Page 20 - HME Business, October 2018

A LOOK
A LOOK
AHEAD
AHEAD
FOR
FOR
HME
HME
MEMBERS FROM HMEB’S EDITORIAL ADVISORY BOBAORADRDIDIEDNETNITFIFEYS SOME KEY TRENDS THAT WILL IMPACT THE INDUSTRY.
By David Kopf
EACH YEAR members of HMEB’s Editorial Advisory Board take the time to scan
the industry’s horizon for new trends, issues, challenges and opportunities that will either impact providers in coming months or are already starting to make themselves felt.
This year’s installment of our annual round- table discussion takes into account some trends providers might already be thinking about, as well as several they might not yet have considered. Let’s dive in and see what trends are coming into focus:
Competitive Bidding Takes a Breather
Jeff Baird, Esq., chairman of the Health Care Group for industry law firm Brown & Fortunato, P.C.
For any providers that
haven’t care to look at
the headlines lately,
competitive bidding is going to go on hiatus starting Jan. 1, 2019, because CMS and
the Competitive Bidding Implementation Contractor (CBIC) did not opt to bid it out again. This means the program will be dormant for 18 to 24 months and during that time Medicare accredited DMEPOS providers can offer items for which they didn’t have a bidding contract.
“This is going to require DME suppliers to decide what relationship do they want to have with competitive bidding,” Baird says.
Baird identifies three issues in this regard:
First, there are a number of HME providers that have entered into what are called common ownership arrangements, other- wise known as 5 percent arrangements. In such an arrangement a provider without
a contract buys 5 percent of the stock of supplier with a contract in order to get added to that providers’ contract, with the permission of the CBIC.
“The question becomes ... do they want to unwind these common ownership arrange- ments effective Dec. 31?” Baird asks.
Second, there are a number of providers that have entered into subcontract arrange- ments. Baird asks whether they too are going to want to unwind these effective Dec. 31.
Third, there have been a number of providers that have simply decided for various reasons to quit playing in the Medicare market and focusing on cash, Medicare Advantage, Medicaid managed care, and other funding sources.
“They have finally gotten used to not being dependent on Medicare fee for service,” Baird says. “Now that competitive bidding is going to go away, are they going to jump back in?”
And for all those scenarios, there remain several factors to consider, if those providers do change their strategy due to this lull:
do they want to change their course when bidding will hit 18 to 24 months later? Do they want to go through establishing new referral relationships? Have they let their Medicare accreditation lapse? Do they want to ensure they have the right licensing?
Will they commit past the gap period when bidding starts again? Do they want to deal with Medicare claims audits?
18 HMEBusiness | October 2018 | hme-business.com
Management Solutions | Technology | Products
Photo © appalachianview