CMS: Master of the double standard

Thursday, March 25, 2010

CMS expects HME providers to have their ducks in a row. When providers submit claims, for example, the agency expects those claims to adhere to certain coverage policy and documentation requirements. It doesn't matter if the day a provider submits his claims he's understaffed and can't get them to his billing manager for final review, resulting in some Is not dotted and Ts not crossed. If claims don't meet the requirements, there's a price to pay--sometimes, a big one.

It's only fair that providers should be able to expect the same from CMS. Providers who were unable to become accredited by the Oct. 1 deadline and who voluntarily revoked their supplier numbers, however, have learned that things don't quite work the same the other way around.

Once those providers were finally able to get accredited, they expected CMS and its counterpart, the National Supplier Clearinghouse (NSC), to reactivate their supplier numbers and allow them to submit claims retroactively to the date they became accredited. It didn't matter (and still doesn't) if CMS and the NSC are understaffed and can't keep up with the thousands of re-activations and claims they need to process, resulting in a huge backlog. (That's another editorial entirely: Did CMS really think that dealing with the accreditation requirement would be just another day in the office?)

Yet, here we are in April and we're still hearing from scores of providers who haven't received the same professionalism that CMS expects of them.

Just check out the next page. Read about one provider who had to drop about 125 claims valued at about $30,000 because CMS and the NSC took nearly two months to process her re-enrollment form. Read about another provider who's been told three times by CMS and the NSC that her supplier number will be re-activated within 60 days, but because it still hasn't been, has had to start sending her Medicare business elsewhere. These providers are real people trying to run real businesses. They're getting second jobs to make ends meet. They're pulling their kids out of school because they can't afford to pay their tuition.

In addition to the question that appears in 48-point font on the front page of this issue (NSC: What's the hold up?), I have to add, CMS: What price will you pay?