Despite much attention given to the annual rate notice concerning MA payment, though, we urge CMS to direct more attention to protecting public funds by ensuring that such payment is accurate. MA “upcoding” – when an MA plan inappropriately reports an enrollee as being more sick than they actually are in order to obtain a higher risk-adjusted payment from the Medicare program – remains an ongoing problem that policymakers must address.
Archives: CMA Comments, Responses, and Letters : Page 2
The Center for Medicare Advocacy has been hearing from people who meet Medicare coverage criteria but are unable to access Medicare-covered home health care, or the appropriate amount of care. These problems have been escalating in 2016.
The Center has significant concerns that the proposed changes will result in drastically reduced access to Medicare home health care coverage for beneficiaries, particularly those who are clinically complex or who have poorly controlled chronic conditions.
We strongly object to other proposals which, on their face, might appear to make things easier for both appellants and adjudicators, but in practice would likely severely dilute the rights of beneficiaries pursuing appeals.
Comments on the proposed rule concerning Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model (CMS-1651-P)
We continue to observe that the misalignment of payment procedures in Medicare and Medicaid results in denials, delays, and higher than appropriate health care costs for essential DME among dually eligible beneficiaries.
Congress should prioritize solutions to improve care quality for persons with multiple chronic conditions. The health care needs of older adults and people with disabilities should be at the center of these efforts.