Medicare Competitive Bidding For Medical Equipment And Supplies Could Reduce Program Payments But Adequate Oversight Is Critical
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Medicare: Competitive Bidding for Medical Equipment and Supplies Could Reduce Program Payments, But Adequate Oversight Is Critical by Kathleen M. King Pdf
Medicare has paid higher than market rates for medical equip. and supplies provided to beneficiaries under Medicare Part B. Medicare has used fee schedules based on historical charges to set payment amounts. But this approach lacks flexibility to keep pace with market changes and increases costs to the fed. gov¿t. CMS is required to test competitive bidding as a new way to set payments. CMS did this through a demonstration in two locations in which suppliers could compete on the basis of price and other factors for the right to provide their products. This testimony describes the effects that competitive bidding could have on Medicare program payments and suppliers and the need for adequate oversight to ensure quality and access. Illustrations.
United States. Congress. House. Committee on Ways and Means. Subcommittee on Health
Author : United States. Congress. House. Committee on Ways and Means. Subcommittee on Health Publisher : Unknown Page : 152 pages File Size : 43,5 Mb Release : 2009 Category : Business & Economics ISBN : PSU:000066753179
United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health
Author : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health Publisher : Unknown Page : 232 pages File Size : 51,6 Mb Release : 2013 Category : Letting of contracts ISBN : MINN:31951D03670326P
Medicare's Competitive Bidding Program for Durable Medical Equipment by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health Pdf
Medicare: Issues for Manufacturer-Level Bidding for Durable Medical Equipment by Kathleen M. King Pdf
In 2009, Medicare spent approx. $8.1 billion on durable medical equipment (DME), prosthetics, orthotics, and related supplies for 10.6 million beneficiaries. DME includes items such as wheelchairs, hospital beds, and walkers. Medicare beneficiaries typically obtain DME items from suppliers, who submit claims for payment for these items to Medicare on behalf of beneficiaries. The Centers for Medicare & Medicaid Services (CMS), an agency within the Dept. of Health and Human Services (HHS), has responsibility for administering the Medicare program. Medicare and its beneficiaries -- through their out-of-pocket costs -- have sometimes paid higher than market rates for various medical equipment and supplies. To achieve Medicare savings for DME and to address DME fraud concerns, Congress required CMS to phase in a competitive bidding program (CBP) for DME suppliers in selected competitive bidding areas (CBA). In CBP, suppliers submit bid prices in the amounts they are willing to accept as payment to provide DME items to Medicare beneficiaries. CMS then enters into contracts with select DME suppliers to provide DME items at the prices determined by CBP. In contrast to CBP's supplier-level approach, some health care purchasers use a manufacturer-level approach to buy DME items directly from DME manufacturers to obtain savings by leveraging their purchasing power. CMS has not been required to develop a manufacturer-level approach. This report provides information on health care purchasers that currently use a manufacturer-level approach and on issues that would need to be addressed if CMS implemented such an approach. It describes (1) efforts used by some non- Medicare purchasers to reduce DME spending by contracting with DME manufacturers or using purchasing intermediaries, and (2) issues that CMS might face if required to implement a DME manufacturer-level approach with broad authority to do so. Figures and tables. This is a print on demand report.
In 2007, Medicare spent $8.3 billion for durable medical equipment (DME) and related supplies. To reduce spending, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required that the Centers for Medicare and Medicaid Services (CMS) phase in a competitive bidding program (CBP) for DME and other items. DME suppliers began bidding in round 1 of the CBP in May 2007. After contracts were awarded, the Medicare Improvements for Patients and Providers Act of 2008 was enacted in July 2008. This report examined: (1) the results of CBP round 1; (2) the major challenges CMS had in conducting CBP round 1; and (3) the steps CMS has taken to improve future CBP rounds. Charts and tables.
Medicare Fraud, Waste, and Abuse: Challenges and Strategies for Preventing Improper Payments by Kathleen M. King Pdf
Medicare¿s size and complexity make it vulnerable to fraud, waste, and abuse. Fraud represents intentional acts of deception with knowledge that the action or representation could result in an inappropriate gain, while abuse represents actions inconsistent with acceptable bus. or med. practices. Waste, which includes inaccurate payments for services, also occurs in the Medicare program. In 2009, the Centers for Medicare and Medicaid Services (CMS) estimated billions of dollars in improper payments in the Medicare program. This statement focuses on challenges facing CMS and selected key strategies that are particularly important to helping prevent fraud, waste, and abuse, and ultimately to reducing improper payments. Illustrations.
United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs. Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security
Author : United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs. Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security Publisher : Unknown Page : 152 pages File Size : 45,8 Mb Release : 2011 Category : Insurance crimes ISBN : UCSD:31822038355590
New Tools for Curbing Waste and Fraud in Medicare and Medicaid by United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs. Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security Pdf
United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations
Author : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations Publisher : Unknown Page : 124 pages File Size : 51,9 Mb Release : 2013 Category : Fraud investigation ISBN : MINN:31951D03492729V
Medicare Contractors' Efforts to Fight Fraud by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations Pdf
OECD Economic Surveys: United States 2008 by OECD Pdf
This 2008 edition of OECD's periodic survey of the United States economy examines key economic challenges the US will face in the coming years including the financial crisis and health care reform.
United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations
Author : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations Publisher : Unknown Page : 328 pages File Size : 55,5 Mb Release : 2011 Category : Medical ISBN : MINN:31951D03405342M
Debates on U.S. Health Care by Jennie Jacobs Kronenfeld,Wendy E. Parmet,Mark A. Zezza Pdf
This issues-based reference work (available in both print and electronic formats) shines a spotlight on health care policy and practice in the United States. Impassioned debates about the best solutions to health care in America have perennially erupted among politicians, scholars of public policy, medical professionals, and the general public. The fight over the Health Care Reform Act of 2010 brought to light a multitude of fears, challenges, obstacles, and passions that often had the effect of complicating rather than clarifying the debate. The discourse has never been more heated. The complex issues that animate the health care debate have forced the American public to grapple with the exigencies of the present system with regard to economic, fiscal, and monetary policy, especially as they relate to philosophical, often ideologically driven approaches to the problem. Americans have also had to examine their ideas about the relationship of the individual to and interaction with the state and the varied social and cultural beliefs about what an American solution to the problem of health care looks like. In light of the need to keep students, researchers, and other interested readers informed and up-to-date on the issues surrounding health care in the U.S., this volume uses introductory essays followed by point/counterpoint articles to explore prominent and perennially important debates, providing readers with views on multiple sides of this complex issue. Features & Benefits: The volume is divided into three sections, each with its own Section Editor: Quality of Care Debates (Dr. Jennie Kronenfeld), Economic & Fiscal Debates (Dr. Mark Zezza), and Political, Philosophical, & Legal Debates (Prof. Wendy Parmet). Sections open with a Preface by the Section Editor to introduce the broad theme at hand and provide historical underpinnings. Each Section holds 12 chapters addressing varied aspects of the broad theme of the section. Chapters open with an objective, lead-in piece (or "headnote") followed by a point article and a counterpoint article. All pieces (headnote, point article, counterpoint article) are signed. For each chapter, students are referred to further readings, data sources, and other resources as a jumping-off spot for further research and more in-depth exploration. Finally, the volume concludes with a comprehensive index, and the electronic version of the book includes search-and-browse features, as well as the ability to link to further readings cited within chapters should they be available to the library in electronic format.
