Moving the HME Industry Forward

Billing/Reimbursement

Road to Medtrade – Preparing for ZPICs and More

September 22, 2014

AMARILLO, TX – The upcoming Medtrade (Oct 20-23, 2014 in Atlanta) has an excellent line-up of speakers who will present programs addressing the most important topics faced by DME suppliers today. Every issue of Medtrade Monday, leading up to Medtrade, will highlight a Medtrade program.

Preparing for and Responding to Increasingly Aggressive Actions by the ZPICs, Accrediting Organizations and the NSC
When most people think of the Affordable Care Act (ACA), they immediately think about the sections related to the provision of health care coverage. What people don’t think about are the provisions of the ACA that added even more weapons to CMS’s arsenal to fight fraud and abuse. Most people are also not aware that in fiscal year 2011, the OIG reported recoveries of about $5.2 billion.

On Monday, October 20th, 2014, Denise M. Leard, JD, attorney with the Health Care Group at Brown & Fortunato PC, will present an in-depth program entitled, Preparing for and Responding to Increasingly Aggressive Actions by the ZPICs, Accrediting Organizations, and the NSC.

In addition, the OIG claims to have identified about $19.8 billion in estimated savings for CMS through legislative, regulatory, or administrative actions that were supported by their recommendations. The OIG also excluded 2,662 individuals and entities from participation in Federal health.  

They launched 723 criminal actions against individuals or entities that engaged in health care related crimes and 382 civil actions.  The OIG did not accomplish these feats by itself. It had help from a number of Medicare contractors including the Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RACs), Accrediting Organizations (AO) and the National Supplier Clearinghouse (NSC).

The ACA gave CMS greater authority to scrutinize provider enrollment.  CMS can halt enrollment in areas of the country where fraud, waste and abuse is suspected.  

CMS has used this power most recently in the home health industry where it has instituted a moratorium on the issuance of new provider numbers in a dozen places around the country. Durable medical equipment (DME) suppliers have been categorized as high-risk providers. The result being increased scrutiny for suppliers wishing to obtain a new Medicare supplier number.  

CMS has changed tactics and instead of chasing overpayments, it is being more aggressive at the front end and auditing providers prior to payment. A supplier can be audited by the DME MAC, the ZPIC, RACS, the Supplemental Medicare Review Contractor. In addition, CMS has broad powers to suspend payments to suppliers where fraud is suspected.

A supplier chooses its AO and pays the AO to come and look at is practices through the survey process.  But remember the authority of an AO to accredit Medicare suppliers is granted by CMS and the AO must take direction from CMS.  This means, CMS can ask the AO to look at your organization and then report back to it.  So while the AO can be your friend, CMS can use the AO for its enforcement activities.

With such aggressive enforcement tactics being pursued by the government, people often ask if it is even worth it to be in the DME industry. The answer to that is yes.  But in order to be successful, a supplier must understand the enforcement landscape and be proactive.  Being reactionary and responding to an action when it hits the supplier’s doorstep will not be good enough.  The only way to be prepared is to understand the hazards that are lurking in the background and being prepared for battle when they rear their ugly heads.

Hear from Denise Leard, Medtrade presenter
Q: Why is the topic important?
A: This topic is important because it will discuss the hazards that DME suppliers face on a daily basis and will provide suppliers with the knowledge they need in order to develop a proactive plan for dealing with these challenges.

Q: Why should people attend this presentation?
A: Attendees of this presentation will not be caught off guard when they are faced with CMS’ aggressive enforcement tactics. They will be prepared to respond quickly and appropriately when necessary.  As a result they will achieve better results with less stress.

On Monday, October 20th, 2014, Denise M. Leard, JD, attorney with the Health Care Group at Brown & Fortunato PC, will present an in-depth program entitled, Preparing for and Responding to Increasingly Aggressive Actions by the ZPICs, Accrediting Organizations, and the NSC.