HME Scorecard: Keeping Track of Industry Changes

ATLANTA–While DMEPOS competitive bidding has garnered the
industry’s most recent headlines, a slew of other changes has
emerged for home medical equipment providers that may have gotten
lost in the chaotic competitive bidding shuffle.

Industry stakeholders marshalled all their muscle this year to
halt the Medicare bidding program that, in fact, went into effect
July 1. It was finally rescinded July 15 when Congress overrode the
president’s veto of H.R. 6331–which includes a delay of the
program–and the measure became law.

Since the beginning of the year, however, CMS and its
contractors have issued several proposals and directives that will
change the way providers do business. To help keep track, here’s a
roundup that includes some of them.

Supplier Standards: For years,
providers had asked for further guidance and clarification of what
many called vaguely written supplier standards. In January, CMS
responded, publishing an 11-page draft rule in the Federal
Register clarifying and expanding existing supplier standards
and adding others that all HME providers must meet to participate
in Medicare and retain billing privileges. Comments on the proposed
standards were taken until March 25. At press time, a final rule
had not been released.

Among the proposed rule’s changes to the existing supplier
standards:

–A change to Standard No. 1, which deals with state and federal
licensure and regulatory requirements, would require that suppliers
providing licensed services not contract out those services. In
other words, personnel furnishing licensed services (in states that
require licensing of any aspect of a provider’s business) must be
W-2 employees, not 1099 independent contractors.

–CMS would expand existing Standard No. 7 regarding physical
facilities and appropriate sites. The agency proposed that hours of
operation be posted on permanent signage at the main entrance to
the supplier location, even if the business is in a building
complex where it is not the only tenant.

In addition, the location must be staffed during posted hours
and must be accessible “regardless of whether beneficiaries
routinely visit the facility,” according to the proposal. The
requirement also would apply to “closed door”
businesses, such as pharmacies or suppliers providing services only
to beneficiaries in a nursing home. “A supplier is not in
compliance with this standard if no one is available during the
posted hours of operation,” CMS said.

–Standard No. 9 would be revised to prohibit answering
machines, answering services or fax machines as the primary
business phone during operating hours and would also prohibit
forwarding incoming calls to a cell phone or beeper.

Among new supplier standards, CMS propopsed:

–That suppliers obtain oxygen from state-licensed oxygen
suppliers. The standard would apply in states that license oxygen
suppliers, but when an HME company is located in a state that
requires such licensing, the company must obtain oxygen from a
licensed supplier, regardless of the state where the oxygen
supplier is licensed.

–That suppliers be prohibited from sharing a location with
other Medicare suppliers, including physicians.

–That suppliers must be open to the public a minimum of 30
hours per week (either six hours a day, five days a week or five
hours a day, six days a week).

To read the proposed rule in full,
click here.

CEDI: Rather than four DME MACS
processing claims, CMS announced in January that a single entity
would take on that responsibility. National Government Services was
awarded the Common Electronic Data Interchange contract and, by
mid-year, had transitioned all four jurisdictions to the CEDI
program. While there were significant hold-ups in claims
processing, as of Aug. 7, NGS said it was working to catch up and
was finishing up paperwork received on June 27 and 30 and had begun
processing paperwork that was received on July 1.

For updates, check the CEDI Web site at
www.ngscedi.com. The CEDI Help Desk is available from 9 a.m. to
9 p.m. ET at 866/311-9184.

To access a CEDI FAQ document,
click here.

CPAP Therapy: On March 13, CMS issued
a National Coverage Determination that changed policy to allow
coverage of CPAP therapy for obstructive sleep apnea if a positive
diagnosis is made from a home sleep test. The decision is effective
Aug. 4. However, in a recent ruling, the DME MACs refused to allow
HME providers to administer those tests. For more, see “Home Sleep
Testing” below.

To see the official instruction issued to the DME MACs regarding
CPAP therapy for OSA,
click here.

NPI and PTAN: As of May 23, CMS
required that all Medicare claims be submitted with a National
Provider Identification number or be rejected. As well, the agency
is requiring that all providers applying for their NPI number prior
to March 1, 2008, be accredited by Jan. 1, 2009; those seeking
enrollment after March 1, 2008, must already be accredited.

Also effective May 23, providers are required to have a Provider
Transaction Access Number to authenticate identification when they
phone or submit written inquiries to a Medicare fee-for-service
contractor. (The PTAN was formerly referred to as a supplier
number, NSC number, Medicare provider Identifier Number or legacy
Medicare Identifier). For providers enrolled in Medicare before May
23, 2008, the PTAN is their legacy number. For providers enrolling
on or after May 23, a PTAN is assigned.

For more information on the NPI,
click here.

CMS announced last week that it would be implementing some
enhancements/updates to the National Plan and Provider Enumeration
System to be effective today. For a detailed listing of the NPPES
enhancements,
click here.

Accreditation Deadlines: On the heels
of the suspension of competitive bidding, CMS announced it was
rescinding previously set accreditation deadlines for round two:
July 21 for providers who wished to submit a bid; and Jan. 14,
2009, for those who wanted to be considered for a contract. CMS
did, however, retain the deadline by which all Medicare providers
must be accredited: Sept. 30, 2009.

For a DMEPOS accreditation fact sheet,
click here.

Home Sleep Testing: Providers were
blindsided in mid-July when the four regional DME MACs issued a
revised Local Coverage Determination for CPAP policy prohibiting
HME providers from conducting home sleep tests–or even delivering
or picking them up. The industry had anticipated a different
outcome since CMS’ March NCD opened the door to home testing with
type II, III and IV devices. But the MAC medical directors decided
differently. “No aspect of a HST including but not limited to
delivery and/or pickup of the device, may be performed by a DME
supplier,” the LCD said. (For more, see
HomeCare Monday, July 21.)

In a proposed rule published in the July 7 Federal
Register, CMS would prohibit CPAP reimbursement if a supplier
or its affiliate performs the test used to diagnose a beneficiary
with OSA. The comment period for the proposed rule is open until
Aug. 29.

To submit electronic comments, go to
www.regulations.gov/search/index.jsp and enter CMS-1403-P in
the “Comment or Submission” bar.

SADMERC Change: Effective Aug. 18, the
SADMERC transitions to a new carrier, according to CMS. Noridian
Administrative Services will be the new Pricing, Data Analysis and
Coding Contractor, taking over the duties of Palmetto GBA, the
Statistical Analysis DME Regional Carrier. (See
HomeCare Monday, July 28.)

Under the contract, the PDAC will be responsible for:

–Providing data analysis support to the DME Program Safety
Contractors;
–Guiding manufacturers and suppliers on the proper use of HCPCS
codes for Medicare billing purposes through product reviews and
decisions;
–The DME coding system and the HCPCS Helpline;
–Conducting national pricing functions for DMEPOS services;
and
–Assisting CMS with DMEPOS fee schedules.

For transition updates, check the SADMERC Web site,
www.palmettogba.com until the PDAC Web
site–www.dmepdac.com–is launched.