US Senators urge CMS head Verma to include med device ID on claims

This article was originally published here
Share

Centers for Medicare & Medicaid Services (CMS)

Two US Senators this week wrote to Centers for Medicare and Medicaid head Seema Verma urging her to add a field for unique medical device identifier information on insurance claim forms.

The letter, from Senators Elizabeth Warren (D-Mass) and Chuck Grassley (R-Iowa), cited a report from the Department of Health and Human Services’ Office of Inspector General from September.

The report claims that nearly $1.5 billion in costs to Medicare came from patients treated with seven specific cardiac devices from 3 manufacturers that were recalled or showed high failure rates over a 10 year period.

The OIG release also claimed that the defective items led to an estimated $140 million in copayment and deductible liabilities for beneficiaries.

“To facilitate the use of claim data to identify and track the additional health care costs incurred by Medicare from recalled or prematurely failed medical devices, we specifically recommend that CMS: (1) continue to work with the Accredited Standards Committee X12 to ensure that the Device Identifier is included on the next version of claim forms and (2) require hospitals to use condition codes 49 or 50 on claims for reporting a device replacement procedure if the procedure resulted from a recall or premature failure independent of whether there was a device provided at no cost or with a credit,” the OIG wrote in its report.

In their letter, Senators Warren and Grassley wrote that they were “encouraged” by CMS head Verma’s statement after the OIG report which stated that the addition could help CMS “more effectively identify and track Medicare’s aggregate costs related to recalled ore prematurely failed devices, reduce medicare costs by identifying poorly performing devices more quickly, facilitate device recipients’ chances of receiving timely follow up care, and protect beneficiaries from unnecessary costs.”

The Senators cited, however, that CMS chief medical officer Kate Goodrich did not confirm whether CMS would take the recommendations of the OIG during testimony before the Senate Committee on
Health, Education, Labor, and Pensions.

In response, Senators Warren and Grassley directly requested that CMS head Verma respond directly to three questions, including whether CMS supports capturing unique device IDs for implantable devices on claim forms. Senators also requested clarity on whether CMS follows recommendations from the HHS OIG and MedPac and is working with the Accredited Standards Committee X12 to “ensure that the DI is included on the next version of claim forms” and what, if any timeline CMS has for it’s ‘review’ of DI inclusion on claims forms.

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply