Tag: Kim Brummett

WASHINGTON – Industry stakeholders are trying to guide what a post-PHE world for home oxygen therapy and other product categories might look like.  AAHomecare recently discussed with CMS a one-page recommended reference document for Medicare audit contractors reviewing claims for dates of service during and after the PHE. The document is a cheat sheet of sorts for the waivers that have been in place during the PHE that don’t require, for example, medical documentation or a signature.  “It...

WASHINGTON – CMS on Sept. 27 posted a final national coverage determination for home oxygen, but now industry stakeholders must “wait and see” what the DME Medicare Administrative Contractors do with the changes.  While the effective date of the NCD is technically Sept. 27, it won’t be implemented until a later date, when the DME MACs update their local coverage determinations.  “There are a lot of positives here, and we will wait and see,” says...

WASHINGTON – In recent comments to CMS’s DMEPOS proposed rule, AAHomecare introduced the idea of a 90/10 blended reimbursement rate in the former competitive bidding areas. Here’s what Kim Brummett, vice president of regulatory affairs for the association, had to say about what stakeholders hope will be a “reasonable” ask – to base rates in those areas 90% on the current rates and 10% on the 2015 unadjusted fee schedule –...

WASHINGTON - Much has been made of CMS's plans to reduce the paperwork burden for healthcare providers, but what about for HME providers, specifically?The agency's most recent attempt was last month, when it released a proposed rule aimed at removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements. The rule, however, focused on Part A.“There was nothing in the rule for us,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “We...

LIVERMORE, Calif. - Providers should strap in: After a protracted lull, RAC audits will likely pick back up in January, now that CMS has tapped Performant Recovery, based here, to perform post-payment reviews for DME and home health/hospice claims nationwide.Stakeholders say Performant will likely kick-start its efforts with reviews* it had previously been performing as the RAC for Jurisdiction A—reviews whose targets were everything from vacuum erection devices to respiratory assist devices...

WASHINGTON - Recent guidance from the DME MACs on coverage criteria for ventilators is a move in the right direction, say industry stakeholders.Specifically, the guidance removes the so-called “imminent death requirement,” which stated that patients must need a ventilator 24/7 for coverage.It's a requirement the MACs issued in April 2015 in an attempt to define criteria for vents vs. bi-level devices.The new guidance doesn't go that far, but “makes very clear that any device which...

WASHINGTON - CMS needs to dial back the wholesale changes it has made to ventilators with little input from the industry, stakeholders say.In January, CMS switched from five ventilator codes to two, and reduced reimbursement by about 33%.“When they are creating codes, providers should have some role in that,” said Stephen Cooper, counselor at K&L Gates, a law firm representing about 30 providers. “Right now, it's somewhat of a black box approach.”K&L Gates has drafted legislative...

WASHINGTON - All eyes last week were on CMS's preliminary list of rural zip codes for the national roll out of competitive bidding, with HME providers doing business in those areas set to feel a little less of a cut.CMS plans to implement bid pricing nationwide on Jan. 1, 2016, with separate fee schedules for regional and rural areas. For regional areas, the agency will base pricing on the average pricing in the competitive bidding areas in the region; for rural areas, it plans to base pricing on...

WASHINGTON - Industry stakeholders are counting on the support of healthcare professionals from outside the DME arena to bolster their arguments against competitive bidding.“We know that lawmakers need to hear from some other people that are affected by the program who don't have a vested interest,” said Karyn Estrella, executive director of the Home Medical Equipment Services Association of New England. “We know that the beneficiaries are not calling and complaining at the numbers...

WASHINGTON - CMS has been enforcing the written order prior to delivery (WOPD) requirement for a year now, but compliance is still a road filled with potholes for many HME providers, industry stakeholders say.One big reason, says AAHomecare's Kim Brummett: The DME MACs are requiring more than the minimum five elements outlined in the Affordable Care Act (ACA): beneficiary name, DME item ordered, prescribing practitioner's NPI number and signature, and date of order.“The MACs all say providers...