Medicare Compliance & Reimbursement

Coding change for respiratory assist devices could spell trouble.

Durable medical equipment suppliers could face a wallop to their wallets under a fee schedule change proposed Aug. 22 by the Centers for Medicare & Medicaid Services.

In a proposed rule published in the Federal Register, CMS says it plans to overhaul the way it pays for respiratory assist devices with bi-level capability and a back-up rate. The changes affect continuous positive airway pressure device codes K0533 and K0544. CMS' plan: to include those HCPCS codes in the capped rental part of the fee schedule, a move that makes them ineligible for "frequent and substantial servicing" payments - and thus takes a big bite out of how much suppliers can get paid for the products.

CMS maintains that the move is necessary to correct overpayments that have resulted, at least in part, from faulty information dispensed by DME regional carriers. And the move shouldn't come as a surprise - the HHS Office of Inspector General has been griping about payments for respiratory assist devices for years (see MDA, June 21, 2001).

To see the proposal, go to http://www.access.gpo.gov/su_docs/fedreg/a030822c.html.

Lesson Learned: DME suppliers should make sure they plan for big changes in the way they get reimbursed for respiratory assist devices.