OIG to target balance billing for medical equipment, supplies
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON Among six other investigations slated for medical equipment and supplies in the Office of Inspector General’s (OIG; Washington) FY00 Work Plan released Oct. 5, the OIG plans to zero in on balance billing for medical equipment and supplies. And healthcare attorney Michael DeCarlo says he questions this item.
"I think the one that scares me the most is the one on balance billing," said DeCarlo, an attorney with Dickstein Shapiro (Washington). "Overall, it strikes me that they are hammering away at the supposition that if Medicare is paying a lot for an item or has not reduced utilization for an item, then there must be a problem."
According to the OIG, the review of balance billing will seek to determine the extent to which Medicare beneficiaries are subject to financial liability when receiving medical equipment and supplies. As the OIG pointed out, there is currently no restriction on amounts for which suppliers can balance-bill a beneficiary if the supplier does not accept Medicare assignment. This is not the case in other areas of the Medicare program, such as inpatient hospital stays and physician services, the OIG noted.
The OIG also stated its intention to conduct a series of studies on the appropriateness of Medicare payments for certain medical equipment used in the home. According to the OIG, such studies are likely to include reviews of airway pressure devices, ventilators, lower limb prosthetics, and seat lift mechanisms.
In addition, the OIG said it plans to examine whether duplicate billings for medical equipment and supplies are being made to durable medical equipment regional carriers (DMERC) and regional home health intermediaries. "Because of the nature of the billing codes used and the difference in contractor claim processing, it is conceivable that Medicare could pay both providers for the same supplies," according to the OIG.
The OIG also plans to continue its examination into whether or not the DMERCs are actually fulfilling their intended purpose. The Health Care Financing Administration (Baltimore) established the four DMERCs in October 1993 to replace the existing 30 local carriers, with the express purpose of establishing medical guidelines and rooting out fraud and abuse. But the DME industry continues to come under close scrutiny.
Rounding out the OIG’s Work Plan in this area are two familiar targets. The first is an examination of the medical necessity of orthotics with a focus on items supplied to nursing home residents. The OIG will also undertake a review of the appropriateness of Medicare claims and payments for blood glucose test strips. The OIG noted that billings and payments for these strips has increased sharply in recent years. According to the Work Plan, the OIG plans to contact suppliers and beneficiaries to identify the cause of that increase and also plans to examine the appropriateness of utilization rates.
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