Washington

Medicare could save millions if beneficiaries with end-stage renal disease (ESRD) used supplies from dialysis facilities rather than from durable medical equipment providers, the Office of Inspector General said May 16.

After studying equipment claims for home dialysis services that took place from 1996 through mid-2001, OIG concluded that Medicare paid $15.3 million more than was necessary for home-dialysis supplies from DME providers. In light of these findings, the OIG recommended that Medicare “change regulations to limit payments for Method II CCPD kits to that of Method I.” That means Medicare would pay DME providers no more for home-dialysis supplies than the agency pays dialysis facilities for the same supplies.

Responding to the OIG's recommendation, CMS said a regulation change is not necessary. The current regulation allows for discrepancies in CCPD-supplies reimbursements, paying less for supplies that are part of “composite” services (offered by facilities) than for supplies provided separately. “We agree that the statute clearly allows a higher payment limit for CCPD supplies under [the HME-provider method]; however, the statute does not require paying the higher limit,” CMS said. “Therefore, we continue to believe that CMS should reimburse suppliers consistently for the same dialysis supplies, irrespective of the method the beneficiary chooses.”

Information about the OIG report is available at http://oig.hhs.gov/oei/reports/oei-07-01-00570.pdf.

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