Tag: reform

Imagine you are having a problem with your car. You need it looked at, so you take your car to an expert to get it checked out at and diagnosed. You know you have problems with your car, but you want someone else to assess your car's problems. The mechanic looks at your car and he is immediately puzzled. There are so many oddball problems with your car. The expert wants to know how this car came about. You tell him: “At one time this car ran great, but over the years, so many changes have been...

WASHINGTON - The lack of substantial changes in the competitive bidding-related final rule likely comes down to cost, say HME industry stakeholders.“The challenge has all along been the cost,” said Tom Ryan, president and CEO of AAHomecare. “I think the political appointees at the agency wanted to do more but were restricted by cost. Cost is everything.”The final rule, released Nov. 1, did not include two areas of additional relief requested by the industry: an extension of...

WASHINGTON - CMS appears to have done little to change its competitive bidding-related rule from the time it was proposed in July until it was finalized on Nov. 1.Despite myriad concerns raised by HME industry stakeholders, the agency did not extend 50/50 blended reimbursement rates to all non-bid areas; and it did not apply CPI adjustments to rates in bid areas retroactively from 2008-13.“While I believe that CMS is making a smart decision in pausing the bidding program to work on additional...

WASHINGTON - AAHomecare argues that CMS should pay HME providers in competitive bidding areas a higher rate during an upcoming “gap period” in the program, according to comments submitted by the association this week in response to a recent proposed rule.AAHomecare recommends that CMS establish rates in the former CBAs at the current SPA rates but provide an increase to those rates by all the CPI-U increases from 2013 through 2018.“AAHomecare has serious concerns about the agency's...

WASHINGTON - CMS Administrator Seema Verma says she wants to “modernize” the agency's long-standing competitive bidding program for DMEPOS by instituting market-oriented reforms.It's a major change in attitude for the agency, which has lauded competitive bidding and the savings it has created since the program was first implemented in 2011.“The current structure doesn't produce the best prices for patients and doesn't drive optimal performance by contractors, and it's simply not...

WASHINGTON - CMS's decision to temporarily delay Round 2019 of competitive bidding could mean a revamp of the program, now that Rep. Tom Price, R-Ga., is taking the helm at the Department of Health and Human Services, say industry stakeholders.CMS said on Feb. 7 it was delaying Round 2019 to give the new administration time to review the competitive bidding program. The announcement came one week after the agency announced it would consolidate all future rounds of competitive bidding into Round 2019.“Given...

WASHINGTON - The Senate Finance Committee on Wednesday passed a bill to improve the Medicare audit and appeals process.The bill, the “Audit and Appeal Fairness, Integrity and Reforms in Medicare Act” or AFIRM Act, was co-authored by Sen. Orrin Hatch, R-Utah, chairman of the committee, and Sen. Ron Wyden, D-Ore., ranking member.“This is a common sense bill that will help untangle the web of red tape that ensnares the current audit and appeals process and guarantee Medicare patients...

WASHINGTON - Rep. Renee Ellmers, R-N.C., plans to sponsor legislation to fix Medicare's broken audit system, AAHomecare and the North Carolina Association for Medical Equipment Services (NCAMES) announced today.“Congresswoman Ellmers has recognized an intensifying problem in the homecare industry,” stated Robert Steedley, president of Barnes Healthcare Services and chairman of AAHomecare's board of directors, in a release. “We look forward to working with her to move this legislation...

WASHINGTON - The week after a scathing forum on audits, CMS on Feb. 18 pledged to make a number of changes to the recovery audit contractor (RAC) program in 2014.The change with the biggest potential impact on HME: CMS will require the RACs to wait 30 days before sending a claim to the MAC for adjustment to allow for discussions. Industry stakeholders say providers can use this defined window to try and clear up claims that have been denied due to technical reasons.“If they say I don't have...

It may not feel like it, but HME providers aren't the only healthcare providers being audited like crazy by the government. Hospitals are, too. I was reminded of this last week when I saw a press release from a group called the American Coalition for Healthcare Claims Integrity (ACHCI). Never heard of them? According to the release, the ACHCI, founded in 2009, is a nonprofit “committed to working toward achieving 100% accuracy in payment claims submitted to public and private sector healthcare...