HME News

OCT 2018

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.h M enew S . COM / OC t O ber 2018 / h M e new S By Theresa F L aher T y, Managing e ditor S p RINGFIEL d , Ill. – Proponents say a bill in the i llinois h ouse of r epresentatives that would address reimbursement cuts for home medical equipment and supplies is critical as more and more payers offer below- m edicaid rates. t his year, i lliniCare h ealth, a m edicaid m C o , announced rate cuts ranging from 10% to 50%. h ouse Bill 5930 would pro- hibit managed care organizations from paying providers less than 10% below m edicaid "fee for service" rates. " i lliniCare was the first one, but there's been quite a bit of talk about Blue Cross Blue Shield doing the same," said Dan h eckman, owner of h eckman h ealth Care in Decatur. " t hat makes it even more critical to get it passed." t he bill, which h eckman hopes gets i llinois Bill targets reimbursement cuts by managed care orgs passed this fall or during the 2019 spring session, would also require "minimum quality standards" for medical supply companies and prohibit m C o s from sign- ing "sole-source" contracts. Cutting reimbursement to the point where it doesn't make sense for provid- ers to be in-network with certain payers would severely curtail beneficiary access, especially outside of the Chicago area, says h eckman. " t he m C o s, in general, don't have real robust networks in the downstate area," he said. "When i llinicare expand- ed downstate, their initial offer to us was the deeply discounted rate. We just didn't take it. Nope, not playing that game." S o l e - s o u rc e c o n t r a c t s h a v e a l s o been a worr ying trend for provid- ers across the country, with m C o s in New h ampshire, i ndiana, New h amp- shire and t ennessee, for example, tar- geting contracts with distributors to provide D me and supplies to their members. HME v AN HALEM c o n t i n u e d f r o m pa g e 4 van Halem: t hey're much more aggressive and seem to be doing a lot more payment suspensions. a lso, one of the things they're doing now is, when a UP i C in one jurisdic- tion implements a payment suspension, all of them initiate a post-payment audit. We've had providers go through this. t here's a sus- pension from one contractor then a letter from all the other contractors requesting claims to review, and then each identifies an extrapolated overpayment. Before, with the ZP i Cs, there was usually one extrapolated overpayment to deal with. HME: Does their aggressiveness have to do with the size of their contracts? Safeguard, for m edicare on j an. 1, and the majority (55%) say they don't think their market share will suffer much under an "any will- ing provider" provision. " i think it will cut into the m edicare business i am already doing, but it may not be that significant, so i am planning for about a 15% drop in m edicare reve- nue," wrote one respondent. For other contract suppliers, however, they say their expired contracts give them a get-out-of-jail-free card. "We currently have the contract for example, is getting about $130 million for its contract for the Southeast. van Halem: t hey have to show C m S a return on investment and the investment is sig- nificant. When they do a payment suspen- sion, that's quantified as savings. When they extrapolate an overpayment, that quantifies as savings. HME: Do providers have any avenues of recourse? van Halem: t he UP i Cs certainly don't make it easy. m ost of the time, they provide a main phone number where you can leave a mes- sage and hope someone gives you a call back. i f they do call you back, they often refuse to give you information. t hey don't neces- sarily want to communicate and they don't have to. HME enteral and we will stop doing accepting new referrals, as we are losing money ser- vicing these customers," wrote t ed o ury of Diamond m edical e quipment & Supply in Little r ock, a rk. "When we made the deci- sion to decline most bids, we moved full force into retail with a new location and higher-end equipment for cash. t he result has been better than we anticipated. We would love to provide service to m edicare beneficiaries, but until reimbursements are reasonable we will continue with retail and other forms of reimbursement." HME pRO v I d ERS SHIFT FROM ME d I c ARE c o n t i n u e d f r o m pa g e 4 Earlier this year, IlliniCare Health, a Medicaid MCO, announced rate cuts ranging from 10% to 50%

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