Moving the HME Industry Forward


Legislative Update – AAHomecare in Action

September 15, 2014

WASHINGTON, DC – The HME community needs a huge push over the next two days to cement support for the binding bids legislation, H.R. 4920, and the Audit Improvement and Reform (AIR) Act, H.R. 5083.

Capitol Hill is back in action with the return of Congress from recess. There isn’t much time left on the Congressional calendar, so putting the pressure on this week is vital! AAHomecare is out in full force on the Hill and the MED Group is hosting a perfectly timed fly-in today and Thursday to build support for these important bills.

Here’s How You Can Help
If you had the chance to meet with your Congressional representatives while they were in their district offices, now is the time to follow up. Let them know that the time is now to formally commit their support to H.R. 4920 and H.R. 5083. Even if they have already verbally committed, they need to be reminded.  

1) Download the AAHomecare issue briefs for H.R. 4920 and H.R. 5083 so that you can use them as talking points
2) Start by calling the Capitol Hill switchboard at 202-224-3121 and ask to speak to your member’s Health Legislative Assistant. Ask them to support the legislation or leave a message if need be.
3) Look up your member’s office line using the congressional directory in AAHomecare’s Action Center. Call that number directly and try to reach the Health Legislative Assistant again.
4) Use the AAHomecare Action Center to submit letters asking your members to support the legislation. Click here for H.R. 4920 and here for H.R. 5083.
5) Spread the word! Forward this email to a colleague and ask for their support!

It is vital that you take action on these important issues to protect patients who need homecare. All the supporting materials you may need are available for download here. If you need assistance contacting your representatives, email Gordon Barnes at or contact your state association. Thank you for joining the fight to save homecare!.

Are Prior Approvals Added to the RAC Data Warehouse? AAHomecare Gets Answers
The recent GAO report on the lack of oversight of CMS audit contractors resulted in increased scrutiny of contractors use (or lack of use) of the RAC Data Warehouse. CMS has reaffirmed their commitment to making sure that contractors are loading audit data into the system, however, on behalf of the industry, AAHomecare followed up with CMS regarding a crucial issue—are DME MACs required to load pre-pay audits and prior authorizations into the RAC Data Warehouse?  

CMS has posted the following response:
CMS is committed to reducing improper payments but must be mindful of provider burden because medical review is a resource-intensive process for both the healthcare provider and the Medicare review contractor.  CMS works to lessen provider burden by instituting changes that will help providers better comply with Medicare policies and documentation requests. Contractors conducting pre-pay audits are required to load that information into the RAC Data warehouse.  Claims that are paid through one of the prior authorization programs have a unique tracking number that follows the claim and is included in all data shared with the Recovery Auditors.  Claims with a unique tracking number are excluded from Recovery Auditor review.

AAHomecare is pleased with the response and will be working with the provider outreach and education groups at the DME MACs to ensure these processes are in place.

AAHomecare Provides Recommendations on Negative Pressure Wound Therapy Coding Changes
On September 2, AAHomecare submitted comments to CMS in response to the proposed CY 2015 Hospital Outpatient Prospective Payment System (HOPPS), CMS–1613-P, specifically concerning coding changes to disposable Negative Pressure Wound Therapy (NPWT). Download the full comments here.

AAHomecare reminded CMS that there is significant confusion among providers regarding the use of G0456 and G0457 with both mechanical and electrical disposable NPWT devices as well as the variance in components billed with distinct products on the market. As a result, the claims data is often inaccurate, given it does not accurately reflect the current charges for this treatment and the device. 

There has been a collaborative effort by three manufacturers through the Alliance of Wound Care Stakeholders to provide CMS with detailed information on the costs of devices, so CMS may appropriately establish non-facility practice expense relative value units for the new CPT® codes for disposable NPWT that will presumably be created effective January 2015. AAHomecare recommended that CMS review those paid invoices and consider the costs of these devices when setting APC assignment of disposable NPWT and that any APC reassignment would be premature at this time and CMS should continue to place disposable NPWT APC 0016.