Sunday, August 31, 2003

More than just NCB
With Kay Cox

Q. In the current Medicare debate, the DME industry has been focused on the bill’s competitive bidding provision, and rightly so. But, have there been any developments on other provisions that affect our profession, such as regulatory reform?

A. Although the final reconciled version of the Medicare bill known as the ‘conference report’ is not expected until late September, at the earliest, the H.R.1/S.1 conferees have come to agreement on some portions of the Medicare bill, such as regulatory reform and the prescription drug discount card. It’s important to note, however, that these agreements are in principle only, which means that the provisions agreed upon will not go into effect unless the Medicare bill is signed into law by the President.

Aside from that caveat, overall the regulatory reform agreement which the conferees announced in late July is a positive development that provides some relief for DME providers and offers a ray of hope in the otherwise discouraging Medicare package. For providers faced with large overpayments, the agreement requires that there be one more level of review before the recoupment begins. At the same time, there will be limits on the level of extrapolation, which in turn has the potential to reduce the size of overpayment. One not so positive development is that Administrative Law Judge (ALJ) hearings will be moved from the Social Security Administration to the Health and Human Services (HHS) department - something that DME providers have fought, but there is a requirement in this provision that HHS ensure the independence of ALJs. AAHomecare will need to monitor the implementation of this provision.

Kay Cox is CEO of AAHomecare. Contact her at 703-836-6263.