Stakeholders map out multi-pronged strategy

‘We may not be able to eat the whole apple with one bite’
Friday, May 22, 2015

WASHINGTON – The buzz at the AAHomecare Washington Legislative Conference last week was the HME industry’s next moves in the fight against Medicare’s competitive bidding and audit programs.

In the works, but not yet ready: legislation that would phase in or delay the national roll out of competitive bidding planned for Jan. 1, 2016. Another talking point: a market-pricing program to replace the program.

As Sen. John Hoeven, R-N.D., told attendees, “We may not be able to eat the whole apple with one bite.”

The industry scored its first big victory in the fight against competitive bidding recently, when a provision requiring binding bids was passed by Congress as part of a “doc fix” bill. The problem: The provision doesn’t go into effect until 2017 at the earliest, leaving the current Round 2 re-compete, the upcoming Round 1 2017 and the national roll out unaffected.

Hoeven, who sent a letter to CMS last year pressuring the agency to stop the expansion of competitive bidding until the Office of Inspector General completes its investigation of Round 2, spoke of the need for stakeholders to keep picking away at the program.

For example, “we can go back to CMS on the timing (of the national roll out),” he said. “We can tell them, ‘We passed this legislation (requiring binding bids). How about some relief on the timing?’”

Also in the works, but not ready: legislation reforming Medicare’s audit program. Stakeholders had hoped that a bill introduced last year by Rep. Renee Ellmers, R-N.C., would have been re-introduced by now, but they’re getting pushback on a provision reinstating clinical inference. That would allow CMS’s contractors to use “common sense” when, for example, a claim for a prosthetic for a beneficiary who has lost a limb is denied.

“We’re working on it,” said Tom Ryan, president and CEO of AAHomecare.