OIG: Medicare pays too much for nutrient therapy in nursing homes
Medicare's fee schedule for enteral nutrients under Medicare Part B was more than double the prices available to suppliers to nursing homes in 2006, according to a newly released report from the Department of Health and Human Services' Office of the Inspector General.
Medicare Part B paid $284 million in 2006 for enteral nutrient therapy for nursing homes for non-Part A stays, according to the OIG report. That far exceeded prices available to suppliers. The average unit price for B4150 nutrients under the Medicare schedule was $0.67 per unit. That compared with $0.32 for suppliers. Similarly, B4154 nutrients were priced at $1.22 per unit under the Medicare schedule. They cost $0.56 for suppliers. (B4150 and B4154 refer to the codes from the Healthcare Common Procedure Coding System.)
The OIG recommends that the Centers for Medicare and Medicaid Services adjust the Medicare fee schedule amounts for enteral nutrients to more accurately reflect supplier prices for nutrients provided to nursing home residents. One other possible fix for Medicare would be to change the classification of enteral nutrient therapy from a prosthetic device benefit, and instead recognize enteral nutrients as food covered under nursing home room and board payment, according to the OIG report.