dmepos Archives - Applied Policy

CMS Finalizes CY 2021 ESRD Policies, Incorporating Calcimimetics into PPS and Adding Transitional Add-on Payment to Cover Certain Home Dialysis Machines

On November 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the final rule that updates the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2021. This rule finalizes changes related to the ESRD PPS, the ESRD Quality Incentive Program (ESRD-QIP), payment for acute kidney injury (AKI), and other [...] Read More

CMS Releases CY 2021 DMEPOS Proposed Rule: Announces Changes to 2021 Competitive Bidding and Proposes to Classify All CGMs as DME [CMS-1738-P]

On the evening of October 27, 2020, the Centers for Medicare & Medicaid Services (CMS) released the unpublished version and fact sheet of its proposed CY 2021 Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) rule, which updates DMEPOS coverage and payment policy for CY 2021: Classifies/establishes payment amount for continuous glucose monitors (CGMs) as [...] Read More

CMS Finalizes Enhanced Payments for New Dialysis Technology and Attempts to Streamline DME Pricing and Claims

Tweet On October 31, 2019, the Centers for Medicare & Medicaid Services (CMS) released its 2020 End Stage Renal Disease/Durable Medical Equipment Payment final rule. In addition to changes to payments under the end-stage renal disease (ESRD) and durable medical equipment (DME) programs, the rule includes changes to payment for renal dialysis, the ESRD quality [...] Read More

CMS Proposes Enhanced Payments for New Dialysis Technology and Attempts to Streamline DME Pricing and Claims

Tweet On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released its 2020 End Stage Renal Disease/Durable Medical Equipment Payment proposed rule. In addition to changes to payments under the end-stage renal disease (ESRD) and durable medical equipment (DME) programs, the rule proposes changes to payment for renal dialysis, the ESRD quality [...] Read More

Anticipating a Gap in DME Competitive Bidding, CMS Proposes Rules for 2019 Competition and Interim Pricing

This evening, the Centers for Medicare and Medicaid Services (CMS) released the CY 2019 proposed payment rule for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and for the End-Stage Renal Disease (ESRD) program. The rule contains changes to the DMEPOS competitive bidding program and proposals for DME fee schedule payments where competitive bidding is […]

Coming in 2018: CMS Limits on Medicaid DME Funding

On December 27, CMS issued a State Medicaid Director letter to explain new limitations on federal financial participation for durable medical equipment (DME) in Medicaid. Beginning on January 1, 2018 (as required by Section 5002 of the 21st Century Cures Act), federal reimbursement to states for DME expenditures in Medicaid will be limited to the […]

There’s a New Secretary in Town: What Do We Know About Tom Price?

On February 10, 2017, the Senate confirmed Tom Price to be the 23rd United States Secretary of Health and Human Services. Prior to his nomination and confirmation, Secretary Price was a Member of the United States House of Representatives, representing Georgia’s 6th district. There, he had chaired the House Budget Committee since 2015. In addition, […]

CMS Adds Prior Authorization Requirement for Two Types of Power Wheelchairs

In 2015, CMS implemented a prior authorization process for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that are frequently used unnecessarily. The agency released an initial master list of 135 DMEPOS items subject to the new requirements on December 30, 2015, which met the following criteria: Are paid off the Medicare DMEPOS fee […]

CMS Awards Contracts for Round 1 DMEPOS Competitive Bidding Program Through 2018; 92% of Suppliers Accept Contracts

Today, CMS announced the Round 1 2017 suppliers for Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. These 182 contracts with suppliers comprising 534 locations in the nine metropolitan statistical areas (MSAs) making up the Round 1 competitive bidding areas will be effective January 1, 2017 through December 31, 2018. The product […]

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