Home Health & Hospice Week

FL, CA suppliers play beat the clock.

Thousands of reputable home medical equipment providers face the risk of losing their Medicare billing privileges under the feds' latest plan to ferret out rogue suppliers.

The demonstration project, unveiled by the Centers for Medicare & Medicaid Services July 17, shocked even insiders with its timing and approach.

Though the plan as announced focuses on "preventing deceptive providers from operating" in the greater Los Angeles and Houston areas, it's creating tough new realities for law-abiding HME providers (see Eli's HCW, Vol. XVI, No. 24)

Big hurdle: Under the demonstration, CMS is requiring that all HME providers in Southern California and Southern Florida become accredited within a 90-day period. The program, which is already under way, calls for the accreditation clock to start ticking upon notification from the National Supplier Clearinghouse.

Big consequences: CMS plans to suspend the Medicare billing number of any affected providers who fail to become accredited within the timeframe.

Bidding + Accreditation = Disaster

"The timing of this is especially bad," says Wayne Stanfield of the National Association of Independent Medical Equipment Suppliers (NAIMES) in Halifax, VA. "Medicare's new competitive bidding for home medical equipment is already taxing the resources of accrediting organizations," he notes.

Others agree that providers are likely to run into roadblocks in securing accreditation.

"It's not feasible," says Miriam Lieber of Lieber Consulting in Sherman Oaks, CA.

Don't Miss Reenrollment Notice

Another heads up: Providers will also be required under the demonstration to re-enroll in Medicare within 30 days of a notice from CMS to do so. Home health agencies are under this same requirement in their fraud-fighting demonstration project (see Eli's HCW, Vol. XVI, No. 26).

Groups including the American Association for Homecare are working with CMS to communicate supplier concerns. But suppliers faced with the mandate should forge ahead, experts say. To delay could cost you your ability to bill Medicare.

Question mark: It's possible that CMS will count pending accreditation as meeting the demonstration's requirement, but the verdict is still out.

In the meantime, it may work to home health providers' advantage that CMS is coming under fire from Congress to address the effectiveness of Medicare contractors in combating fraud and abuse.

"Why hasn't the government held them responsible?" asks Stanfield, echoing concerns expressed recently at Congressional confirmation hearings for CMS Administrator nominee Kerry Weems. "Instead, CMS is slapping this demonstration on law-abiding suppliers."