Proposed rule goes too far

Friday, May 31, 2013

WASHINGTON – Providers with high error rates could lose their billing privileges if a proposed rule takes effect.

The Department of Health and Human Services published a proposed rule in the Federal Register April 29 that contains a provision that would expand Medicare’s authority to revoke billing privileges to cases where the provider “has a pattern or practice of billing for services that do not meet Medicare requirements.”

That’s going too far, say stakeholders.

“This is not revocation for fraud,” said Steve Azia, counsel at Washington, D.C.-based Baker Donelson. “A provider could lose billing privileges based on an error rate that’s often overturned.”

The provision basically does away with due process, said Azia.

“What’s the point of the appeals process if this goes through?” he said.

The criteria for revoking billing privileges are still unknown. The provision outlines a likely scenario—revocation based on a significant number of denials for medical necessity over time—but seeks input on the number of claim denials that might trigger the review, and the length of time over which those denials occur. CMS also seeks input on whether the amount of time a provider was enrolled in Medicare before the denials should be taken into consideration. 

“They’re not laying out guidelines,” said Azia. “They’re asking for this authority, but they’re also asking for input on the standards. It’s very important for the provider community to weigh in and protect their rights.”

Providers have until June 28 to comment on the proposed rule. To comment electronically, providers can go to


This proposed rule is obsured when Medicare contractors do not follow the LCD requiring DME providers to appeal the claims for payment due to the contractor errors.

Why don't we all just give them back their provider number anyway and have them deliver equipment to patients. This whole thing is beyond protecting Medicare dollars. Until this occurs this will keep happening. IRS spent 1500-3500 a night per employee for a hotel room.  What is a government employee doing in a presidential suite that cost 1500-3500? But if we deliver a cane and bill $45.00 because we have to physically take the equipment to the patient, burn fuel, collect paperwork; it is considered waste of taxpayer dollars.

What ever happened to the principal that you are innocent until proven guilty?  The government is killing this industry!

The error rate is often overturned by ALJ so what is a true rate. Doctors will not fill out paperwork the way medicare auditors want it done, so error rates skyrocket. How can a medicare auditor presume to tell a Doctor how to run his practice. This rule should not be implimented.

High billing rate error we could lose our billing number goes to far. This is saying that we could lose our medicare billing number on an error rate that is often overturned. Once we receive an audit request and we submit that information and it is a correct claim would that be deducted from the error rate? At this point EVERY SINGLE claim is being audited by Medicare reguradless of error rate. As of July 1st just about every single piece of equipment will have to have a Detailed Written Order Prior to Delivery. Based upon this that will effect the timely care and equipment the patient will receive. Based upon this a Prior approval process would benefit all parties involved. This rule should not be implemented and thrown out.