Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
The Centers for Medicare & Medicaid Services Dec. 29 said it would postpone two demonstration projects intended to reduce improper payments and eliminate fraud, waste, and abuse.
The Prepayment Review and Prior Authorization for Power Mobility Devices demonstration, and the Recovery Audit Prepayment Review, scheduled to begin Jan. 1, were delayed indefinitely.
CMS in an announcement to providers said it “is carefully considering” the many comments and suggestions received. The programs were announced in November.
The power mobility program required a prior authorization process for Medicare beneficiaries who were prescribed a power wheelchair or scooter.
CMS had said the demonstration was intended to ensure that beneficiaries' medical condition warrants their medical equipment under existing coverage guidelines.
The recovery audit program is to authorize Recovery Audit Contractors (RACs) to review Part A claims that have high rates of improper payments before they are paid. The prepayment reviews were to focus on inpatient hospital claims involving short stays, which have had high rates of improper payments.
The demonstration was aimed at lowering the error rate by preventing improper payments rather than methods of looking for improper payments after they occur, CMS said.
The program, slated to run for three years, was to take place in 11 states—Florida, California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina, and Missouri.
The power mobility program had been fought by the industry and some in Congress.
The demonstration will serve to “ration medically necessary items and services to Medicare beneficiaries and will actually increase health care costs,” the American Association for Homecare said in a Dec. 8 statement.
“Studies show that beneficiaries with limited mobility who don't receive power wheelchairs require more medical treatment, additional skilled services and may even have to be admitted to expensive care facilities and nursing homes.”
A group of 22 House members wrote to CMS in mid-December asking the agency to stop the program.
The letter said that “taking a one-size fits all approach adds burdensome regulations to good-standing providers and threatens jobs.”
The three-year program was to take place in seven states—California, Texas, Florida, Michigan, Illinois, North Carolina, and New York—that have large populations of at-risk providers.
The seven states accounted for 43 percent of the $606 million that Medicare spent on power mobility devices in 2010, according to CMS.
“We are pleased that CMS has taken a deep breath to better understand the power mobility sector and the impact that any widespread prepayment review would have on Medicare beneficiaries and homecare providers,” Walt Gorski, AAHomecare, vice president of government affairs, said in a statement.
CMS said it will provide at least 30 days' notice before the demonstrations begin.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)