Industry appeals for ‘common sense’

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Friday, February 2, 2018

WASHINGTON – HME issues took center stage at the inaugural meeting of a new CMS focus group aimed at putting “Patients Over Paperwork.”

The Provider Compliance Focus Group, which is expected to meet quarterly, discussed how reducing onerous regulations could help improve documentation compliance.

“You can imagine we probably spoke up more than anyone else in the room,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “It’s the same issues—we just bring them up over and over.”

Among those issues: CMS hasn’t published official guidance that the effective data stamp requirement has been removed; providers report difficulties complying with the proof of delivery requirement; and the industry’s pleas to bring back “common sense” clinical inference have so far fallen on mostly deaf ears.

With President Donald Trump’s pledge to reduce regulations on businesses, however, there’s definitely a change in the air, says Brummett.

“The political appointees at CMS now are engaged with us in a much more meaningful way,” she said. “I feel there’s more intention to make changes. There is pressure to make changes.”

That pressure to make changes—especially where it concerns HME—stems, in part, from the massive appeals backlog, much of which can be attributed to claims denied for documentation errors.

“When you have so many technical requirements, any auditor can sit there and look at a claim and find a reason to deny it,” said Wayne van Halem, president of the van Halem Group. “I’d like to see them focus on easing up on that. With that, and reinstating clinical judgment, I think we’d see a huge improvement.”