DME Industry Nears Crucial Legislative Milestone

Las Vegas – Tom Ryan an NY-based provider, the president and CEO of AAHomecare knows the pain felt by many providers in today’s competitive bidding climate. He bid on 35 competitive bidding contracts. He emerged with one bid award, and considerably less revenue. “I know what you guys are going through,” said Ryan during the Medtrade Spring AAHomecare Update on March 11 at the Mandalay Bay Convention Center. “It is tough as hell. We are all fatigued, but the only way we are going to win this battle is to get up every single day and fight, fight, fight. We can’t do it alone. I need you, and you need us.”

One way to possibly move forward in the next couple of weeks is through the sustainable growth rate (SGR) legislation that Congress is bound to enact at the end of March. “We have some opportunities ahead of us where we can fix some things that are egregious right now,” said Ryan. “We have a small window with this SGR fix where we believe we can get an amendment attached…such as binding bids to make the program more fair.”

Jay Witter vice president, Government Affairs, added that he and AAHomecare officials are working with House and Senate committees to include key components of the market pricing program (MPP) in the large piece of SGR legislation.

“For the first time, we got a provision in a Senate Finance Committee markup,” said Witter. “The issue is small—it deals with licensure in competitive bidding. But it is the first time the committee has ever officially voiced concern with competitive bidding. It’s a huge step forward…We have a place marker in there, so we are fighting to expand that…We are working to get something done in a very short time. Tell your stories and have your patients tell their stories.”

In the Soup
With this month’s release of the Advanced Notice of Proposed Rule Making (ANPRM), CMS confirmed that competitive bidding rates will eventually be applied throughout the country in 2016. “If you didn’t think competitive bidding was coming,” said Ryan. “You are in the soup…If you’re in a rural area, you’re not going to get increased market share, you are just going to get egregious prices.”

Witter called the ANPRM’s inclusion of non-bid areas a disaster. “You [rural providers] are just going to get the prices,” lamented Witter. “You are not going to get any increased volume. It is just not fair, but it’s coming by 2016. Enough is enough. We need the rural Senators to be outraged by this.”

As for HR 1717, it has 171 cosponsors, and Witter deadpans that the magic number is “more.” As the bill to replace current competitive bidding methodology with the market pricing program, the legislation gains clout with each new cosponsor, and that could add up to crucial influence.

Kim Brummett, senior director, Regulatory Affairs, AAHomecare, outlined the following recommendations for audit reform:
• conduct independent reviews of contractors to hold them accountable;
• enact interest penalties for MACs when claims are overturned;
• remove ability for MACs to issue clarifications;
• enhance review of DME providers who do not respond to audit requests;
• limit the number of audits a DME provider can receive during a given period;
• reinstate “clinical inference” policy;
• require that electronic health records include DME medical necessity documentation; and
• mandate use of a template in power mobility device (PMD) prior authorization demonstration


Source: MedTrade

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