RICHMOND, VA – Virginia Medicaid DME policy was updated on Jan. 1, 2024 to include several revisions sought by industry advocates. Key changes include:

• Adding coverage of CRT for Medicaid recipients living in a nursing facility. This is the result of a multi-year effort in collaboration with United Spinal Association of Virginia, who spearheaded legislation to support this change.
• Updating NIV policy to allow for continuous rental instead of only capping.
• Enhancing the enteral policy to allow for certain formula substitutions in the event of formula shortages.

These policy gains are the result of collaborative efforts to build and maintain strong relationships with Virginia Medicaid leaders by AAHomecare’s Payer Relations team and our partners at ACMESA, and set the stage for continued engagement going forward.  See the updated VA DME policy guide for more details.

Enteral Rates Get Significant Boost in New York
ALBANY, N.Y. – In New York, Medicaid enteral reimbursement rates saw rate increases between 10%-36% for seven codes, effective Jan. 1, 2024. NEMEP’s Payer Relations Committee, led by AAHomecare’s David Chandler, made a compelling case to Medicaid officials to secure the substantial rate increases.  See the New York enteral rate increases here.

DMEPOS Improper Payment Rate Shows Continued Improvement

WASHINGTON, D.C. – CMS recently published their 2023 improper payment report. The DMEPOS improper payment rate continued to decline from the all-time high of 74% in 2010 to 22.5% in 2023.

While this shows significant improvement, it is still the highest improper payment rate when compared to all Medicare Parts A and B. Overall CMS reported an improper payment rate of 7.38% for all segments of healthcare.

While CERT audits are random with only 8,248 claims reviewed for DMEPOS, this is the only published improper rate and as such is often viewed by policymakers and legislators as a benchmark.

AAHomecare reviews the report in detail each year to help educate the supplier community and the DME MACs on specific policy groups and supplier types that have higher improper payment rates.

This year’s reports continue to show the supplier types podiatry, orthopedic surgery and multispecialty clinic or group practice to have much higher improper rates than traditional DMEPOS suppliers.

On review of the product categories with the highest improper payment rates, lower limb orthoses, surgical dressings, LSO, diabetic shoes, manual wheelchairs and pneumatic compression devices topped the list.

See CMS’ 2023 Medicare Fee-for-Service Supplemental Improper Payment Data for more details.