The work plan gives suppliers a glimpse into where Medicare may be making changes in the future. In 2016, the DME focus appears to be on lower volume products such as orthotic braces, osteogenesis stimulators and ventilators.
- In 2016 the OIG will evaluate the reasonableness of Medicare fee schedule amounts for orthotic braces. The agency will compare costs with non-Medicare payers to potentially identify wasteful spending on the part of Medicare and, based on the results, may consider reducing fee schedules for these items.
- Also for orthotic braces, the OIG will be assessing DME supplier compliance with the medical necessity requirements for these products.
- The agency will consider imposing capped rental guidelines and eliminating the lump sum purchase for osteogenesis stimulators.
- Due to a spike in ventilator utilization, the agency will be reviewing various trends in billing that are likely contributors. This review will include analysis of the utilization and billing for respiratory assist devices (RAD) and continuous positive airway pressure (CPAP) devices from 2011-2014. Additionally, the OIG will examine the impact of the competitive bidding program on ventilator billing trends.