News briefs
Wheelchair and scooter criteria set by CMS
The Centers for Medicare & Medicaid Services (CMS) announced new national coverage criteria for mobility assistive equipment (MAE) including power wheelchairs and scooters. The new criteria, which are effective immediately, adopt a function-based determination of medical necessity. The determination looks at the ability of the beneficiary to safely accomplish mobility-related activities of daily living, such as toileting, grooming, and eating, with and without the use of mobility equipment such as a wheel-chair. The national coverage determination (NCD) addresses the full range of MAE from simple canes and walkers to sophisticated power wheelchairs.
The coverage criteria are part of a larger three-pronged Modern Mobility Initiative announced in April 2004 that are focused on improving coverage, payment, and quality of suppliers of power wheelchairs and other mobility aids. In addition to developing new coverage criteria, CMS has developed new billing codes that will take effect Jan. 1, 2006, to reflect the variety of wheelchairs now on the market. CMS expects to issue new quality standards for suppliers in 2006.
“During the course of reviewing Medicare’s policies for power mobility devices, CMS came to the conclusion that there are more accurate tools to root out fraud and abuse,” explains Kimberly Brandt, director of CMS’ Program Integrity Group. “The combination of the new NCD and the planned enhanced educational outreach by Medicare to physicians and treating practitioners, as well as to suppliers, will eliminate most honest billing errors. More accurate claim submission will allow CMS to better analyze claims data and focus claims review to target abusive billers.”
HHS looks at changes to HIPAA enforcement
The Department of Health and Human Services (HHS) has published a notice of proposed rulemaking that changes rules related to investigations of breaches of the Health Insurance Portability and Accountability Act (HIPAA). The proposed changes include expanding the enforcement rules to include all HIPAA administrative simplification provisions in addition to the privacy rule. Civil monetary penalties also could be imposed under the proposed rule change. Clarification of the investigation process, the process for determining penalty amounts, the grounds for waiver, and the hearing and appeals process also is described in the notice.
To see the proposed changes, go to www.gpoaccess.gov/fr/. In the search box, enter: “page 20223,” “45 CFR parts 160 and 164,” “HIPAA,” AND proposed rule. Choose “Administration Simplification: Enforcement proposed rule.”
The Centers for Medicare & Medicaid Services announced new national coverage criteria for mobility assistive equipment including power wheelchairs and scooters.
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