OIG to focus on DME payments
Device Regulation Alert: Safety, Compliance and Reimbursement News, October 6, 2008
The OIG will review Medicare Part B claims for durable medical equipment, prosthetics, orthotics, and supplies furnished to beneficiaries receiving home health services, as part of its 2008 Work Plan.
The Work Plan lays out the OIG’s plans for investigations into Medicare and Medicaid spending over the upcoming year.
Medicare pays for reasonable and necessary DME, but the OIG said interviews with home health patients indicated unnecessary DME was ordered for these patients. The OIG plans to determine whether DME claims paid by Medicare on behalf of home health beneficiaries were allowable.
The OIG also plans to:
- Investigate the appropriateness of Medicare Part B payments to DME suppliers of power mobility devices, hospital beds and accessories, oxygen concentrators, and enteral/parenteral nutrition
- Determine whether Medicare beneficiaries received the required face-to-face examinations from the referring practitioners before receiving power wheelchairs
- Review certain aspects of CMS’s CERT methodology for determining the 2008 DME error rate
- Review Medicare Part B DME payments allowed for items or supplies provided to beneficiaries in nursing homes
- Review Medicare Part B payments to DME suppliers that have multiple national provider identifiers
- Determine the appropriateness of DME categorization in the Medicare fee schedule for selected DME items
The OIG will review the FDA’s oversight of post-market surveillance studies of medical devices and the FDA’s system for monitoring adverse event reporting.
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