Can any healthcare provider be compliant?

Sunday, September 25, 2011

With everything going on in the HME industry right now, it's hard to believe that any other industry has it as bad.

Competitive bidding. The expansion of competitive bidding via Round 2. No purchase option for standard power wheelchairs. Threats of further cuts as part of trimming the debt deficit and preserving physician payments. A steady stream of reports from the Office of Inspector General (OIG), the Government Accountability Office (GAO) and the DME MACs criticizing: reimbursement for HME, the prevalence of fraud in the industry, and the quality of the claims providers submit.

But the HME industry is not alone, as a few providers have pointed out to me in recent emails.

Provider Gerry Dickerson in New York noted that home health agencies are grappling with a requirement that HME providers aren't grappling with--yet: a face-to-face rule that requires Medicare beneficiaries to see a physician in the past six months before any products or services are rendered. (Per the Affordable Care Act, CMS must also implement the requirement for HME, but the agency hasn't gotten around to it yet. It has gotten around to issuing a proposed rule outlining a similar requirement for Medicaid, though. But I digress.)

Dickerson says there's been some interesting chatter about the rule on home health discussion boards, chatter like:

Oh My, F-2-F is not going well I am sure with most agencies. We have had to dedicate one employee who spends at least 80% of her time tracking and attempting to get the documentation as well as getting the documentation filled out correctly. CMS has gone overboard on this one. It is so nice for them to work behind a desk making laws and regulations instead of doing the actual work.

We are really working F2F but still only have a 49% compliance rate from physicians. It is a full-time job.

When we first started using the (face-to-face) form, one of our physicians wrote under the homebound status: no footprints in the snow.

See what HME providers have to look forward to?

And provider Scott Lloyd in Georgia noted a recent report from the OIG that found 82% of hospice claims for beneficiaries residing in nursing facilities did not meet Medicare coverage requirements.

These are difficulties that HME providers live and breathe every day, of course. Just read Mark Leita's op-ed in this issue about the no-win situation that mobility providers have been in for, oh, almost a decade.

Still, it's kind of nice to know, in a way, that it's not just HME providers.

Which begs the question: If it's not just HME providers, but home health agencies and hospice agencies, then who?

Lloyd asks: "Is it possible Medicare's coverage criteria for many things, not just HME, are just too darned vague/cumbersome/detailed/difficult for any healthcare provider to be compliant?"

You can say that again.