Home Health & Hospice Week

Federal health plan's costs aren't the same as Medicare's. Durable medical equipment suppliers are getting some lawmakers in their corner. Rep. Dave Hobson (R-OH), along with Democratic co-sponsor Harold E. Ford, Jr. (TN), have introduced a bill calling for the repeal of the DME payment rate cuts down to Federal Employees Health Benefit Plan levels. Last December's Medicare Modernization Act called for cuts to FEHBPpayment rate levels by 2005. Some of the cuts may be as high as 22 percent, the American Association for Homecare has estimated. The FEHBP payment rates referenced in MMA, which would affect oxygen and oxygen equipment, wheelchairs, nebulizers, diabetes lancets and test strips, hospital beds and air mattresses, were contained in an HHS Office of Inspector General study that is very small in scope. And the costs and beneficiary population for FEHBPversus Medicare are very different. Thus, paring Medicare prices down to FEHBPlevels is unfair, critics say. Bill proponents hope the legislation will gain cosponsors, showing congressional support for repealing the DME cuts. Then, the provision could be included at the end of the congressional session in a possible wrap-up bill containing many Medicare changes. Observers expect the specific FEHBP cuts to be announced this summer. More details about coverage for Diabetes Self Management Training are forthcoming in the new section on the topic in the Medicare Benefit Policy Manual. Certified providers of DSMT can include DME suppliers, the Centers for Medicare & Medicaid Services clarifies in May 28 Transmittal No. 13. The DME suppliers must bill Medicare for other services, obtain a provider number from the local carrier to bill DSMT, and must be accredited. Aregistered dietitian can't be the sole provider of DSMTservice, CMS also says. CMS has added a listserv for DME, prosthetics and orthotics suppliers at long last. Suppliers interested in the Medicare DMEPOS provider listserv can sign up at www.cms.hhs.gov/mailinglists. CMS already has established a listserv for HHAs, also available through the Web site.

"One of the key goals of the President's Electronic Government Initiative is to make it easier for citizens and providers to get services from their government," CMS Administrator Mark McClellan says in a release announcing the new listerv. If you receive a rejection forcertain prosthetics due to skilled nursing facility consolidated billing, you can rebill and receive separate payment -- but only if you're paying attention.

CMS accidentally left two new codes -- L5673 (Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism, effective January 1, 2004) and L5679 (Addition to lower extremity ... not for use with locking mechanism, effective January 1, 2004) off the list of codes [...]