Home Health & Hospice Week
Suppliers Want CMS To Forget Anniversary Date Change
Tracking DME patients' hospital stays is nearly impossible. A reimbursement change touted as helping suppliers will actually make their lives much harder - and put their reimbursement at risk. So said participants in the Dec. 3 Open Door Forum for home health, commenting on Aug. 1 program memorandum B-03-055, which is scheduled to take effect next month. The memo instructs durable medical equipment suppliers to change the anniversary date of their capped rental DME items when a patient is in the hospital on the original anniversary date (see Eli's HCW, Vol. XII, No. 30, p. 235). Currently, suppliers are denied just for that month's payments and resume billing for the next month. But suppliers see a number of problems with the new procedure. First, it's unclear from the memo whether the instruction applies to capped rental items only, one attendee said. While the memo refers only to capped rental items, it uses oxygen as one of its examples. Suppliers, who have no common working file access to check hospital stays, will have a devil of a time trying to track them, commented Kimber-lie Rogers-Bowers with Lake Forest, CA-based Apria Healthcare Group Inc. "It's a monumental change for us considering we have no way of knowing when a patient is discharged from the hospital," Rogers-Bowers told CMS. The mandate "is something very difficult to be in compliance with." she added. "It's a monumental change," Apria's Kimberlie Rogers-Bowers says of the anniversary date instruction. Other DME issues addressed in the CMS forum include: But that still leaves thousands of applications in the queue, noted one attendee. "I can't emphasize enough how significant this freeze has been at least from the orthotics & prosthetic side," said a participant who said he was from the American Orthotic & Prosthetic Association. Most managed care payors won't sign contracts with suppliers who don't have Medicare numbers, he pointed out. The backlog created by the freeze, combined with the longer application process involving more scrutiny, means suppliers may have quite a wait for their numbers, a CMS official said. "We recognize that some suppliers may be under cash flow problems, but we still have to safeguard the program." But many legit suppliers haven't seen payments since early September, said Dan Meuser, President of Exeter, PA-based Pride Mobility Products Corp. "It's a real problem for those folks." CMS said DME regional carrier Palmetto GBA has forwarded only a handful of claims to the Dallas regional office for approval, presumably because submitted claims aren't passing muster.
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