This week leaders on Capitol Hill hosted two hearings related to HME issues. The powerful Senate Finance Committee hosted a hearing on the backlog of claims appeals at the administrative law judges (ALJ) level, and the Small Business Administration hosted a forum on regulations impacting small businesses. These two hearings are a great example of how coming to D.C. in person, to meet with legislators can have a powerful impact on our industry. This year's Washington Legislative Conference, May 20-21, is right around the corner, and we need our members of Congress to understand what is at stake for the HME community. If you haven't already registered, now is the time!
At the Senate Finance Committee hearing on Tuesday, Chairman Orrin Hatch (R-Utah) said the Medicare appeals backlog has had the negative effect of delaying payments to providers and blocking Medicare coverage for beneficiaries. Hatch said appeals are taking an average of 547 days to be processed in fiscal year 2015—“far too long for beneficiaries to find out whether their medical services will be covered or for providers to find out if they will be paid.”
AAHomecare staff Jay Witter, senior vice president of government affairs, Peter Rankin, assistant director of government affairs and Ashley Jackson, government affairs associate, attended the hearing on behalf of the HME industry.
In addition to testimony from Nancy J. Griswold, the chief ALJ for the OMHA, the committee heard testimony and recommendations from two Medicare contractors involved in the first two levels of the appeals process.
Sandy Coston, chief executive officer and president of Medicare contractor Diversified Service Options, said appeals at the ALJ level should be sent back to the previous appeals level when new evidence is submitted, an idea also supported by the OMHA.
“In cases where new evidence is submitted at the ALJ level, remanding these case back to the prior level for handling would result in a reduction in the ALJ backlog, as well as quicker resolution for the providers,” Coston said.
Thomas Naughton, a senior vice president with MAXIMUS Federal Services, a QIC, said the appeals backlog could be reduced by establishing a support unit for ALJs capable of providing expertise on RAC audits. The unit would provide subject matter experts such as nurses, physicians and certified coding specialists who could help the ALJs resolve appeals.
Naughton also said that transitioning to electronic submission of documents at all levels of the appeals process would provide “significant time and cost efficiencies while ensuring access to the complete case file.”
On Monday, the Small Business Administration hearing was convened by National Ombudsman Brian Castro and the Region III Regulatory Fairness Board to hear testimony from small business owners, representatives of trade associations, and other members of the small business community regarding federal regulations and enforcement and compliance actions impacting America’s small businesses.
AAHomecare staff Jay Witter, senior vice president of government affairs attended the hearing on behalf of the HME industry in addition to other HME stakeholders.
Several AAHomecare members, DME, orthotic and prosthetic suppliers were able to give testimony explaining the enormous burdens of bidding and audit regulations. Many thanks to VGM for playing a big role in the hearing and coordinating the speaker's trips and testimonies; and thank you to Sara Beck of San Joaquin O & P, David Chandler of Liberty Medical Specialties and president of NCAMES, John Tyo of Syracuse Prosthetics and guest, patient David Lewis, Colleen Brabec of Mobilis, Inc., and Wayne Sale formerly of Health First for taking the time and effort to travel to D.C. to share their stories and educate the Small Business Administration about the challenges that small DMEPOS suppliers face.
