CMS makes providers pay to play

Thursday, September 9, 2010

BALTIMORE - CMS plans to shut down all direct dial-up connections that allow HME providers and others to submit claims electronically for free. During a call last week, officials announced that providers, third-party billers, software vendors and clearinghouses must start using one of six network service vendors to access the Common Electronic Data Interchange (CEDI) Gateway by April 30, 2011. (Those vendors: ECC Technologies, IVANS, McKesson CareBridge, MedXpress, NEBO and VisionShare.) Here's what industry consultant Andrea Stark, who was on the call, says providers need to know about the change.

HME News: First, do a lot of providers use direct dial-up connections to access the CEDI Gateway?

Andrea Stark: The majority of providers do. There are providers that, for ease of transmission, will send their claims to a clearinghouse, but because a clearinghouse typically changes a per-claim transaction fee and Medicare doesn't, most providers connect directly to Medicare to send claims.

HME: So the biggest impact on HME providers will be financial?

Stark: Exactly. It's one more expense.

HME: What kind of expense are we talking about?

Stark: It's going to vary, and providers should shop around for the best deal. There may be clearinghouses that allow you to transmit without charge, but they may not provide any added services. There may be clearinghouses that charge a per-claim fee that ranges anywhere from 10 cents to 30 cents per claim, depending on your volume. You may also be able to negotiate with some of the direct service vendors to purchase a block of time or an unlimited Internet connection. Then you may have to pay an initial fee that could range anywhere from $100 to $1,000 to get the account established and to get their software set up. Then you may have to pay anywhere from $50 to a couple hundred dollars a month. I'm not comfortable quoting specific prices, but the fact is there is likely going to be an expense where there hasn't been one before.

HME: What's the impact on providers who are just getting set up to use direct dial-up connections to access the CEDI Gateway?

Stark: If they're up and running by Nov. 1, 2010, they can use the free gateway until it's officially brought down in April.

HME: What's the reason for the change?

Stark: This is the option that they chose to pursue to maintain security. It seems counterintuitive to add another party to the mix--the network service vendors--instead of going direct. There are a lot of concerns in the provider community. Obviously, this is a big shock. No one expected that they would take down this gateway and require everyone to go through a particular set of vendors.