Home Health & Hospice Week

Physicians and other clinicians who supply DME to patients directly will be able to continue to do so under Medicare's newest competitive bidding program--a plan that might not come off without a hitch.

How it works: Physicians, therapists and others included in the exemption will be required, like other home medical equipment providers, to secure accreditation to participate in the program, and they'll be paid according to the accepted "single payment" rate for their patients' Competitive Bidding Areas.

Who's included: The final rule allows some clinicians to continue furnishing certain types of competitively bid items to their own patients if the items are part of their professional services. Those clinicians include physicians, physician assistants, clinical nurse specialists, nurse practitioners, and occupational and physical therapists in private practice.

Stay tuned: CMS has not set a firm date by which physicians and other clinicians must be accredited, Norwalk noted.

Round one: Only practitioners in the first 10 CBAs will be affected by the new pricing at first.

Skilled nursing facilities will also be allowed to serve as DMEPOS providers, but only to their own residents--and not without some legwork. To continue supplying medical equipment and supplies to their residents, each SNF would need to compete for a contract without having to meet the general requirement of being able to serve the entire CBA.

CMS' decision to exempt doctors, therapists and others eases the burden on clinicians, but it could prove to be problematic--for the agency itself.

In the long run, the exemption could present opportunities for fraud, cautions Jeffrey Baird, an attorney with Brown & Fortunato in Amarillo, TX.