Page 10 - HME Business, June 2017

News / Trends / Analysis
More than 40% of Providers Have Abandoned Medicare Since July 2013
An AAHomecare study of Medicare data also shows number of unique locations dropped by 38.7% during the same period.
A total of 40.9 percent of traditional HME providers previously serving Medicare beneficia- ries have dropped out of the Medicare program since July 2013, according to research on Medicare data conducted by the American Association for Homecare.
Additionally, the number of unique provider locations serving Medicare beneficiaries dropped by 38.7 percent during the same period.
“This drastic loss of suppliers is impacting
Medicare beneficiaries’ access to critical home medical equipment and services, and the situ- ation is sure to become even more dire without more sustainable reimbursement policy for HME,” a statement from the association read. “This data paints a stark picture of the effects of the bidding program, which went into widespread effect in July 2013, on the HME infrastructure serving HME beneficiaries across the nation, in both bidding areas as well as rural locations.”
The drop off in the number of providers serving Medicare patients increased with the national expansion of competitive bidding-derived pricing to non-bid areas in 2016, which resulted 26.3 percent decline in the number of of providers, and a 23.3 percent reduction in the number of unique locations, according to the association.
In comparison, total Medicare enrollees
have increased by 8.6 percent from 2013 to 2016, according to data from CMS. n
ACMESA Preps for its Summer Meeting
Atlantic Coast association’s conference and expo focuses on theme of ‘Staying in the Game to Win!’
The Atlantic Coast Medical Equipment Services Association (ACMESA) is gearing up for its summer meeting, which will be held June 15-16 at the Holiday Inn Resort in Wrightsville Beach, N.C. is now open.
The agenda and registration form for both providers attendees and vendor exhibitors can be downloaded as a PDF at bit.ly/2qdMTAz.
The two-day education agenda includes presentations from:
• Kim Brummett, vice president of regulatory affairs for AAHomcare
• Laura Williard, senior director of payer rela- tions for AAHomecare
• Mark Higley, vice president of regulatory affairs for The VGM Group Inc.
• Ty Bello, founder and president of HME sales consulting firm Team@Work
• Rhonda Hines, vice president of The MED Group
• Sarah Hanna, president of ECS North
Online registration for the event will soon open ASAP. In the meantime, providers who want to seal their spot can print, scan or email to beth@atlantic- coastmesa.org. Payment can be made by check, or attendees can request a credit card payment link in their emails. n
CMS Eases Adjudication Process
for Serial Claims
DME MACs will change appeals of recurring claims for capped rental items and certain inexpensive and routinely-purchased items.
The American Association
for Homecare reports that after years of effort by its Regulatory Council, CMS has made significant changes to improve the processing and adjudica- tion of serial claims for capped rental items and certain inexpensive and routinely purchased DME.
The good news comes after Kim Brummett, vice president of regulatory affairs for AAHomcare, and the association’s Regulatory Council have spent years working with CMS leadership to address the
issue, according to an association statement.
“... We are pleased to hear this announcement,”
the statement read. “Recently, the Council met with CMS leadership and discussed the challenges with serial claims and their effect on suppliers
and the appeals backlog. This announcement will provide welcome relief to suppliers.”
Complete details on the changes are available in a CMS statement (go.cms.gov/2qU1Qir). Key changes include:
• CMS recently directed the DME MACs to change the process used to adjudicate appeals of serial claims. Once the reason for denial for one claim in a series is resolved at any appeal level, the DME MACs will identify other claims in the same series that were denied for the same or similar reasons, and take that determination into consid- eration when adjudicating such claims.
• The DME MACs will also communicate the favorable decisions to the DME QIC and the Office of Medicare Hearings and Appeals (OMHA) to consider when adjudicating related appeals pending at those levels.
• CMS has also instructed the DME MACs to update the Certificate of Medical Necessity (CMN) in the ViPS Medicare System (VMS), when appro- priate, to reflect when a favorable decision has been rendered for a serial claim, allowing future claims in the same series to pay without requiring See CMS Eases Adjudication Process continued on page 12
UPCOMING COVERAGE
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