional staff was hard at work continuing to consider ways to prevent a cut to Medicare providers’ payment rates that will be triggered by the sustainable growth rate...more

Advance Preparation For Medicare Revalidation Requests: Good Decision For The Bottom Line

The 2009 Affordable Care Act (ACA) has provided no shortage of new regulations for health care providers of every shape and size. One such item is the requirement that providers that enrolled in Medicare prior to March 25,...more

Private Health Insurance Fraud – Rooting Out Bogus Providers

The United States spends over $2.81 trillion dollars on health care annually and generates billions of claims from millions of health care service and product providers. The vast majority of these providers of services and...more

Medicare Delays Face-to-Face Encounter Requirement for Certain Durable Medical Equipment

On September 9, 2013, CMS announced that it would delay a requirement that medical providers have a face-to-face encounter with a Medicare beneficiary within six months of prescribing certain durable medical equipment (DME). ...more

PA Tax Law News - September 2013: Commonwealth Court Denies Manufacturing Exclusion to Service Provider

On August 6, 2013, in a case with possible implications for other providers of nontaxable services, Pennsylvania’s Commonwealth Court ruled, en banc, that a medical group’s MRI and CT scan equipment does not qualify for the...more

DME Face-to-Face Encounter Final Rule Effective October 1, 2013

The 2013 Final Physician Fee Schedule included final regulations for the durable medical equipment (DME) face-to-face encounter requirement for Medicare and Medicaid beneficiaries....more

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

In an April 24, 2009 transmittal, CMS announced a two-phase claims editing expansion designed to allow verification that the physician or non-physician practitioner (NPP) listed as the ordering/referring provider on a...more

CMS to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare

Effective May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will begin to deny Part B Durable Medical Equipment (DME) and Part A Home Health Agency (HHA) claims for services or supplies when the...more

Health Care Enforcement in 2012: A Year in Review

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

The False Claims Act and Healthcare Providers: Key Results from 2012 and Likely Trends for 2013

From the perspective of False Claims Act (FCA) results, 2012 was a decidedly mixed year for healthcare providers. The bad news was quite bad—increased FCA scrutiny by the Department of Justice (DOJ) led to $3 billion of...more

New Medicare Regulations Require Face-to-Face Physician Encounters for DME Products

On November 16, 2012, the Centers for Medicare & Medicaid Services ("CMS") published a final rule making various changes to payment policies under the Physician Fee Schedule. Included in this rule is a new requirement that...more

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