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Council takes in win 

Council takes in win  Readies strategies around competitive bidding, audits and telehealth 

WASHINGTON – AAHomecare’s Regulatory Council always has a list of challenges it’s working on, but it was nice during its most recent meeting to have something to celebrate: the removal of the budget neutrality requirement for home oxygen therapy. 

The change, long-fought for by the industry, will result in a 10% increase in reimbursement, on average, for competitive bidding areas; a 5.1% increase for non-rural areas; and a 4.9% increase for rural areas. 

“Well, it’s not too often that we get an increase and when we do it’s cause to celebrate,” said Missy Cross, chair of the council. 

Here’s what Cross of ProMedica in Sandusky, Ohio, had to say about the council’s stances on competitive bidding, audits and telehealth. 

HME News: First, what’s it like for the industry to have a win like the removal of the budget neutrality requirement under its belt? 

Missy Cross: A lot of the credit goes to AAHomecare, which has had their noses to the ground on this issue. When others gave up, they stayed the course. It’s a nice increase for the CBAs – when was the last time anyone got a double-digit increase in reimbursement? We’ve taken double-digit decreases, not increases. It’s needed. If you look at any oxygen provider out there today, they’re scrambling with supply chain and access issues. 

HME: What’s the council’s stance on the current state of the bid program, which is essentially on pause until Round 2024, with the exception of knee and back braces? 

Cross: We’re still trying to look at the disparity in the bids that were submitted. Are the changes to the program the right changes? Have we hit the magic number for the single payment amounts? We’re all waiting on the final rule and we’re all trying to speculate on what they’re going to do and determining whether we support it, or whether we’ll need to challenge it.  

HME: Two other items on the agenda at the meeting: audits and telehealth. What’s the council’s stance on audits, which in many cases are back up and running, but not the Targeted Probe and Educate (TPE) program? 

Cross: Do we like the TPEs? There are a myriad of differing opinions. We like them because it’s more collaborative and not as punitive, but with TPEs, there’s a much larger volume. If you’re looking at a post-pay audit, you’re looking at two or three or a few. TPEs are a minimum of 40. When you look at all we’re contending with right now, onesie twosies are easier to deal with. 

HME: Telehealth: Here to stay or nice while it lasted? 

Cross: We’re all in favor of it. What the pandemic has brought to light is that we need to make changes to health care. When you look at some of these patients – it’s hard for them to get out of the house and see a physician. Telehealth allows them to do that in a safe manner. The biggest thing to monitor is – who’s using it and how? Do we have rules laid out appropriately, so everyone is billing appropriately for it? The recent MedPAC report says telehealth isn’t appropriate for high-cost DME, but what’s the definition of high-cost DME? 


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