Proposed Medicare Cuts Ignore Service

Baltimore

Bi-level respiratory-assist devices with backup, designed to treat patients with severe respiratory conditions, should fall under Medicare’s capped rental reimbursement policy — not under the government’s policy for items requiring “frequent servicing,” the Centers for Medicare and Medicaid Services said.

Attempting to rectify what CMS called the “erroneous” classification of these items, the agency published a proposed rule Aug. 22 in the Federal Register.

The move essentially would cut Medicare reimbursements for bi-level respiratory-assist devices with backup by approximately 13 percent, CMS explained. However, device manufacturers and home medical equipment providers argued at a 1999 public meeting that these devices merit reimbursement under the “frequent servicing” classification, because ensuring patients’ compliance requires frequent visits from respiratory therapists.

CMS disagreed. “No information was presented at the public meeting that would indicate that the equipment itself requires [frequent servicing],” the agency said.

Ron Richard, vice president-marketing, The Americas, for San Diego-based ResMed, says that although the proposed rule may have only a limited effect on many providers, it highlights a deeper problem with Medicare’s reimbursement system for service-intensive home medical equipment. “There should have been a service payment established long ago for patients requiring servicing in the home,” he said.

Ideally, doctors would write prescriptions not only for the device but also for the service level that each patient’s condition requires, Richard said.

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