Disappointing Reimbursement Adjustment Timeline for Patients and Suppliers

via AAHomecare WASHINGTON, D.C. (February 15, 2017)—As we reported last week, CMS has released guidance to the DME MACs for retroactive reimbursement adjustments for rural/non-bid area providers for equipment and services furnished between July 1-Dec. 31, 2016, as mandated by CURES legislation that passed late last year.

While AAHomecare is pleased that CMS has finally released this much-awaited guidance and that it appears that HME suppliers will not have to take any specific action to receive their reimbursements, the timeline CMS had laid out for this program is very disappointing. The implementation date on CMS’ guidance is set for July 3, 2017, although it is noted that DME MACs can start reprocessing the affected claims as soon as the revised fee schedule files are loaded into their systems, which is described in their guidance as being “available for download on or after [emphasis ours] May 1, 2017.”

Additionally, there remains some question as to the exact rate-setting methodology CMS will be employing, based on this statement in last week’s guidance:

To implement section 16007 for dates of service July 1, 2016 through December 31, 2016, the 50/50 blend fee schedules have been recalculated so that the adjusted portion of the payment blend utilizes July 1, 2016 adjusted fees.

For many home medical equipment companies faced with the unique challenges and costs of serving patients over widely-spread geographic areas, this adjustment schedule will further strain finances and potentially cause more suppliers to make difficult business choices or even shutter their operations. The uncertainty about how the rates will be recalculated is also an unwelcome development; in our opinion, applying rates in effect on June 30, 2016 for products and services delivered from July 1 through Dec. 31, 2016 is the common-sense reading of the intent of the CURES bill.

AAHomecare has reached out to CMS to ask for clarification on how the reimbursements will be calculated, and we remain committed to a longer-term solution to deliver sustainable reimbursement rates for rural and non-bid area providers. We hope to build relationships with new leadership at HHS and CMS that will result in a better appreciation for the regulatory challenges our industry faces and lead to action to reduce these burdens to the benefit of patients and suppliers alike.

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