HME News

MAR 2017

HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o

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News 8 www. HM enew S . C o M / MARCH 2017 / HM e new S WASHINGTON – Suppliers won't need to resubmit claims to get retroac- tive payment adjustments mandat- ed by the 21st Century Cures Act, according to guidance released Feb. 9 by CMS. The Cures Act, signed into law in December, rolled back cuts that went into effect in non-competi- tive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments. In guidance released to the DME MACs, CMS said it will recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from the Jan. 1 to June 1, 2016, timeframe to the July 1 to Dec. 31, 2016, time- frame, according to a bulletin from AAHomecare. The revised fee schedule will be available to the DME MACs on or after May 1, 2017. The DME MACs can start processing affect- ed claims as soon as the revised schedule–expected to be avail- able May 1—is loaded into their systems. Suppliers don't need to submit new claims or other materials. Instead, the DME MACs will cre- ate a one-time process to validate and adjust claims, and will auto- matically perform a mass repro- cessing of claims. Suppliers who believe that their claims weren't reprocessed will then need to sub- mit a request. hme CMS issues guidance on bid-rate relief recognized the therapeutic aspect of these devices," said Maura Toole, director of field marketing for Philips Health- care, who is leading the work group. "Being able to monitor sleep apnea and what's going on with mask fit, AHI and periodic breathing—these are all thera- peutic benefits that providers offer with new technology. We've all focused on utilization, and not as much about the ther- apeutic benefits. That's a way to reframe the issue to payers." The work group encompasses a cross-functional representa- tion of manufacturers and pro- viders. Helping Toole to lead the group is l aura Williard, AAHomecare's senior director of payer relations. While the work group doesn't have a road map yet to achieve their goal, their strategy is to set a precedent with one payer, then give providers tools that they can use to motivate other payers to follow suit, Toole says. "With private payers, there's no cookie-cutter, turn-key solu- tion," she said. "We want some kind of mechanism that provid- ers can use to take it further." Key to setting that precedent will be proving the value of new technology, Williard said. hme T e CHNOLOG y c o n t i n u e d f r o m pa g e 4 r O u ND 2019 c o n t i n u e d f r o m pa g e 1 "I think a lot of people think Price is going to come in and just do away with competitive bidding and that's not the case," said John g allagher, vice president of gov- ernment relations for The V g M g roup. "He can't scrap competi- tive bidding, but he can rewrite it to include the market-pricing program." In fact, the broad underlying statute governing the competi- tive bidding program gives com- plete discretion to the administra- tion. Details like what products to include, what areas to include, and how to set the median bid are "all up for grabs," Bachenheimer says. "There could be a major revamp- ing of the program," she said. As head of HHS, Price will have a full plate, but stakeholders say they stand ready to press him on the competitive bidding program. "We have been working on our opportunities with Dr. Price as sec- retary since the beginning of 2017 and we are working on a strategy as we speak," said Kim Brum- mett, vice president of govern- ment relations for AAHomecare. "He will have his hands full with the Affordable Care Act repeal and replace, but we hope to be able to work with him to make changes to the current program." hme medtrade booth 605

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