Moratorium ends, but spotlight on enrollment and compliance continues

YARMOUTH, Maine – The home medical equipment (HME) industry welcomed the end of a six-month moratorium on new provider enrollments on Aug. 27, but providers shouldn't mistake that move for a broader easing of regulatory oversight, says Jamie Davis, a health care compliance attorney and owner of Cornerstone Medical Supply.

In September, the Centers for Medicare & Medicaid Services (CMS) announced a new one-year probationary period that will require newly enrolled providers and those undergoing changes of ownership to submit prior authorization requests for specific HCPCS codes (see list below).

"People were just excited about the lifting of the moratorium," Davis said. "It was like, 'Ok, we're free to work,' and that's not really the case. It's going to be a lot of oversight that I don't think people are prepared for."

Davis recently spoke with HME News about what providers need to consider as enrollment opportunities reopen under a more compliance-focused regulatory environment.

Understand what you're buying

For providers considering changing ownership, due diligence is more important than ever, Davis says.

Buyers should take the time to understand not only the business they are purchasing, but also any potential liabilities that may come with it, she says.

"When you are acquiring that business, you are also acquiring their liability," she said. "That is where you have the most exposure. If they have a claim against them or something like that, that could impact you. But people want it to be an easy buy; they want to be able to bill immediately."

Build compliance into daily operations

As CMS increases enrollment oversight, providers must move beyond treating compliance as a box-checking exercise, Davis says.

Providers should invest in training and education to ensure staff understand why claims may face additional scrutiny and why compliance matters, she says.

"Truly embed compliance in every aspect of the operations," she said. "When you're onboarding your team, are you teaching them about the risk and understanding the why."

Accreditation isn't enough

Beyond internal policies and employee training, suppliers should regularly evaluate the strength of their overall compliance programs, Davis says.

That means not relying solely on periodic accreditation surveys to identify potential problems.

"Now that the moratorium is lifted, there is a need for someone that understands health care with the different lenses," she said. "You need someone on your side who is going to look in the policies and procedures (and ask) where are the risks, where are the gaps. Now is not the time to try to do it yourself."

Items that will require prior authorization under the new probationary period:

• Osteogenesis stimulators: E0747, E0748
• Ankle-foot/knee-ankle-foot orthoses: L1902, L1906, L1971, L2035, L2132, L2134, L2136, L4360, L4361, L4396, L4397
• Knee orthoses: L1810, L1812, L1820, L1821
• Lower limb orthoses: L1652, L1653, L1686, L1690
• Spinal orthoses: L0626, L0627, L0628, L0630, L0633, L0635, L0641, L0642, L0643, L0649, L0720
• Upper limb orthoses: L3660, L3670, L3760, L3762, L3809, L3908, L3915, L3960