Hope Springs Eternal

In a series of recent delays and rule changes, this industry has won a few lately in the ongoing battle over regulatory issues.

HME providers working frantically to get physicians enrolled in the Provider Enrollment, Chain and Ownership System (PECOS) got some relief when CMS announced it would delay implementation of the requirement. Claims were originally scheduled to reject beginning Jan. 4, 2010, if the prescribing physicians or non-physician practitioners listed were not registered in the nationwide enrollment system.

CMS first pushed that date out to April 5 but, facing overwhelming enrollment problems (the AMA estimated 30 percent of all Medicare physicians and other health care practitioners were not in PECOS), announced last month it would delay again until Jan. 3, 2011.

In August, CMS unexpectedly added a section to its Program Integrity Manual revising the rules governing loan closets, or “stock-and-bill” arrangements, as the agency called them. The new provisions essentially would have prohibited providers’ participation in closet arrangements by limiting billing for items only to the physician or non-physician practitioner. The new rules were to take effect in September of 2009 but were subsequently delayed until March of this year. Then, in an instruction to its contractors last month, CMS rescinded the new closet rules for further review.

After the Office of Inspector General issued a special fraud alert on telemarketing in January, AAHomecare pointed out the OIG’s interpretation would have prohibited an HME provider from contacting a Medicare beneficiary unless the beneficiary had given consent to do so. That meant even after a doctor prescribed an item of medical equipment, an HME provider couldn’t call the beneficiary to arrange for its delivery without violating the telemarketing prohibitions.

But in an FAQ published in February, CMS clarified that HME providers actually don’t engage in unsolicited telephone communication when they call beneficiaries to fill orders for DME (as long, of course, as certain stipulations are met).

In each case, the industry’s providers ultimately got a reprieve. But these examples also point up how little regulators seem to understand about the home medical equipment business and the way it really works.

When the OIG issued its telemarketing alert, for instance, AAHomecare President Tyler Wilson commented, “It is one thing for the federal government to be vigilant in making sure Medicare claims are properly paid. It is another thing for federal DMEPOS officials to fail to grasp, time after time, how home medical equipment and related services are actually provided to Medicare beneficiaries. A workable system under Part B has to reflect the way the real world operates and how patients, physicians and HME providers interact.”

While these recent decisions seem to indicate that CMS and other government officials are at least listening, there’s a broad concern among HME proponents that those in Congress — and those who carry out Congress’ orders — still don’t understand a whole lot about this sector of health care.

In the words of Bill Cheek, a Georgia provider who attended AAHomecare’s Legislative Conference earlier this month, “We provide a service. That’s what we do. I don’t think they understand it at all.”

Cheek and 200 other providers made the trip to tell Washington legislators more about their companies and their patients in an effort to garner additional support for H.R. 3790, the bill to repeal competitive bidding. Let’s all hope their efforts work, because the consequence of the bidding program, both for providers and their patients, is something that most lawmakers and regulators truly don’t seem to get.