HHS Offers Tactics To Boost Proper Diabetes-Related Medicare Claims
CMS should provide more education and information to suppliers of diabetes test strips and Medicare beneficiaries about proper billing practices to reduce the number of inappropriate and questionable payments for such products, according to a report released Tuesday by the HHS Office of Inspector General, Modern Healthcare reports.
For the report, OIG examined six measures for suspicious billings, such as:
- The average percentage of suppliers' non-mail order test strips claims for beneficiaries who would have to travel far distances; and
- The average percentage of suppliers' test strips claims that exceed Medicare's utilization guidelines.
The report found $425 million in questionable bills from about 10% of test strips suppliers in 2011. Of those claims, suppliers in 10 geographic areas -- including parts of California, Florida and New York -- were responsible for 77% of the questionable bills.
In addition, the OIG report found that Medicare inappropriately allowed $6 million for test strips claims billed for beneficiaries without a documented diagnosis code for diabetes or claims that overlapped with an inpatient hospital stay or skilled-nursing facility stay.
Despite the findings, OIG analysts concluded that Medicare's competitive bidding program "appears to have reduced questionable billing for mail-order [test strips] in (competitive bidding areas)."
The OIG report recommended that CMS:
- Enforce claims-processing edits to avoid wrongful claims that do not have the appropriate diagnoses codes;
- Increase oversight of test strips suppliers' Medicare billing; and
- Offer suppliers and beneficiaries more education about inappropriate billing practices.
According to the OIG report, CMS officials reviewed a draft of the analysis and agreed in part with its recommendations to better enforce existing edits and to increase test strips supplier oversight. CMS also agreed with OIG's recommendations to provide more education, as well as a fourth recommendation to take appropriate action when wrongful Medicare test strips claims and suppliers with questionable billing are identified (Zigmond, Modern Healthcare, 8/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.