CareCentrix Reconsiders CPAP Copay Policy

WASHINGTON, D.C. (February 7, 2020)—AAHomecare has engaged CareCentrix on a new copay collections policy for PAP and PAP supply patients with balances of more than 180 days. The association encouraged CareCentrix to reconsider the new policy, which went into effect on Jan. 1.

Early in February, CareCentrix let AAHomecare know they planned to modify the suspension policy as follows:

• PAP Rentals—If a patient’s account is not suspended prior to the initial rental of PAP equipment, then rental, PAP repair, and PAP replacement payments will not be interrupted. CareCentrix requests providers temporarily suspend PAP supplies until patients establish payment arrangements and will not provide authorization for these supplies.
• The suspension policy will not affect patients who are on other life sustaining services, such as oxygen. CareCentrix will develop and share a complete list of corresponding HCPCS codes.
• Notification of suspension will be shared through the HomeBridge provider portal. Effective March 17, providers will be notified during the authorization process in real time if the patient is in a suspension state now or in the past. Effective in April, real time notification during the authorization process will be expanded to include patients with a future suspension date.  Additionally, providers can download a list of patients flagged for suspension with suspension dates at least 60 days in the future through HomeBridge.

AAHomecare appreciates that CareCentrix has given serious consideration to HME stakeholder feedback on the impacts of their original policy change and has worked to reduce these impacts. The association still maintains that payments for PAP supplies should also not be interrupted for patients with co-pay balances and will continue to engage CareCentrix on that point. Note: As aforementioned, CareCentrix will provide at least 60 days advance notice to providers and patients. Should providers continue to send PAP supplies to these patients, only then will claims payments be at risk.

AAHomecare encourages providers to follow their contracts with CareCentrix when suspended patients are requesting to purchase items outside of their medical benefit. Providers should review their individual contracts for determination of providing supplies as cash items for suspended patients.

Thanks to the many providers who shared their perspectives with us on the potential impacts of the originally proposed co-pay policy and helped make a strong case for these changes.

Visit aahomecare.org for more information.