Moving the HME Industry Forward

Legislative/Advocacy

AAHomecare in Action – Final Rule, Stand Up, and Appeals Backlog

November 3, 2014

WASHINGTON, DC – CMS intends to use single payment amounts (SPAs) from the competitive bidding program to adjust Medicare payment rates in areas outside the competitive bidding areas (CBAs). CMS made its intent known via final rule CMS-1614-F, issued last week. AAHomecare regulatory experts are reviewing the final rule and will update Medtrade Monday and AAHomecare membership with important details as soon as possible.



This rule is the final step in the regulatory process that CMS began earlier this year via an Advanced Notice of Proposed Rule Making (ANPRM) and continued with the proposed rule, CMS-1614-P, released in July.

The final rule included a number of other issues pertaining to DMEPOS, including a worrying proposal to amend the competitive bidding regulations to permit the Agency to conduct auctions using bundles of equipment, services and supplies for enteral products and DME.

In response, AAHomecare convened a working group of member company leaders to analyze and reply to these regrettable proposals, the main points of which are summarized below. Download the full set of detailed comments here.
• Mandates an adjusted fee schedule for states in different regions of the country based on the average competitive bidding pricing. The regional prices would be limited to a national ceiling that is 110% of the average of regional prices and floor that is 90% of the average of regional prices.
• Rural and frontier states that are predominately rural and/or sparsely populated would use the national ceiling that is 110% of the average of regional prices as the adjusted fee.
• Non-contiguous areas would use an adjusted fee schedule based on the average of competitive bidding pricing from these areas or the national ceiling, whichever is higher.
• CMS proposes a pilot that will bundle CPAP devices and accessories, oxygen, respiratory assist devices, and additional items. This includes testing in 12 markets. The monthly rate will include payment for all items and service, including maintenance of the equipment, and replacement of supplies. Comparative markets will be established to compare outcomes.

AAHomecare Officials Meet to Discuss Appeals Backlog
The Office of Medicare Hearings and Appeals (OMHA) held a hearing last week to address the overwhelming administrative law judge (ALJ) appeal backlog. AAHomecare CEO Tom Ryan asked Chief Judge Nancy Griswold and other CMS spokespersons about ways to work together to put real time practical solutions in place to prevent the issues that are occurring with the backlog.

“Significant dollars are tied up and the providers are going out of business,” said Ryan. “When I hear about IT solutions, scanning documents or portals, these are things that the managed care community has had for years. Pilot programs are all well and good, but these are years away and I have providers going out of business everyday. There are things we can do. For the DMEPOS community, these timely filing requirements are causing us to clog the program up. This can be fixed. The other issue is clinical inference. Bringing that back would be a big solution that can work today. I appreciate the forum and the collaboration, but we’re in a crisis here.”

Many of the speaker remarks where similar to what came out of the last OMHA hearing in February. However in a short segment specifically related to DME, Latesha Walker, CMS Provider Relations Coordinator, spoke about the need for open channels of communication. Walker shared with the audience one of the many ways her office is working with suppliers, and the resulting success.

When the HME community was able to show Walker the denials resulting from a faulty understanding of who is allowed to fill in the delivery date of service for DME, CMS was able to go back to the original chapter of the requirement and clarify that there was no specific instruction regarding who was allowed to fill out the delivery date. This resulted in CMS going back to the MACs to clarify that a delivery date filled in by the supplier should not cause a denial.

The proof of delivery date requirements being clarified is just one example of how AAHomecare is working to create a more collaborative relationship with CMS. Many of these types of issues, including the proof of delivery date, originate at the AAHomecare level, and are brought to CMS through conversations at AAHomecare Regulatory Council Meetings and AAHomecare staff meetings with CMS.

These types of hearings magnify the need for the highly anticipated HME Audit Key initiative currently being developed by AAHomecare. The ability to bring hard data to meetings such as these and show the true impact of audits on the industry will lead to more open conversations about workable solutions. Fundraising is currently underway to launch the audit tracker in 2015.

Donations are needed from all around the industry to get this program to be successful and return the data needed.

Audit data will be collected on a quarterly basis from HME providers and corporate offices, through a simple and easy-to-use system designed to enable providers to share audit data in a secure and confidential way. The system was built by Provider Consulting Solutions, the same group that developed the American Hospital Association RACTRAC survey tool.

More information on the HME Audit Key can be found online at the industry audit headquarters, www.fixmedicareaudits.org

Diamond Issues Challenge at Stand Up for Homecare at Medtrade
Last month in Atlanta, AAHomecare hosted the Stand Up for Homecare reception. With 300 plus VIPs in the room, Drive Medical CEO Harvey Diamond challenged the industry to “check their egos at the door,” and do more to support the industry and AAHomecare.



In a rousing speech, Diamond called on attendees to step up their financial contribution and for each attendee to reach out to five of their friends, colleagues and competitors and challenge them to become an AAHomecare supporter by contributing $1000 and to attend the next Stand Up for Homecare, bringing potential attendance up to 1500 supporters.



“Stand Up for Homecare began as a humanitarian effort,” Diamond noted. “We care about this industry, we care about this business and we care about the people we serve. We come from different backgrounds, but we share a common goal.”



“Harvey Diamond has challenged the industry to do what it takes to move the needle,” said AAHomecare CEO Tom Ryan. “The Diamond Stand Up for Homecare Challenge is exactly the type of big thinking that will help energize the industry. AAHomecare is very thankful to have Drive Medical as a Corporate Partner and Harvey as a passionate advocate for the HME community.”

Save My Medical Supplies is Asking for Anecdotes
Save My Medical Supplies is gearing up for Homecare Month in November by asking providers to share stories that show what a great industry this is, and the positive impact they’ve made on their patients. The more you tell us about why your patients prefer homecare, and the ways you’ve benefitted them, the more we can share that information with the world and make a more positive image of homecare in the media. Click here to share your experience in our quick and easy one-question survey.