Providers wary of re-supply change

WASHINGTON - The lack of clarity surrounding CMS's new policy for re-supply orders could make it hard for HME providers to comply with documentation requirements, they say.

At issue: How do providers differentiate patients who need supplies from those who don't, and how do they prove it?

"They are throwing this out there in such a fashion that it's hard to get all hands on deck to make sure everybody understands what we need to do," said Patrick Clevidence, director of respiratory services for Greensboro, N.C.-based Advanced Home Care. "What questions will we ask patients? What's going to be acceptable documentation?"

In a notice published June 8, CMS stated that providers can only replace items that need periodic replacement, like PAP and respiratory assist device supplies, when they are no longer functional, rather than every three months, as stated in the existing LCD for PAP.

With the rule, technically, already in place—the notice stated it was effective for dates of service on or after Aug. 2, 2011—all providers can do, at least for the time being, is ask patients questions like, is your tubing cracked or is your mask leaking, and document their answers, stakeholders say. But, without clear guidelines, providers risk running afoul of auditors, they say.

"The auditors are wide open and can make their own interpretations on these," said Eric Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga. "I think we have to look at, it's not how we adhere to the rule, it's how it's interpreted by the auditors."

Although the rule encompasses earlier dates of service, stakeholders doubt existing claims will be targeted.

"No one was on notice that they needed to be doing any of this so I would be surprised,” said Elizabeth Jepson, an attorney with Brown & Fortunato. "But, going forward, what are we supposed to be doing? My guess is we are going to see some more clarification."