Legislative

One of the most supported healthcare-related bills currently pending in Congress, this may be the year H.R. 930 crosses the finish line, lymphedema advocates say. “We are looking at any possible vehicles to get this attached to,” said Judy Woodward, chairwoman of awareness for the Lymphedema Advocacy Group. “There are people championing this and trying to find ways to make that happen.” The Lymphedema Treatment Act would amend Medicare statute to pay for compression

Written by: Nikki Jensen, vice president, Essentially Women I want to connect with you to educate you on the importance of contacting your members of Congress to ask for their support of the Lymphedema Treatment Act, H.R. 930 and S. 497.   Why?  Because it matters!  A little background on why this bill is so important: Lymphedema is a serious medical condition that has no cure.  When the lymphatic system becomes damaged or impaired the body cannot effectively remove

Essentially Women has been working towards getting a bill introduced to allow Medicare coverage for custom breast prosthesis. We have been in communication with several legislative offices that have requested additional information. This is where we need your help! We need to hear from patients from both perspectives: those who were able to obtain coverage for their custom breast prosthesis and those who are not covered. As you are aware, Medicare created L8035, a code for custom breast prosthesis

Women’s health advocates ready to drum up support for legislation WASHINGTON – A recently introduced bill seeking Medicare coverage for wigs is an exciting step forward for women’s health, say advocates. “It’s a relatively inexpensive DME item but it certainly carries a lot of importance for a woman undergoing chemo—the hair loss is an extremely difficult piece,” said Mary Aframe, owner and founder of Women’s Image Center in Worcester

FOR IMMEDIATE RELEASE New Legislation Would Provide Medicare Coverage for Wigs to Cancer Patients Last week Rep. Jim McGovern (D-Mass.) introduced a bill which would provide coverage for wigs to Medicare beneficiaries. The bill, H.R. 2925 would allow wigs to be covered as durable medical equipment; opening access for Medicare beneficiaries that a dermatologist, oncologist, or attending physician can certify medical necessity as a part of rehabilitative treatment. Click here to read the full

You know the old slogan, “Do you want the good news first or the bad news?” Well, we are optimistic so we will give you the good news first. Good News – Mass Adjustments Starting in May not July! They are starting two months earlier than expected, AND providers do not have to take any action as these will be processed as a MASS ADJUSTMENT. Bad News – Mass Adjustments will Take Approximately 24 Weeks to Complete! Here’s what we know as of today: The DME MACs

DME contractor CGS announced on May 8 that it is preparing to begin mass adjustments to all claims covered under Section 16007 of the 21st Century Cures Act for DMEPOS items for jurisdiction B and C. It was indicated in CGS' announcement that the process will take approximately 24 weeks to complete, adjusting up to 40,000 claims per day in Jurisdiction C and 20,000 per day in Jurisdiction B. The van Halem Group published a blog post going into further detail about the announcement. Click here

A major win for DME Suppliers was announced yesterday, as CMS released information regarding improvements to the adjudication process of serial claims. Effective April 7, 2017, CMS has implemented changes to improve the processing and adjudication of recurring (monthly) claims for capped rental and certain inexpensive and routinely purchased (IRP) items. Prior to April 2017, if a monthly rental claim was denied and then appealed separately, then the claim was adjudicated independently and without

AMARILLO, TX - Assume that ABC Medical Equipment, Inc. is related to XYZ Medical Equipment, Inc. and DEF Medical Equipment, Inc. For example, assume that while the three companies do not have identical stockholders, John Smith and Jack Jones are stockholders of each company. Assume that ABC determines that Medicare paid claims to ABC that should not have been paid. Assume that ABC does not report and repay the overpayment to CMS. Assume that there is no evidence of improper claims submissions

When a Medicare beneficiary transitions to a new supplier, the DME MACs currently do not accept medical documentation from the original supplier. As we all know, this has been a burden on both the beneficiary and the new supplier. Change is about to happen. Effective April 24, 2017, the DME MACs WILL accept medical documentation from the original supplier when a beneficiary transfers to a new supplier.   What Does This Mean for the New Supplier? This means that, when a beneficiary switches