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3 Takeaways from the Health Subcommittee Meeting

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In the Trenches
The HME suppliers’ perspective on fraud.

Fraud tied to durable (DME) or home medical equipment (HME), of course, is not a victimless crime. The Medicare trust fund is harmed by fraud, and as a result, so are the beneficiaries who rely on it — seniors, people with disabilities, and indirectly, their caregivers. But others are harmed as well, whether the fraud…

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CMS Publishes Competitive Bidding Fact Sheet for Small Suppliers
Small suppliers can form networks to bid, the Centers for Medicare & Medicaid Services said.

As details about the restart of Medicare competitive bidding for durable medical equipment continue to emerge, the Centers for Medicare & Medicaid Services (CMS) has published a fact sheet for small suppliers who want to participate. The Small Supplier Considerations fact sheet, released June 4, said that in accordance with the Social Security Act, CMS…

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In the Trenches
The HME suppliers’ perspective on fraud.

Fraud tied to durable (DME) or home medical equipment (HME), of course, is not a victimless crime. The Medicare trust fund is harmed by fraud, and as a result, so are the beneficiaries who rely on it — seniors, people with disabilities, and indirectly, their caregivers. But others are harmed as well, whether the fraud…

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Shields Up!
Policy experts on CMS’s newly proactive strategy against fraud.

Combating Medicare fraud is hardly a new topic to the durable and home medical equipment industry (DME/HME). What does change from administration to administration is how the Centers for Medicare & Medicaid Services (CMS) chooses to fight fraud. The most recent CMS initiative is known as Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH), announced in…

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VGM Names Director of Billing & Reimbursement
Stephanie Robinson has more than 25 years of experience in operations, revenue cycle management, compliance and reimbursement.

VGM & Associates has appointed a director of billing and reimbursement. Stephanie Robinson, an industry veteran with more than 25 years of experience in the home medical equipment segment, brings to her new role deep expertise in operations, revenue cycle management, compliance and reimbursement, VGM said in a June 5 announcement. Robinson will collaborate with…

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Balancing Tech, Human Expertise Amid Medicaid Work Requirement Changes
Aeroflow Urology’s Mica Phillips on patient education as Medicaid eligibility rules shift.

As soon as the Centers for Medicare & Medicaid Services (CMS) issued a June 1 interim final rule outlining new work requirements for Medicaid beneficiaries, patient organizations announced concerns that documentation to prove and maintain Medicaid eligibility could be a very heavy burden for states, patients and caregivers. Even before the interim final rule came…

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Prior Authorization Process Change Now in Effect at DME MACs
The new process, involving exempted suppliers, began June 1.

CGS Administrators, the jurisdictions B and C DME MAC, is reminding home medical equipment providers who bill Medicare about the June 1 change in the prior authorization process. Starting June 1, exempt suppliers — defined as those who didn’t opt out of the process — should not submit prior authorization requests. “All other suppliers must…

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Competitive Bidding Update Announces Lead Items, Pricing
The June 4 update marks the beginning of CMS’s pre-bidding supplier awareness program.

The June 4 update of the Centers for Medicare & Medicaid Services’ (CMS) Medicare competitive bidding website for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) includes information on lead items for bid categories and accompanying pricing. The update marked the start of CMS’s “pre-bidding supplier awareness program.” This summer, CMS is also due to…

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Rethinking RCM in HME Operations

Amanda Wreede hears it all the time. As the Senior Customer Success Manager at HME business management solution platform Brightree, Wreede meets with HME providers monthly and runs through their top revenue KPIs, such as held accounts receivable (AR) days, denial rate, net revenue and more. What she hears is a realization from providers of…

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Separating the Winners from the Losers in the Next HME Era

As reimbursement pressure, documentation requirements and patient financial responsibility all rise, successful providers will stop thinking in terms of individual workflows and instead start modernizing their entire operating system — from intake and fulfillment to resupply and revenue realization. Automation, backed with intelligence, can create new pathways to revenue that manual processes simply can’t achieve.…

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