Medicare Paid Doctors Millions, Analysis Of Claims Database Shows

WASHINGTON (AP) — How is it that a few doctors take in millions of dollars from Medicare?

Explanations for Wednesday’s eye-popping numbers from Medicare’s massive claims database ranged from straightforward to what the government considers suspicious, as the medical world confronted a new era of scrutiny.

The long-sought release of Medicare data revealed just how much the program paid individual doctors in 2012. An analysis by The Associated Press found that a tiny group, 344 out of more than 825,000 doctors, received $3 million or more apiece — a threshold that raises eyebrows for the government’s own investigators. Overall, about 2 percent of clinicians accounted for one-fourth of payments.

Read More…

Don’t become complacent!

WASHINGTON – Industry stakeholders caution HME providers against putting too much stock in CMS’s announcement last week that it will not initiate new audits as it transitions to new recovery audit contractors (RACs).

“Essentially, this is common that a contractor slows down their new workload so they can finish it out before their contract ends,” said Wayne van Halem, president of The van Halem Group. “So, unfortunately for the DMEPOS industry, I believe it’s just the calm before the next storm.”

read more…

Budget Deal Whacks Medicare Providers

WASHINGTON — It’s hard to discern in the budget deal announced Tuesday night, but the bulk of its deficit savings come from fresh cuts to Medicare providers.

Under the proposal announced by Rep. Paul Ryan (R-Wis.) and Sen. Patty Murray (D-Wash.), chairs of their chambers’ respective budget committees, lawmakers will replace about two-thirds of the hated automatic cuts under budget sequestration (totaling $63 billion) for this year and next, and cut the deficit by about $23 billion.

read more on Huffington Post

Is Grass Really Greener?

For the past few years, providers have eyed O&P as a fertile expansion opportunity, but what is the funding and regulatory reality?

orthotics and prostheticsFor the past few years, many home medical equipment providers have looked toward orthotics and prosthetics with considerable interest. While the home medical equipment business has been besieged by a number of funding and regulatory threats — competitive bidding and audits chief among them — that have promised to all but decimate their reimbursement, the O&P market has seemingly been operating in carefree conditions and reaping what looked from the HME perspective to be reimbursement rates that seemed on par with the fabled age of the “golden commode.”

read more…

The HME Thrill Ride

Can providers keep their businesses and industry on the rails?

HME Competitive Bidding Thrill RideEver since the Centers for Medicare and Medicaid Services began testing its competitive bidding program, providers have been on a roller coaster trying to stop the program. They’ve seen some bright points, such as the delay through the Medicare Improvements for Patients and Providers Act, but they’ve seen even more terrifying plummets, such as the Round One implementation, and now the even more precipitous Round Two implementation.

read more…

Get ready to add UPIC to the HME lexicon

WASHINGTON – A new auditor that’s in the works has the potential to streamline the process, but it will likely mean more activity, as well, industry stakeholders say.

“Anytime there’s a new contractor, they tend to be more active,” said Wayne van Halem, president of the Atlanta-based van Halem Group.

CMS this month announced plans to create a new program integrity contractor for Medicare and Medicaid called a Unified Program Integrity Contractor (UPIC). The agency plans to fold the existing ZPICs and the Medicaid program integrity contractors into the UPICs.

A likely result of the shake-up will be an increase in audits for Medicaid, stakeholders say.

Read full article here…

Lawmakers call on OIG to investigate competitive bidding

WASHINGTON – In a June 21 letter to the Office of the Inspector General (OIG), Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, call on the agency to investigate the possibility that CMS deliberately overlooked its own rules when awarding contracts for competitive bidding, according to a press release.

The OIG is charged with identifying and combating waste, fraud and abuse in more than 300 programs, including Medicare.

“We have asked the Inspector General to look into the shortfalls, but also to investigate the possibility that officials at Medicare intentionally ignored their own rules when problems began to arise,” Thompson stated.

Read full article here…