Fraud bill shifts focus

Thursday, November 10, 2011

WASHINGTON - The House version of the FAST Act, introduced Nov. 10 by Rep. Peter Roskam, R-Ill., modifies the Senate version of the act, introduced earlier this year, in a way that should benefit power wheelchair providers. 

The big difference between the two acts: The House version calls for industry-preferred prior authorizations for standard power wheelchairs; the Senate version calls for prepayment reviews for all HME at high risk for fraud and abuse.

"Both bills are better than the president's budget proposal that would require prepayment reviews for all power wheelchairs," said Seth Johnson, vice president of government affairs for Pride Mobility Products.

Stakeholders have been fighting numerous proposals calling for prepayment reviews for power wheelchairs, because they would require that providers give patients equipment before receiving payment. If a claim is denied, providers are stuck holding the bag. Prior authorizations, alternatively, would give providers some measure of assurance that claims would be paid, while still modifying the current payment system to reduce fraud and abuse. 

Jay Witter, senior director of government relations for AAHomecare, said he has worked with sponsors of the FAST Act in both the House and Senate and feels that everyone is on the same page.

"For our mobility members, this bill includes language they're more comfortable with," Witter said. 

The act also calls for the creation of a document that could be used to collect medical necessity information--easing the process of collecting documentation. Stakeholders, including Medicare representatives, clinicians and HME representatives, would craft the document.

"The fraud issue has been a dark cloud over the HME sector for decades," said Michael Reinemer, vice president for communications and policy at AAHomecare. "It's essential not only to support anti-fraud efforts, but also to be in front and help lead those efforts." HME



Prepayment review is more profitable for Medicare.

As if we needed another reason to not be in the business of providing home medical equipment.