New HCPCS for Two-Function Vents

For those of you offering multi-function ventilators, CMS assigned a new HCPCS for the two-function VOCSN VC and VC Pro units. Suppliers should use E0468 for dates of service on or after April 1, 2024. The reimbursement rates range between $1,200 and $2,200, depending...

When they don’t follow Medicare …

“We follow Medicare.” It’s a common answer DME suppliers get when trying to understand why a Medicare Advantage Plan (MAP) denied a claim. It’s a common answer, but not always an accurate one. CMS, however, has been active in pinning MAPs down to follow Medicare...

Medicare Still Requires Direct Home Assessments

You may have missed it … Back in January, the DME MACs published a joint reminder that Medicare requires in-person home assessments before billing for manual wheelchairs. I suspect this will catch a lot of suppliers off guard. The Policy Article is Vague Supplier...

MAPs! Why can’t you be more like your sister?!

It does seem like CMS is on a crusade to force Medicare Advantage Plans (MAPs) to be more like Medicare Fee-For-Service (FFS), right? And in the latest move to provide consistency and transparency to all Medicare, Medicaid, and marketplace beneficiaries, CMS issued...