OIG: Physicians not clear on Medicare home health rules

Thursday, January 31, 2002

WASHINGTON - Physicians aren't really clear about the rules governing Medicare's home nursing benefit, according to a recent OIG study. And they may be equally in the dark when it comes to Medicare's DMEPOS program.

"Physicians don't understand the eligibility criteria for HME, either," said Elizabeth Hogue, a healthcare attorney who practices privately in Burtonville, Md. "The OIG has put their finger on something, here, that we've all known for some time."

For the study, the OIG mailed questionnaires to 600 physicians who signed Medicare home health plans of care in the last six months of 2000. An example of what the OIG found: 38% of physicians are unclear on the Medicare criteria for "homebound."

Hogue said the results of the report fly in the face of an OIG-held belief that much of the fraud and abuse in the HME industry could be eliminated if only physicians were more involved in dispensing equipment and supplies. The OIG goes as far as to think physicians should act as "gatekeepers" between beneficiaries and the equipment and supplies they need, she said.

"I don't think there are strong enough words for how much I disagree," Hogue said. "How can they do that when they don't even know the eligibility criteria?"

A classic example of an area where physicians are unclear on eligibility is oxygen therapy, Hogue said. Physicians aren't clear on who's supposed to test beneficiaries. Another is the CMN. Physicians aren't clear on who fills out what, and why HME providers can't just fill out the entire form and send it to them for their signature, Hogue said.

To alleviate the problem, physicians need to be schooled, but there's no easy way to do that, Hogue said.

"It'd take an intensive education effort that I don't believe the OIG, or any federal government agency, can pull off," she said. "Meeting one on one with a provider would be best, but what provider has time for that." HME