Cuts squeeze providers, patients, says PFQC

Tuesday, October 25, 2016

WATERLOO, Iowa – Forty percent of the calls it receives through a hotline number are now from patients and caregivers who are being asked to pay out of pocket for their home medical equipment, according to People for Quality Care.

An increasing number of HME providers are filing claims non-assigned, requiring their patients to cover more of the cost of their equipment, PFQC said in an Oct. 24 press release.

“I just received a letter from my oxygen provider saying that they would not be taking assignment anymore, and I would be required to pay upfront for my supplies,” said Terrie of Grand Island, Neb., a caller to the hotline. “I am on a fixed income and don’t have the ability to do so.”

PFQC has seen an uptick in these types of calls in the wake of Medicare slashing reimbursement in non-competitive biddings areas on Jan. 1 and again on July 1.

Providers like Air-Way Medical in Bishop, Calif., say they have done all they can to save money—in addition to filing claims non-assigned, they’ve laid off staff and they’ve discontinued product categories.

“If I am forced to go bankrupt, no one else is left to fill this void,” said Glenn Steinke, owner of Air-Way Medical, which is the only provider with a physical location within 150 miles of the rural town.

In the release, PFQC calls on Congress to intervene in November, when lawmakers return to the Hill, by passing legislation that would retroactively delay the second round of reimbursement cuts in non-bid areas on July 1.

“Many patients don’t have the financial capacity to take on this additional cost, yet the companies who serve them are operating in the red with Medicare’s current reimbursement,” said Kelly Turner, director of advocacy for PFQC, which maintains the hotline. “Both sides are being squeezed. It’s a no-win system.”


PA Medicaid is following suite with squeezing providers and will surely be losing many providers in the state of PA. We are now required to provide our cost, msrp, and our payment terms on Manufacturer Letterhead or we can not get an authorization to provide products to Medicaid Subscribers. And since we are also not permitted to charge the subscriber any co-pays we are feeling the double whammy.

We were asked to provide a subscriber with a Low Air Loss Mattress to a bed bound subscriber and we did our due diligence and provided the document from the Manufacturer. Our cost plus Shipping was $611.50 when we received the authorization in the mail the purchase amount was for $773.00. Subtract the delivery, setup, instruction, and any other overhead, we figured we owed the patient about $150.00

I called the Medicaid Provider Line and got a very nice woman who openly said I found the same unit online for $700.00. She proceded to explain that she raised the reimbursement $73.00 to cover the addional cost. She was not allowed to add in for Delivery, and Setup so she felt the $73.00 was plenty for the education.

Raise your hand if you think this is a Bonus in any way possible. Being in this business for 24 years I am not always about making a huge profit but I am all about helping my CEO stay in business.

Between Medicare and Medicaid and their influences on the private insurance companies such as AETNA, the Blues, United Healthcare, etc. it is only a matter of time before they are playing tricks on our livelyhood.

I stand by the providers who are trying to stay in business doing what the folks in the post about "Cuts Squeeze Provider", are doing. Certainly our elected officials are not going to lose money or go bankrupt so why should we.

Make every elected official use Medicare and or Medicaid for a 2 year period and they will surely( Hopefuly) understand what they are doing to our industry over a tiny little 2% of the Medicare Budget.