Novel CMS Suggestions Simplify Medicare’s Coverage of Novel and Innovative Diabetes Devices

CMS has recently suggested additional modifications to Medicare’s payment guidelines and coverage for durable medical equipment, prosthetics, orthotic devices, and supplies (DMEPOS). This brief will help you understand “How” these proposed changes, which will streamline Medicare coverage for cutting-edge and novel diabetes devices, will work.

The suggested regulation for novel and cutting-edge diabetes devices

Proposals from CMS provide entrepreneurs with a clearer roadmap on the items that Medicare will cover.

For instance, the FDA reports that new modifications may increase the amount of continuous glucose monitors and insulin pumps covered by Medicare. Nevertheless, the current CMS guideline only applies to therapeutic CGMs or those that have FDA approval for use in making decisions about diabetes treatment, such as changing a patient’s diet or dosage of insulin only on the basis of CGM readings.

The definition of when external infusion pumps are appropriate to use at home and qualify as DME under Medicare Part B has been broadened by new CMS proposals. The proposed rule’s primary goals are to lessen administrative costs and improve access to medication infusion therapy services, including insulin pumps, in the home.

The primary cause of these administrative difficulties is the complexity of government coverage, coding procedures, and payment, which prevents entrepreneurs from promptly supplying their products to Medicare patients. However, the proposed rule addresses these issues, as you will see in the short that follows.

Delivery of Novel and Innovative Diabetes Devices to Medicare Recipients on Schedule

Both patients and manufacturers benefit from the new CMS proposed rule, which allows manufacturers to launch new products and obtain an instant Medicare payment amount and billing code. Medicare beneficiaries will have faster access to the newest technical advancements and state-of-the-art devices thanks to this expedited process.

The rule also shortened the 18-month time limit to six months for pricing calculations, Medicare benefit classifications, and DMEPOS billing code creation.

Due to the fact that one in three Medicare members in the US has diabetes, this idea may benefit both Medicare beneficiaries and their doctors by giving them access to a greater selection of technologies and gadgets.

Finally, the regulation addresses the increased compensation that CMS will continue to give suppliers for DMEPOS goods and services provided in non-contiguous and rural areas. This will incentivize suppliers to offer beneficiaries residing in these areas access and choice.

Thus, it is possible to conclude that the proposed rule will assist CMS in creating a more efficient coding, coverage, and payment system while also prioritizing patients and giving them the freedom to select the treatments that will best suit their needs for managing their diabetes.

We monitor every minor changes in US healthcare, and our HIPAA-compliant billing specialists will assist you with medical coding and invoicing so that you receive payment on time and without any problems.