HME News

FEB 2019

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 6 www. HM e N ew S . C o M / febru A ry 2019 / HM e N ew S as participating? "That's a good question," Buhrmester said. "Back in the day, the rates were reasonable, so it didn't matter. I think we're going to see an increased number of pro- viders that went non-participating in 2019, I really do," she said. Luddite S N o M ore If Miriam Lieber has one thing she wishes providers would embrace in 2019, it's technology—current and future technology. "The notion of a patient being able to tap into their i p hone to know if they had a leak in their C p A p mask, that goes so far in the patient managing themselves and the provider managing the patient," said Lieber, president of Lieber Consulting LLC. "That's really where it's at and it's here now." Lieber says providers also need to jump on technology that's not exactly here now, like an automat- ed intake process using artificial intelligence. "Checking and verifying eligibil- ity is not straightforward today," she said. "We need a more robust and automated intake process to find out who the payer is and how you can marry the payer with the authorizer, and what the documen- tation requirements are, etc." p roviders have one thing push- ing them toward technology, Lieber says: tight margins. "They're realizing they can't do it alone and it's too expensive to hire more people," she said. HME c ONS u LTANT c o n t i n u e d f r o m pa g e 3 TPE c HANGE c o n t i n u e d f r o m pa g e 3 "Where I can see a problem is if you have one issue with your process, it affects every claim," she said. "It's a smaller sample from which they'll determine your compliance rate." CMS has also published a new transmittal instructing the MACs to review only services/ items with dates of service after one-on-one education for Rounds 2/3 of the T p E program, whereas they can review dates of service or dates of submission for Round 1. The MACs must allow 45-56 days between each intervention to give providers time to make improvements. "The intent of the T p E is, tar- geting an issue, doing an audit or probe, then educating," Gra- hovac said. "They need to give you time to fix it, then come back and see if y0ou fixed it." Industry stakeholders had noted inconsistency across con- tractors and even reviewers on when an audit was "turned back on," Grahovac says. "I think enough folks said, 'This doesn't make sense, it needs to be date of service not submission,'" she said. HME WASHINGTON – Reimbursement rates for stationary and portable oxygen concentrators fare quite differently in the 2019 fee schedule, accord- ing to an analysis by AAHomecare. The rural rate for stationary con- centrators (E1390) will increase 10.9%, from $121.46 to $134.71, and the average regional rate will increase 4.4% from $69.31 to Budget neutrality dampens oxygen reimbursement $72.32. The rural rate for p OCs (E1392) will decrease 5.2% from $46.77 to $44.32, and the average region- al rate will decrease 6.5%, from $38.10 to $35.64. Rates for portable gaseous con- tents (E0431) and portable gas- eous 02 system (K0738) will also see decreases ranging from 3.8% to 6.5%, according to AAHomecare. "These additional cuts for home oxygen therapy are certain to impact providers and patients in rural and other non-CBA areas," stated AAHomecare in a bulletin. "The HME community needs to make this a priority for advocacy efforts in the 116th Congress." A competitive-bidding related final rule released in November creates a new class for portable liquid oxygen equipment by split- ting the existing class of portable gas and portable liquid oxygen, and changes the way budget neu- trality is calculated by applying the offset to all oxygen and oxy- gen equipment classes beginning Jan. 1. HME

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