Andrea Stark asks the hard questions


HME providers weighed heavily on the mind of Andrea Stark in the wake of the announcement that CMS would reduce payment amounts, on average, 45% as part of Round 2 of competitive bidding.

There were so many things going through her mind, including how providers might not have understood the weighting system that made their bids for items like disposable filters more important than their bids for CPAP devices.

“If you didn’t get the disposable filters right, it didn’t really matter when you got down to the CPAP machines themselves,” said Stark, a reimbursement consultant for MiraVista.

Regardless of how the industry got here, Stark believes providers must now focus all of their attention on making decisions—decisions based on sound business and not based on the fear of not being able to do business with Medicare anymore.

“People need to start looking at what this is going to look like," she said. “They need to make a hard and fast decision and the risk is that they’re going to make poor business decisions.”

For example, it may sound like a no-brainer for providers who weren’t offered contracts to grandfather their existing patients, Stark says.

“But let’s think this through,” she said. “You’re locked into these rates and you still have to meet all the service requirements like 24-hour care, but you don’t have any new business coming in. It’s not doom and gloom, but you have to accept where your businesses will be under this program.”

Another wild card that Stark says providers should factor into their decision: audits.

“A contract doesn’t exempt you from audits,” she said. “You’re still going to have that throwing down your revenue. You’re still going to have to chase down new patients and re-qualify patients. There are definitely operational concerns to be had, as well.”

For more food for thought, read Andrea’s blog, “To Accept or Deny? To Grandfather or Not? To Survive or Thrive?”