Medicare Compliance & Reimbursement

Durable medical equipment suppliers are the least happy of all Medicare provider types with their contractors.

That's according to the latest Medicare Contractor Provider Satisfaction Survey (MCPSS) commissioned by the Centers for Medicare & Medicaid Services. The survey conducted by MCPSS contractor Westat polled 35,000 randomly selected providers in its third year.

Physician DME suppliers submitting DME claims report the lowest level of satisfaction at 4.22 on a 1 to 6 scale, while hospices had the highest level of satisfaction at 4.74, the report says.

Of the four categories of contractors, Regional Home Health Intermediaries (RHHIs) received the highest average score -- 4.68, the report says. DME Medicare Administrative Contractors (DME MACs) received an average score of 4.41, which was higher than Carriers and Part B MACs with an average score of 4.35.

Overall, contractors received a 4.51 score, which equals a 75 percent "C" average. That's down a bit from last year's 4.77 score.

For RHHIs, the lowest overall score is 4.54 for National Government Services (formerly UGS) while the highest score is 4.86 for Cahaba GBA. "As in the previous two national administrations of the MCPSS, the RHHIs score high and all have scores above the national average," the report notes. Last year Palmetto GBA took the high-scoring honors.

For DME MACs, the lowest overall score is 4.36 for CIGNA and the highest score is 4.45 for Noridian. "DME MACs tend to have lower scores than average; all four have scores below the national average," the report notes.

More information including the survey results report is at http://www.cms.hhs.gov/MCPSS.

• CMS appears to be getting its feet wet in pay-for-performance, announcing high marks for the participants of its physician incentive program. The program could provide a model for future P4P programs for home care and other providers, industry observers predict.

Each of the 10 groups participating in the Physician Group Practice (PGP) program "improved the quality of care delivered to patients with congestive heart failure, coronary artery disease, and diabetes mellitus during performance year two of the demonstration," CMS announced in a release.

Because the participating groups met their pre-set benchmarks, they collected bonus payments that totaled $16.7 million.

"We are paying for better outcomes and we are getting higher quality and more value for the Medicare dollar," CMS Acting Administrator Kerry Weems says in the statement on the CMS website.

Weems also appears to confirm what many analysts had already suspected -- that the pilot program is simply an "audition" for a move to pay-for-performance.

"These results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians," he says.

• You can now give CMS a piece of your mind. CMS is holding a town hall meeting Sept. 22 to gather feedback on "relevant Fee-for-Service (FFS) Medicare policy and operational issues," the agency says.

The agency will make presentations on HIPAA standards, recovery audit contractors (RACs), and Medicare administrative contractor (MAC) transitions, it says.

More information, including how to sign up, is at http://www.cms.hhs.gov/center/provider.asp under the "Spotlights" section.

• Expect to see a specific claim adjustment reason code (CARC) if your claim gets denied due to Stark reasons. Contractors will use CARC #213 when denying a claim for non-compliance with the Stark law's self-referral prohibitions for physicians and their family members, CMS says in Transmittal No. 1578.

Contractors will begin using the new code Jan. 1, CMS notes in MLN Matters Article 6131.