WASHINGTON, D.C. (Oct. 29, 2014)—The Office of Medicare Hearings and Appeals (OMHA) held a hearing on the overwhelming administrative law judge (ALJ) appeal backlog.
AAHomecare’s Tom Ryan and Jay Witter were in attendance at the hearing to represent the interests of home medical equipment providers. Chief Judge Nancy Griswold and other CMS spokespersons discussed the situation and proposed solutions.
AAHomecare CEO Tom Ryan asked the panel how to work together to put real-time practical solutions in place to prevent the issues that are occurring with the backlog.
“Significant dollars are tied up and the providers are going out of business," said Ryan. “When I hear about IT solutions, scanning documents or portals, these are things that the managed care community has had for years. Pilot programs are all well and good, but these are years away and I have providers going out of business everyday. There are things we can do. For the DMEPOS community, these timely filing requirements are causing us to clog the program up. This can be fixed. The other issue is clinical inference. Bringing that back would be a big solution that can work today. I appreciate the forum and the collaboration, but we’re in a crisis here.”
Many of the speaker remarks where similar to what came out of the last OMHA hearing in February. However in a short segment specifically related to DME, Latesha Walker, CMS Provider Relations Coordinator, spoke about the need for open channels of communication. Walker shared with the audience one of the many ways her office is working with suppliers and the resulting success.
When the HME community was able to show Walker the denials resulting from a faulty understanding of who is allowed to fill in the delivery date of service for DME, CMS was able to go back to the original chapter of the requirement and clarify that there was no specific instruction regarding who was allowed to fill out the delivery date. This resulted in CMS going back to the MACs to clarify that a delivery date filled in by the supplier should not cause a denial.
The proof of delivery date requirements being clarified is just one example of how AAHomecare is working to create a more collaborative relationship with CMS. Many of these types of issues, including the proof of delivery date, originate at the AAHomecare level, and are brought to CMS through conversations at AAHomecare Regulatory Council Meetings and AAHomecare staff meetings with CMS.
These types of hearings magnify the need for the HME Audit Key initiative currently being developed by AAHomecare. The ability to bring hard data to meetings such as these and show the true impact of audits on the industry will lead to more open conversations about workable solutions.
Fundraising is currently underway to launch the audit tracker in 2015. Donations are needed from all around the industry to get this program to be successful and return the data needed.
Audit data will be collected on a quarterly basis from HME providers and corporate offices, through a simple and easy-to-use system designed to enable providers to share audit data in a secure and confidential way. The system was built by Provider Consulting Solutions, the same group that developed the American Hospital Association RACTRAC survey tool.
More information on the HME Audit Key can be found online at the industry audit headquarters, fixmedicareaudits.org.
