Moving the HME Industry Forward


AAHomecare in Action – Tennessee Association Gets Response on F2F and More

September 1, 2014

WASHINGTON, DC – The question of retroactive application of face-to-face requirements had been unanswered—until now. Undeterred by the lack of response, ATHOMES turned to its Tennessee delegation for assistance.

“When ATHOMES went to Washington in May for AAHomecare’s Legislative Conference, one of our primary objectives was to rally our elected officials for assistance with the ambiguity in the face-to-face implementation vs. enforcement,” explains Ashley Plauché (pictured), executive director for ATHOMES. “The Tennessee delegation understood our concerns and frustration with CMS and offered to help.”

ATHOMES worked with Congressman Phil Roe’s office on a delegation letter to Administrator Tavenner, and on July 28th, seven of Tennessee’s nine Members of Congress signed a letter with the declarative stance that CMS should not apply the enforcement of face-to-face retroactively.

Congressman Roe received this response from Admin. Tavenner last week, stating:
The CMS has instructed its contractors not to retrospectively audit providers and suppliers for compliance with those requirements. The delay in enforcement on the face-to-face encounter requirements applies to reviews conducted by the DME MACs, Recovery Auditors, the Zone Program Integrity Contractors and Program Safeguard Contractors. However, this delay in enforcement does not apply to reviews completed by the Comprehensive Error Rate Testing Program (CERT). CERT must review claims in accordance with all Medicare policies to produce an unbiased improper payment rate. Once an enforcement date is announced for the delayed requirements, CMS and its contractors will begin enforcement after the announced date. When CMS begins enforcing the face-to-face encounter requirements audits will be conducted prospectively.

“It took them less than a month to get an answer that had been haunting suppliers for over 13 months. While face-to-face audits still exist for CERT, overall this is a win for suppliers,” says Plauché. “Results like these illustrate the important role that state associations play in the HME Industry. We cannot rely solely on the efforts of our national leadership; we must all do our part. I’m thankful that we were in a position to utilize our existing relationships with Tennessee’s elected officials to help provide relief and clarification for the supplier community.”

CMS Announces Fingerprinting Requirement
According to AAHomecare’s Wednesday in Washington, CMS recently released MLN SE1427 announcing the implementation of the fingerprinting requirement effective August 6th, 2014.

Currently the A/B MACS have started the process and are notifying providers of the requirement. Any owner with 5% or more interest in a supplier may be subject to the finger printing requirement. If a supplier receives a letter, those owners identified must comply with the requirement. If the owner is found to have a felony conviction, then the Medicare supplier number can be revoked.

Owners are identified in the old Section 5 of the 855S and Section 9 of the current version. Medicare is only interested in those people identified in Section 9 that are people, not entities and where it is indicated they are an owner.  Other individuals, such as board members and managers are not subject to the requirement.

AAHomecare at Work
Tom Ryan, president, and Jay Witter, senior vice president of public policy, met with the Surety & Fidelity Association of America to discuss issues related to performance bonds for companies taking part in the competitive bidding program… Witter and Peter Rankin, assistant director of government affairs, presented a webinar on current legislative priorities to members of United Spinal Association… Kim Brummett, vice president of regulatory affairs, and Beth Ludwick, senior director of communications, attended a Medtrade Education Advisory Board planning meeting… Witter presented the Washington Update at the Kentucky Medical Equipment Suppliers Association conference.