WASHINGTON, D.C. (September 24, 2020)—In a recent audit from the Department of Health and Human Services Office of Inspector General (OIG), the department found a 52% increase in Medicare-allowed charges on noninvasive ventilators (NIVs) between 2016 and 2018.
The audit covered $1.1 billion in Medicare-allowed charges for approximately 1 million NIV rental units under E0466 between 2016 and 2018. The audit estimated that Medicare and beneficiaries could have save $86.6 million if Medicare-allowed charges were comparable with payment rates of non-Medicare payers.
The Centers for Medicare & Medicaid Services (CMS) uses mandated fee schedule payments for NIVs that have an economic update factor applied annually.
The OIG recommended that CMS add E0466 to the DMEPOS Medicare Competitive Bidding Program. NIVs were intitally included in the program for Round 2021, but removed in April of this year due to the pandemic and supply concerns.
"The most interesting and disconcerting thing about the OIG’s comparison of Medicare and non-Medicare payment rates for non-invasive ventilators," said Cara Bachenheimer of Brown & Fortunato, "is the omission of the differential expressed as a percentage. The fact is that the payment rates between Medicare and commercial payers are not terribly different. The actual difference is only about 15%—not something alarming like forty percent or more. Instead, the OIG report’s title translates this 15% differential as “substantially higher,” misleading those who will take the report’s title as the lasting sound bite."
CMS stated it would consider including noninvasive ventilators in future rounds of the program.
