Bid relief needs adjustment, stakeholders say

Friday, February 17, 2017

WASHINGTON – CMS has said it plans to use the lower payment amounts that went into effect July 1 as part of its calculation for retroactive adjustments, but that’s not what Congress intended, say industry stakeholders.

“The intent was to use the same rates that were in effect from January to June, for the rest of the year,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Instead, they factored in the lower July 1 Round 2 re-compete numbers in their calculation.”

A provision in the 21st Century Cures Act that was signed into law in December rolled back that start date for cuts that went into effect in non-competitive bidding areas from July 1, 2016, to Jan. 1, 2017, paving the way for providers to recoup six months of payments.

In guidance released to the DME MACs on Feb. 9, however, CMS stated: “To implement section 16007 for dates of service July 1, 2016, through Dec. 31, 2016, the 50/50 blend fee schedules have been recalculated so that the adjusted portion of the payment blend utilizes July 1, 2016, adjusted fees.”

“They are recalculating, not simply putting back in the rates they had before,” said Kim Brummett, vice president of government relations for AAHomecare.

That’s not fair for providers who may have made planning decisions based on the higher rates, say stakeholders.

“I think a lot of people made changes based on thinking it would go back to the Jan. 1, 2016, rate,” Brummett said.

Stakeholders also take issue with the timeline for the relief, which sets an implementation date of July 3, although the DME MACs can start processing affected claims as soon as the revised fee schedules are available—on or after May 1. That’s a long time to wait to be paid, they say.

“Some providers probably haven’t even submitted claims,” Brummett said. “Instead, they’re waiting for the right fee schedule to be loaded as opposed to getting a partial payment.”



This is just another abuse of power by CMS. Do they not have to abide by the law? When they want their money back they give us 30 days and then they hammer us with a 9.5% penalty. Can we apply that policy back to them? NO!