HealthAware

In a recent Press Release, the Centers for Medicare & Medicaid Services (CMS) reports that it has revoked the Medicare billing privileges of 1,139 suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) in South Florida and Southern California to prevent fraud.

"With seven health IT projects that are ready to go, New York estimates that we are ready to obligate in excess of $300 million within 180 days to implement a plan for health information exchange and $1 billion for provider electronic health records," he said. "A national investment of $20 billion is necessary to implement qualified statewide programs and to promote the adoption of electronic health records by physicians and hospitals."

 

A contingent of seven Republican senators on Friday called on CMS Acting Administrator Kerry Weems to "revise and, if necessary, delay" the Jan. 1 implementation of the 36-month oxygen rental cap.

Attendees at National Association of Independent Medical Equipment Suppliers (NAIMES) health care town hall meeting this week agree that Congress and CMS do not understand the service component of home care. Heeding the Obama administration’s call for a nationwide dialogue on health care, NAIMES convened a group that included suppliers, hospital staff, and consumers.

On December 17, the Healthcare Information and Management Systems Society (HIMSS) issued a report: "Call for Action: Enabling Healthcare Reform Using Information Technology – Recommendations for the Obama Administration and the 111th Congress."

Published HIMSS materials state that Society leadership and members believe the priority recommendations can help reform healthcare and stimulate the U.S. economy, and should be implemented within the first 120 days of the Obama Administration. First, HIMSS recommends the Administration and Congress invest a minimum of $25 billion dollars on health IT. This funding should:

Mandate electronic medical record adoption,
Provide electronic medical records for children, and
Establish health IT Empowerment Zones.

HIMSS’ second recommendation is to apply recognized standards and require certified health IT products among all federally funded health programs by mandating that any funding appropriated for the purchase or upgrade of new health IT products among providers and payors of federally funded health programs be allocated only for the use of health IT products that apply HITSP interoperability specifications and are CCHIT-certified.

The Wall Street Journal has reported that it is likely the new Democratic Congress and Administration will seek to reduce reimbursements to private health insurers under Medicare Advantage (MA) and make changes to the Medicare prescription drug benefit.

Basing its opinion on statements made by President-elect Barack Obama and key Congressional committee heads during the campaign, the Journal believes the padded payments for insurance companies over what Medicare itself reimburses for services are "long-sought targets" for Democratic lawmakers. In the past, the same members of Congress have attempted to reduce them to fund other efforts, such as an expansion of SCHIP.

 

At one time or another, most home care agencies inadvertently provide services to Medicare beneficiaries who are not eligible for direct Medicare because they have enrolled in a Medicare Advantage plan with an insurance company. Some of those agencies are able to recoup a portion of their lost payments from the insurance company, others are not; some who win the promise of payments reports waits of 6 to 18 months.

Two or three home care software vendors have developed products that automate the laborious process of checking Medicare eligibility every day for every patient, a task that is sufficiently labor-intensive to be cost prohibitive if done by hand. Customers using these products report saving thousands of dollars by be alerted in advance to avoid providing hundreds of unbillable visits. Agencies not taking advantage of these products are the ones taken advantage of by all but the most ethical insurance companies.

 

The more we look into the Medicare/Medicaid fraud problem, the more we are drawn back to Miami-Dade County. While home nursing care providers in South Florida have a serious problem with organized criminals getting licensed and posing as legitimate providers, the situation may be worse for honest home medical equipment (HME) companies. They have a similar but larger stain to eliminate.

The growing computerization, exchange and analysis of patient data offer the potential to improve the quality of care and reduce costs and medical errors, but those benefits will not be fully realized until privacy concerns are effectively addressed. This is the thematic statement with which HHS Secretary Mike Leavitt opened his keynote address Monday to the Nationwide Health Information Network Forum.

The 5th Nationwide Health Information Network Forum, held this week in Washington, D.C., showcased the groundbreaking work of the Nationwide Health Information Network (NHIN) trial implementations which began more than 14 months ago.  This work, carried out by members of a public-private “NHIN Cooperative,” lays the foundation that will serve as the next step toward secure nationwide interoperable health information exchange.  By making information available when and where it is needed, nationwide exchange of health information promises to increase health care quality, reducing both cost and medical errors.