Stakeholders ‘push back’ on vent changes

Friday, June 12, 2015

BALTIMORE – CMS’s plan to overhaul vent codes has industry stakeholders saying, “Slow down.”

“We want to understand what authority CMS has to make that drastic of a change,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “We will certainly be pushing back a little bit, from a clinical standpoint and a regulatory standpoint. This is a coding and allowables issue.”

CMS announced June 4 that it wants to overhaul the product category on Jan. 1, creating two new codes for vents (one for non-invasive and one for invasive) and discontinuing five existing codes (E0450, E0460, E0461, E0463, E0464).

But Brummett says those codes exist for a reason and “dumbing them down” is a bad idea. The more generic the code, the wider the variety of product included in that code, which impacts pricing and allowables, and eventually limits a patient’s ability to get needed equipment.

“We need to work with manufacturers to formulate arguments on why those different codes were needed and why they should be preserved,” she said. “There are different clinical outcomes based on need.”

The move is the latest in a series of dramatic changes to vents driven by a spike in billing for E0604. Last fall, CMS announced a widespread prepay review; earlier this spring, it created a separate category for vents on its provider enrollment form and made clear that providers must meet specific accreditation criteria. 

“I think what they are trying to do is eliminate providers that are just providing this equipment like it’s a Bi-level,” said Wayne van Halem, president of The van Halem Group. “I’ve had conversations with medical directors who said CMS feels ventilation is for people who, if respiratory function was interrupted, it would lead to serious harm or death.”

As part of the overhaul, CMS also dropped non-invasive vents from Round 1 2017 of competitive bidding. Vents are a Class III device, which are excluded from the program.