HME News

JUL 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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■ With the IFR in many ways a disappointment, it's time to get back to H.R. 4229, says Jay Witter. See story this page. Industry stays focused on bid relief. . . . . . . . . . . . . . . . . . . 1 Newspoll: Providers mixed on extending contracts . . . . . 3 FAHCS lawyers up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 AAHomecare pushes e-prescribing. . . . . . . . . . . . . . . . . . . 6 News Briefs CMS releases adjusted rates WASHINGTON – CMS on May 25 published the adjusted reimbursement rates that will go into effect for seven months in ru- ral areas.The adjustments, called for in a recently released interim final rule, means reimbursement for oxygen concentrators, for example, will go from $77.16 to $121.46 per month from June 1 through Dec. 31 in rural areas. Per the IFR, CMS is reverting to 50/50 blended reimbursement rates in rural areas, but not in all non-bid areas, as stake- holders had hoped. OIG says access intact in bid areas WASHINGTON – Round 2 of Medicare's competitive bidding program does not ap- pear to have impacted access to oxygen or enteral supplies for most beneficiaries, according to two new reports from the Office of Inspector General. The OIG ana- lyzed claims data from three months be- fore and six months after the July 1, 2013, kick-off of the program in both CBAs and non-CBAs. For oxygen, the OIG found that Medicare payments continued for 86% of beneficiaries in CBAs and 89% of ben- eficiaries in non-CBAs. Those rates were consistent with payments being made for 88% of beneficiaries in 2012. For en- teral nutrition supplies, the OIG found that Medicare payments continued for 91% of beneficiaries in CBAs and 94% in non- CBAs, slightly lower than the 95% in 2012. CQRC questions OIG findings WASHINGTON – The Council on Quality Respi- ratory Care criticized a recent report from the Office of Inspector General, saying it underestimates the negative impact of the competitive bidding program on access for oxygen patients. The CQRC states that the "limitations in the report's methodology signal significant flaws in the OIG's conclu- sions." It points out that the OIG, itself, ac- knowledges that continued Medicare pay- ment "is not a direct measure of continued access to oxygen equipment and contents" and that "the response rate for our survey was too low to project the results to all ben- eficiaries for whom claims did not continue." MACs ease denial process WASHINGTON – The DME MACs are adding modifiers that will allow HME providers to provide additional information related to the coverage and/or liability when the policy criteria are not met for oxygen patients. Ef- fective for claims with dates of service on or after Aug. 1, providers should use: the KX modifier when the requirements specified in the medical policy have been met; GA for a waiver of liability (expected to be denied as not reasonable and necessary, ABN on file); GY for item or service statutorily excluded or does not meet the definition of any Medicare benefit; or GZ for item or service not reason- able or necessary (expected to be denied as not reasonable or necessary, no ABN on file). www.h M e N ew S . COM / july 2018 / h M e N ew S 3 By Liz Beau L ieu, e ditor WASHINGTON – A major goal of the AAHomecare Washington Legislative Conference in May was determining whether or not Sen. John Thune, R-S.D., will continue to lead the HME industry's bid relief efforts. With a bill in the House of Representatives, but no bill in the Senate, the big question is: Is Thune satisfied with the relief outlined in the recently released interim final rule, which impacts rural states like the senator's the most, or does he want to continue pushing for more widespread relief? "Everyone's looking at Thune," said Jay Witter, senior vice president of pub- lic policy for AAHomecare. "If (he's satisfied), we have other By Liz Beau L ieu, e ditor WASHINGTON – With the fate and details of the interim final rule no longer a mystery, stake- holders and their champions in Congress are putting their full weight behind H.R. 4229, a bill that would provide more b ro a d - b a s e d relief in non- c o m p e t i t i v e bidding areas. T h e I F R , published in t h e F e d e r a l R e g i s t e r o n May 11, will apply 50/50 blended reimbursement rates, but just in rural and non-con- tiguous bid areas, and only from June 1, 2018, through Dec. 31, 2018. "The IFR was holding back H.R. 4229," said Jay Witter, senior vice president of public policy for AAHomecare. H.R. 4229, which has 152 co-sponsors, would apply the blended rates from Jan. 1, 2017, to Jan. 1, 2019. A pro- vision in the 21st Century Cures Act has already applied the blended rates retroactively from July 1, 2017, to Jan. 1, 2017. That provision in the Cures Act is proof that Congress is ready and willing to provide more broad-based relief in non-bid areas, stakeholders say. "They know how to do it," Witter said. "They've already done it." By Theresa F L aher T y, Managing e ditor I F CMS decides to extend current com- petitive bidding contracts, a slight majority (53%) of respondents to a recent HME Newspoll say they would accept them—reluctantly. "We currently have the contract and have provided the equipment and ser- vices, so it just makes sense to continue with it," said one respondent to a recent HME Newspoll. "Either way, you lose." Contracts for both competitive bidding and the national mail-order contract for diabetes are set to expire Dec. 31, 2018, and 81% of poll respondents say there's no longer enough time to complete the bid process by Jan. 1, 2019. While CMS has the authority to extend contracts, several rounds of the flawed program have d r i v e n r e i m b u r s e m e n t rates to unsustainable lev- els, making the contracts extremely unattractive, say respondents. "We would decline the offer because with all the cuts that have been made it is a big loser," said Melody Amos, office manager at Quality Tem in Bakersfield, Calif. "You're lucky if you can make your cost back and just break even." Other contract suppliers say they are committed to the bidding program for better or worse. " We h a v e i n v e s t e d a t re m e n d o u s a m o u n t o f resources to service many t h o u s a n d s o f p a t i e n t s under the bid program," said Robin Soblick, presi- dent of Michigan-based S p e c i a l t y M e d i c a l a n d Texas-based AJT Diabetic, which hold national-mail order contracts for diabe- tes testing supplies. "It has taken years By Liz Beau L ieu, e ditor T HE EARS of HME providers perked up during the AAHomec- are Washington Legislative Conference, when CMS's Melanie Combs-Dyer said the agency was working on a documenta- tion requirement lookup service for prescribing providers. Combs-Dyer, the acting deputy director of the Center for Pro- gram Integrity, said CMS plans to pilot the service, which allows prescribing providers to look up documentation requirements at the time of service from their EHR or practice management system, in late 2018 or early 2019. What's more, looking at its pool of claims for high levels of utiliza- tion, errors and appeals, Combs-Dyer said CMS has tapped CPAP Post IFR, stakeholders cast wide net for support senators raring to go, but no one wants to move unless it's blessed by Thune." Per the IFR, CMS will revert to the 50/50 blended reim- bursement rates in rural areas from July 1, 2018, through Dec. 31, 2018. It will not revert to those rates in all non-bid areas. Thune, who sits on the Geor G ie Black B urn, vice president of government relations and legislative affairs at Blackburn's in Tarentum, Pa., spoke from the audience during the AAHomecare Legislative Conference. live from washington CPAP, oxygen on tap for pilot Melanie c o MB s-Dyer detailed a new documenta- tion look-up tool. 'We're an industry in crisis' Extended bid contracts? 'Either way you lose' h M e NEWS POLL c r I S I S s e e pa g e 6 c O N f e r e N c e s e e pa g e 1 9 p I l O T p r o g r a m s e e pa g e 4 N e W S p O l l s e e pa g e 6 Bachenheimer

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