AHA supports CMS' proposed rule to mitigate $3 billion fraudulent catheter billing impact; rule would exclude suspect catheter billing codes from 2023 MSSP expenditure calculations

The AHA July 29 applauded a proposed rule by the Centers for Medicare & Medicaid Services to address concerns raised by the AHA and other organizations about the potential impact of significant, anomalous and highly suspect catheter billing within the Medicare Shared Savings Program. CMS data showed a 20-fold increase in catheter billing from 10 durable medical equipment suppliers over two years, equivalent to a nearly $3 billion increase in spending. The AHA supported CMS' proposal to hold ACOs harmless for SAHS catheter billing that occurred in calendar year 2023, and specifically supported exclusion of catheter billing codes submitted by any supplier from MSSP expenditure and revenue calculations for CY 2023. "Inclusion of this anomalous billing in accountable care organization (ACO) spending figures for CY 2023 would have a severely inappropriate impact on these calculations," AHA wrote to CMS. "Indeed, the recent catheter billing issue increased some ACOs’ total spending by as much as 2%. As such, in many cases, inclusion of this spending would actually lead to a loss of shared savings."