Roller Coaster Redux

It’s been another roller-coaster year for HME.

Pricing for both oxygen and power mobility has been up, down and all around. Coverage and coding for both types of equipment changed, too. The SADMERC’s thrice-issued PMD codes took effect, and when overhauling its oxygen fees, CMS created new payment classes and added supplier requirements.

The DME rental cap was shortened from 15 to 13 months, and Washington-watchers say the 36-month rental cap on oxygen — with a counter that began on January 1st this year — remains a target for further reduction. In fact, industry advocates have moved from crisis to crisis all year fending off assault after assault on home care.

There’ve been lots of twists and turns in housekeeping matters as well. Providers must get a National Provider Identifier number. The claims appeal process has changed. Medicare’s new 1500 claim form is now in play, and paper remittance notices have been discontinued. DMERCs have morphed into DME MACs (Medicare Administrative Contractors, which process claims) and PSCs (Program Safeguard Contractors, responsible for medical policy and review). Here the transition in Regions C and D traveled its own bumpy course as contractors fought over CMS’ awards.

A number of CMNs have changed to DIFs (DME MAC Information Forms), and CMNs have been dropped entirely for hospital beds, Group 3 support surfaces, wheelchairs and scooters, though the latter two have been replaced with different sorts of requirements. Power mobility patients must complete a face-to-face exam, and providers must keep the doc’s chart notes or similar supporting documentation in their files.

Accreditation activity has picked up speed. It will be mandatory in 2007 for those providers who operate in competitive bidding areas — wherever those 10 MSAs turn out to be — and at some point for all Part B providers. It’s based on CMS’ supplier quality standards, which, in a proposed 104-page draft, seemed impossibly tough. But in another loop-de-loop, the standards were downscaled in a 14-page final version to what some have dubbed “accreditation light.” The NSC’s 21 supplier standards also still apply.

The government’s crackdown on DME fraud continues, with whistleblower cases on the rise (some say due to liberal monetary rewards). Recovery efforts have intensified at Medicare, and a new Medicaid fraud program is in the works.

On the big track, Medicare is looking at massive outlays as 78 million baby boomers approach eligibility, and Medicaid has hobbled state budgets, overtaking K-12 education as the largest single expenditure.

Is it any wonder that as the year pulls to a close, HME owners report they’re feeling not only stirred but shaken? CMS’ decisions and revisions have caused more than a little confusion. And speaking of confusion, I haven’t yet mentioned Congress. While some legislators are catching on to the concept that home care offers a solution to the nation’s health care woes, that body as a whole seems to keep making it harder for HME providers to serve their patients well and make a fair profit.

Of course the most nerve-racking part of all this is that no one yet knows what’s around that last turn: There is at present no final rule on competitive bidding, no word on where the program will begin or what the products in the bid will be.

So hold onto your ticket and cinch up your seat belt, because this ride’s not over yet.

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