Page 10 - HME Business, August 2017

News / Trends / Analysis
TRICARE to Comply with CURES Act
Letters from the military insurance program indicated that it will work with providers to adjust past claims so that they align with CURES reimbursement rates.
TRICARE will reprocess claims from July 1 through December 31, 2016 to reflect the adjustments to the fee schedule mandated by
the CURES Act. The news came via letters sent to HME providers that had previously asked TRICARE about whether it would be adjusting reimburse- ment for claims according to the Act.
“You are correct TRICARE uses Medicare’s DMEPOS fee schedule, Medicare reduced their rates in the second half of 2016, and a subse- quent resolution (the 21st Century Cures Act) delayed that reduction, and retained the orig-
inal, higher rates for claims with dates of service between July 1 and December 31, 2016,” the letter
read. “TRICARE followed suit and we suggest you resubmit any claims adjudicated under the reduced rates to the Managed Care Support Contractor (MCSC) in your region for reprocessing.”
TRICARE is the insurance program serving active duty and retired military personnel and the fami- lies, and, per law, the program’s reimbursement rates are tied directly to Medicare’s DMEPOS rates.
When CMS’s full implementation of national expansion of competitive bidding rates hit on
July 1, 2016, TRICARE became the poster child
for the “ripple effect“ caused by that expansion. TRICARE’s rates are not only tied to Medicare reimbursement, but are discounted off those rates. While the national expansion’s full cuts fell somewhere between 35 to 60 percent off previous rates, TRICARE was discounting roughly 30 percent on top of that.
Focused Advocacy Battle
Since that time several organizations, including the American Association for Homecare, ACMESA and various providers and advocates have been steadily working for several months to convince Defense Health Agency, which runs the TRICARE program, and the TRICARE contractors, to adhere to adjust reimbursement rates per the CURES Act, and recoup providers for the difference on undercut reimburse- ment during the time the rates were not adjusted.
“This is a big win for the industry and that hope- fully other payers who base reimbursement off
of Medicare will follow suit,” said Laura Williard, AAHomecare’s vice president for payer relations, in a conversation with ACMESA executive director Beth Bowen. “Insurance payers are watching what others are doing and this is a BIG message to them.”
“I am ecstatic to see that TRICARE is aware of the CURES-mandated adjustments and is ready to imple- ment them,” said Tyler Riddle, vice president of HME provider MRS Homecare and president of the Georgia Association of Medical Equipment Suppliers. “Now the HME community needs to keep making the case to
TRICARE and other third-party payers that the current bidding-derived rates are unsustainable going forward and need to be adjusted on a long-term basis.”
How to Get Recouped
Providers that have not already done so
should submit the letter titled “Sample
Provider Letter to DoD on CURES-Mandated TRICARE Reimbursements,” said Laura Williard, AAHomecare’s vice president for payer relations. A sample of such a letter in Microsoft Word format can be found on payer relations resources page
at aahomecare.org/advocacy/payer-relations- resources. Sending such a letter should an elicit a response letter from TRICARE.
Providers should resubmit a small, initial batch of claims to check that they are correctly repro- cessed prior to sending all claims, according to Williard. This would save a provider from having to resubmit all its claims multiple times if its TRICARE contractor denies or improperly processes them. n
The Number of HME Providers Continues to Slip
Provider numbers see significant drop from 2013 to now, including provider of major HME categories such as wheelchairs and oxygen.
The number of HME providers continues to steadily decline, according to research performed by the American Association for Homecare.
Each quarter AAHomecare reviews the Medicare Supplier Directory to tabulate the number of HME providers currently providing services to beneficiaries. This includes providers of major categories, such as beds, NPWT, support surfaces, wheelchairs, and oxygen products.
“Our most recent review of the data found that the supplier numbers are steadily decreasing,” a statement from the association read. “... there are roughly 6,086 unique suppliers and 9,810 locations nationally. Compared to 2013, the number of suppliers has decreased by about 42 percent.”
More details from AAHomecare on state-by-state counts can be found at bit.ly/2up5OKL. n
“This is a big win
for the industry and
that hopefully other
payers who base
reimbursement off
of Medicare will
follow suit.”
— Laura Williard,
American Association for Homecare
WEBINARS
More industry intelligence is available at hme-business.com.
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New Webinar Archive — The RAC is Back! Are you ready? CMS has given Performant Recovery, the new national Home Health, Hospice and DMEPOS RAC, the greenlight to start auditing. The first round of RAC audits, occurring in 2011 to 2013, were rough on providers. In this informa- tive webinar, presenter Kelly Grahovac, senior consultant for The van Halem Group, provides keen insights into what you can expect from the next round of this audit, and how you should be preparing to respond to those audits.
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10 HMEBusiness | August 2017 | hme-business.com
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