Providers Analyze Bid Data
After Prof. Peter Cramton’s analysis of Medicare data that showed 60% to 80% decline in the number of claims for HME in Round 1 competitive bidding areas, several providers have emailed HME News to offer their opinion on why the number of claims have dropped in bid areas.
One provider states that contracted suppliers not submitting claims, suppliers employing fewer sales staff, and referral sources having to wait a long time are the main reasons behind the drop in the numbers of claims.
Another provider named John Reed said that some reasons for the decline are as follows:
- CMS taking so much time to review and approve novation agreements
- Contract losers still taking Medicare referrals and holding claims hoping for an eventual repeal or delay
- Traditional revenue cycle for processing are delayed by subcontractor activity
- Contract suppliers were actively seeking to sell their business while developing subcontractor agreements
- And patients shifting from traditional to Medicare Advantage plans are growing in numbers.
Editor’s Note: Beware of numbers, especially this soon after a big change. It will take quite a while for the real numbers to be clear. Still, I don’t think anyone will be surprised to find that the number of claims will go down. Patients will fall off the radar and have coverage denied when they really need the therapy. If those patients don’t pay cash, they will drop therapy eventually and end up costing Medicare a lot more in the long run.
AAHomecare Push for the Inclusion of MPP in ‘Doc Fix ‘ Legislation
Congressional negotiators have been urged by the American Association for Homecare to include the Market Pricing Program (MPP) in “doc fix” legislation. AAHomecare President Tyler Wilson called for the measure to replace competitive bidding in letters sent to each members of the House-Senate conference committee working on the legislation. The legislation, which is aimed to prevent sharp cuts in Medicare payments to doctors and also extend cuts in payroll, needs to be enacted by the end of February, and advocates are trying to replace competitive bidding before its implementation in 91 more metropolitan areas. The Competitive Bidding Program has been implemented in nine areas and has disappointed the HME industry.
AAHomecare will be visiting Capitol Hill for its annual Washington Legislative Conference, and will try to push for MPP. In addition, the National Association of Independent Medical Equipment Suppliers is calling on HME advocates who will not be going to Washington to participate in a “Virtual Capitol Hill Conference.”
Editors note: Bravo AAHomecare for bringing a solution rather than just fighting change. I haven’t dug into MPP at all, so I have no idea how viable an alternative it is, but I suspect it’s a good one. The current model leaves MUCH to be desired, improving on that shouldn’t be hard. This is how the legislative process works. It will take time to fix the current broken system, but we can all be certain there is no going back. Being an HME provider in the Medicare world is different now than it was 4 years ago, to say the least.
Auditor Requests for Pre-Medicare Qualified Sleep Study
According to industry sources a semi-automated review of certain CPAP claims in Jurisdiction C could be a waste of time and energy for HME providers and auditors. Recovery auditor contractor (RAC) Connolly Healthcare has been asking for proof of a qualified sleep study from patients in cases where Medicare did not pay for the study, which is common for a condition that is diagnosed before patients reach Medicare age. Andrea Stark, a reimbursement consultant with MiraVista, found this particularly vexing, saying that there is a lot of work to do to produce the information that could be very old.
Scott Lloyd, president of Extrakare, said that they don’t dispense orders for supplies or device replacement until they get a copy of the sleep test. This, he admitted, has not been a huge challenge for them. However, Advanced Home Care vice president of contracting and reimbursement Kim Brummett believes the requests have increased, and that he has assigned four people solely in charge for pulling sleep studies.
Editor’s note: I think the core problem here is for competitive bid winners who didn’t get full documentation on patients they inherited. Other than that situation, I thought Medicare was always clear that they required a sleep study to be on file before billing for a Medicare patient. Am I missing something here?
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