CareTouch

 AAHomecare Reacts to the Advancement of “Doc Fix” Bill Without MPP

The urgency in getting the MPP measure passed was stressed by Hamilton. He stated the need to spread the pain around competitive bidding, adding that it could kill people and cost jobs. Hamilton also said that only the Centers for Medicare & Medicaid Services (CMS) has serious opposition to MPP.

In a preemptive press release issued by CMS just before conference participants went to Capitol Hill, the agency said that competitive bidding does not have an impact on the health of Medicare beneficiaries. CMS said it has released a much broader analysis data that shows there were no problems with competitive bidding. However, AAHomecare officials believed that the press release was a step made by CMS to save a badly flawed program.

Meanwhile, at the conference, economists Peter Cramton of the University of Maryland and Brett Katzman also spoke out against competitive bidding. Cramton opposed to the expansion of the program to another 91 metropolitan areas in Round 2, while Katzman called the program a misnomer saying the program is not competitive.

Stakeholders Face Set Back at Legislative Conference

At the eve of the AAHomecare Washington Legislative Conference, lawmakers announced they were close to a compromise package on the payroll tax cut extension. This affected HME stakeholders’ plan to ask lawmakers to include the market-pricing program (MPP) in the package during the meetings on Capitol Hill. The approve compromise package includes a delay to a 27% cut in Medicare payments to physician.

AAHomecare vice president of government relations Walt Gorski believes that the fight is not over as some lawmakers indicated that they would support providers in pressing the Congressional Budget Office (CBO) for a score for MPP. In addition, it was evident during a meeting between the members of the New England Medical Dealers Association (NEMED) and an assistant to Sen. John Kerry that lawmakers favored MPP than H.R. 1041, a bill that would repeal the program. Kerry’s aide mentioned that their office would try to schedule a bipartisan hearing with the CMS regarding MPP. But with the Round 2 bidding window closing on March 30, time is very tight to get anything done.

 Fight Against Competitive Bidding Gains Online Support

An online petition, which was a brainchild of an HME provider’s daughter, has gained traction ahead of AAHomecare’s Washington Legislative Conference. It attracted 1,500 signatures from 15 state and regional HME associations. The petition originated with Peter Falkson and Eric Cohen, both members of the New England Medical Equipment Dealers Association (NEMED), and started with a conversation about competitive bidding Falkson had at home.

The idea of the online petition came when Falkson was telling his wife about how poorly aligned competitive bidding was when his daughter Zoe, who was listening to the conversation, suggested the idea which she had done in her class. She had previously participated in a petition drive that prompted Universal Studios to change the trailer of the movie “The Lorax” because it was incorrectly marketed. The website used to create the online petition was Change.org.

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?