Thursday, June 9, 2016

Respiratory Care Leaders Urge Support for Patient Access to Durable Medical Equipment Act as July 1

Read the full press release: Respiratory Care Leaders Urge Support for Patient Access to Durable Medical Equipment Act as July 1:

"Home oxygen leaders stress the importance of consistent and uninterrupted access to home respiratory care, particularly for patients managing Chronic Obstructive Pulmonary Disease (COPD) who are vulnerable to hospitalizations and readmissions and reside heavily in rural areas.  The CQRC and other leaders across the DME provider and supplier communities have warned that, "Six months is not enough time to monitor disruption in Medicare beneficiaries' access to the DME items they need, and to evaluate what impact major reductions in payment have on their access to life-sustaining equipment and services.""

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Tuesday, June 7, 2016

Apria Brings to Light New OIG Report Highlighting Concerns Surrounding CMS Competitive Bidding Program for Home Medical Equipment | Business Wire

Read the full article: Apria Brings to Light New OIG Report Highlighting Concerns Surrounding CMS Competitive Bidding Program for Home Medical Equipment | Business Wire:

"Report findings show that more than 40% of the 146 suppliers examined did not meet licensure requirements and were incorrectly awarded contracts by CMS due to database inaccuracies. An additional 14 of the examined suppliers still require further research by CMS to determine whether they have met the necessary licensure requirements. These database deficiencies and inaccuracies were attributed to complex variations in state licensure requirements and the challenges that CMS has faced in maintaining a current and accurate database."

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Read the OIG report:
Department of Health and Human Services - OFFICE OF INSPECTOR GENERAL - INCOMPLETE AND INACCURATE LICENSURE DATA ALLOWED SOME SUPPLIERS IN ROUND 2 OF THE
DURABLE MEDICAL EQUIPMENT COMPETITIVE BIDDING PROGRAM THAT DID NOT HAVE REQUIRED LICENSES (pdf)

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Friday, June 3, 2016

California and the Future of the US Rx Pricing | Pharmaceutical Executive

Read the full article: California and the Future of the US Rx Pricing | Pharmaceutical Executive:

"First of all, what does the California proposition mandate?

 “The California Drug Price Relief Act” states that any prescription drug obtained by the State of California shall be purchased at the same “fixed price” that is accorded to the U.S. Veterans Administration, i.e., at about a 42% of average wholesale price. This is a really low price that is accorded to the VA as gesture of drug industry support for the armed services. It was never meant to be a market price point, but that is exactly what may happen if this California initiative passes on Nov. 8th."

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Wednesday, June 1, 2016

Big Data Tool Saves CMS $1.5B by Preventing Medicare Fraud - RevCycle Intelligence

Read the full article: Big Data Tool Saves CMS $1.5B by Preventing Medicare Fraud - RevCycle Intelligence:

"Using big data tools and predictive analytics, the Centers for Medicare and Medicaid Services (CMS) has saved approximately $1.5 billion by preventing Medicare fraud in the traditional fee-for-service program, according to the official CMS blog.

Since June 2011, CMS has employed the Fraud Prevention System, which is a predictive analytics tool that identifies fraudulent claims and illegitimate Medicare payments. The tool analyzes about 4.5 million Medicare pre-paid claims each day to pinpoint potential issues before providers are paid."

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