Medicare Compliance & Reimbursement

Plus: Could a Senate subcommittee hearing on competitive bidding bring changes?

The United States lags behind the rest of the international community in transitioning from the current coding system--with 17,000 diagnosis and procedure codes--to the ICD-10 system--which has 210,000.

Now the Centers for Medicare & Medicaid Services has contracted with the American Health Information Management Association to begin assessing the impact of replacing the ICD-9 code sets with the ICD-10 versions, the agency announced.

AHIMA is to assess CMS' systems, policies and operations "to determine potential impacts" of making this transition, CMS says in its press release. This includes looking at ICD-10's "ability to support more accurate payment for new procedures, efficient claims processing and improved disease management," CMS says.

While CMS is still assessing the implementation and timing of this transition, the agency's "proactive approach should send a signal to hospitals and other stakeholders who use the ICD-9 coding to begin making their own transition plans," says CMS Acting Administrator Kerry Weems.

Competitive Bidding Program's Future May Hinge On Congressional Action

Small suppliers of home medical equipment could be looking at a reprieve from the pressures of Medicare's new competitive bidding program.

On Oct. 31, members of the House Subcommittee on Investigations and Oversight heard testimony on the program's impact on small HME players.

CMS is reviewing approximately 6,300 certified bids from round one of Medicare's new competitive bidding program for home medical equipment, testified agency official Laurence Wilson.

That number falls significantly short of an early CMS projection that nearly 16,000 would "submit a bid because they will want the opportunity to continue to provide these products to Medicare beneficiaries and to expand their business base."

Industry insiders say the low number of total bids adds to concerns that many small suppliers will falter under the strain of competitive bidding.

Georgetta Blackburn, a home medical equipment provider in Pittsburgh who testified on behalf of the American Association for Homecare, said that the low number of bids reflects an attitude that suppliers "chose not to get involved."

"Since Medicare typically makes up between 35 to 50 percent of a small homecare provider's practice, losing the ability to provide competitively-bid items for the three-year contract is essentially a death knell to these providers," she said.

"While the objective is to reduce costs, it is not clear that the new competitive bidding program will achieve this goal without unraveling the DME small business community," said subcommittee chair Jason Altmire (D-PA). "This may spell ruin for small providers whose revenues are often less than a million dollars a year."

Altmire added that he expects that the only businesses to survive the program will be national suppliers. Altmire and others could push for a House Ways and Means Committee hearing on competitive bidding's impact.

In Other News...

May 2008 seemed like a long way off back when CMS said it was delaying the original May 2007 requirement for the National Provider Identifier for a year.

But now that May 23 deadline is looming closer, and CMS warns that you absolutely must have the NPI, and only the NPI, in all relevant fields on your claims by that date. That includes the NPI of the referring/ordering /attending/service facility provider, CMS notes in MLN Matters article MM674. Without NPIs in all fields, your claims will be denied.

Don't furnish services to Medicare beneficiaries unless you already have the NPI of the referring provider, CMS suggests.