Home Health & Hospice Week

Feds tighten standards to fight fraud--but will the changes stop you, too?

A proposed rule designed to make Medicare more fraud-resistant may present reputable home medical equipment suppliers with obstacles that are difficult to navigate--especially rural suppliers.

The Centers for Medicare & Medicaid Services issued the rule on Jan. 25 to boost protection against "dishonest," "low quality" and "unscrupulous" suppliers, says the agency in a press release.

But "the proposed new standards are really cumbersome," says Mary Ellen Conway of Capital Healthcare Group in Bethesda, MD. "You can see CMS' intent, but these standards are likely to be problematic for legitimate suppliers."

Highlights: The rule creates five new supplier enrollment standards and strengthens seven of the 21 existing standards that HME companies must meet. The proposed rule deals only with enrollment standards, not quality standards, though CMS has said that it will release proposed changes to quality standards "soon."

The five new requirements are:

1. Suppliers of durable medical equipment and supplies must be open to the public for at least 30 hours a week. Suppliers of prosthetics and orthotics are exempt from the "open to the public" requirement.

2. A supplier must notify the National Supplier Clearinghouse when it experiences any adverse legal action, change of location or change of ownership. A supplier who fails to report the required information within 30 days won't be eligible to receive Medicare payments, and any payments received by the supplier while out of compliance will be treated as overpayments and must be returned to Medicare.

3. CMS prohibits suppliers from sharing a practice location with another Medicare supplier.

4. Suppliers must maintain ordering and referring documentation received from the physician or other treating professional for seven years.

5. DMEPOS suppliers can't obtain or retain Medicare billing privileges if they have a federal or state tax delinquency.

The proposed rule also revises existing enrollment standards.

Beware: Some of the new revisions could prove unwieldy for small suppliers and those serving rural areas, says Eric Sokol of the Power Mobility Coalition in Washington, DC. "Now on top of the cost of accreditation, you may have increased costs of meeting new standards. And then what happens if you add the cost of a surety bond?"

With careful revisions, however, the new standards could point the industry in the right direction, adds Sokol: "CMS needs to acknowledge that if suppliers can meet tough standards, they are a cut above the Internet suppliers"--and deserving of reimbursement that's in keeping with the costs of providing high quality of care.

"We need to shrug off this taint of fraud that's really holding us back on the reimbursement side," says Sokol.

Resource: To read the proposed rule, go to www.gpoaccess.gov/fr/index.html and select "Browse the table of contents," for 2008. Then select "Friday, January 25, 2008."

Deadline: CMS will accept comments on the proposed rule until March 25 and will publish a final rule later this year.