Reporter's notebook: Right hand, left hand

Cover yourself in more ways than one, says Greene
Monday, July 25, 2016

As if the sheer quantity of audits wasn’t enough to contend with, HME providers often have to untangle inconsistencies in regulations and guidance, says Stephanie Morgan Greene, a healthcare attorney who’s executive vice president of business development for ACU-Serve.

Case in point: C2C Solutions, the CMS contractor handling the second level of Medicare appeals, says it will not consider an amendment added after the date of delivery, but the Program Integrity Manual is less black and white on the issue, Greene says.

“There is guidance from the DME MACs on how to apply the Affordable Care Act and it says you have to have the amendment before delivery, but the manual doesn’t say anything about it,” she said. “C2C is applying this across the board to items not listed in the Affordable Care Act, such as prosthetics.”

Another case in point: The DME MACs have said that the HCPCS long definition for orthotics and prosthetics does not meet the requirement to sufficiently describe what’s being delivered to the patient, but the Program Integrity Manual says it is enough, Greene says.

“There’s a lot of confusion out there around proof of delivery,” she said. “You have different regulations coming out from different contractors, and you have regulations come out from CMS, and the contractors aren’t clarifying.”

So what’s a provider to do?

“Try to comply with both sets of guidance until the confusion has been resolved,” Greene said. “For example, for proof of delivery, we include the HCPCS long definition, the brand name and the serial number.” hme