Page 8 - HME Business, May/June 2020

THE HME BUSINESS PODCAST
(hme-business.com/podcast) launched its coverage of the HME industry’s response to the COVID-19 pandemic almost as quickly as the industry did, with multiple in-depth interviews to share prac- tical responses to the public health emergency, track key develop- ments, share best practices, and see the issues from the providers’ point of view. Here is a run-down of the interviews so far at press time:
Episode 032 — HME Operations: Inside the Pandemic. New York respiratory, sleep and HME provider Hampton Homecare Inc. has found itself at ground zero of the COVID-19 pandemic, and as its director of operations, Joe Candiano has overseen the compa- ny’s response to the public health emergency in terms of deliveries, equipment-handling, patient set-up, telehealth, staffing and other aspects of the business.
Episode 031 — A Deep Dive into Federal, State and Private Payer Funding Changes During COVID-19. This installment looks at the many regulatory changes at the Federal and state level — as well as with private payer insurance — to help HME providers continue serving patients during the pandemic. The American Association for Homecare’s Kim Brummett, regulatory affairs VP, and Laura Williard, payer relations VP, join the podcast to discuss the $30 billion relief fund, relaxed funding requirements, telehealth guide- lines, the pause on audits and more. Sponsored by McKesson.
Episode 030 — Assessing and Addressing Your COVID-19 Risk. Accreditation expert Sandra Canally, RN, founder and CEO of The Compliance Team, joins the podcast to provide a mountain of specific, how-to information on how HME providers can implement
processes and procedures that will help protect their patients and staff, while continuing to provide care and services. She reviews practices HME businesses should implement at the storefront, in the warehouse, and out in the field. Sponsored by The Compliance Team.
Episode 029 — HME’s Emerging COVID-19 Protocols. An in-depth effort to interview more than 20 HME providers of varying types and business models has uncovered common responses to COVID-19 being implemented across the industry. Ty Bello, president of HME sales and management consulting firm Team @Work, joins the HMEB Podcast to discuss his survey, which covered all aspects of HME: sales; engaging with patients at the business and in the home; tele- health; deliveries; working with referral providers; and operations. Sponsored by PlayMaker Health.
Episode 028 — Respiratory HME and COVID-19. Josh Parnes, president of national provider AdaptHealth, which provides a full suite of HME supplies and services, including in- home and portable Oxygen, ventila- tion and CPAP and BIPAP, outlines the various steps his business has taken to protect both patients and staff during the pandemic. He also explains why providers must convince Congress and CMS to protect patient access to oxygen equipment during COVID-19.
Episode 027 — One HME Provider’s COVID-19 Response. Gary Sheehan, MBA, president and CEO of Cape Medical Supply, explains in detail how his business prepared in terms of staff protec- tion, patient care, teleworking, and operations. Moreover, he discusses why the preparations providers are making right now aren’t just to keep their businesses running, but because they are on the front lines of a broad, national healthcare response to the disease.
The HME Business Podcast exam- ines essential industry news, trends and developments, and interviews the industry’s experts to learn how HME professionals can run efficient, profitable and growing businesses with an eye on patient care. Here are the most recent episodes:
Make sure to subscribe on iTunes, Stitcher or Google Play, or visit hme-business.com/podcast, and start listening today!
With CMS’s April IFR, one section reviewed the CARES Act’s provisions regarding reimbursement rates rural and other non-bid-area and affirmed it would extend the 50/50 blended rate for rural suppliers through Dec. 31 or the end of the COVID-19 public health emergency (PHE), if that lasts longer.
CMS also said it will use the blended rate of 75 percent current adjusted rates and 25 percent unadjusted rates for suppliers in non-rural, non-bid areas during that period, as well. Both of those rate structures are retroactive to March 6.
Additionally, CMS stated in the April IFR that it wouldn’t enforce certain clinical criteria in local coverage determinations governing therapeutic continuous glucose monitors to give diabetes patients more flexibility to monitor their glucose and adjust insulin doses at home.
Also, the duration of the COVID-19 PHE, CMS said it is waiving any limita- tions on the types of clinical practitioners that can furnish Medicare tele- health services. This means CMS has broadened its telehealth list to include both two key clinical partners/staff for HME providers: Physical Therapists (PTs) and Occupational Therapists (OTs).
But those IFRs weren’t all that CMS did. Citing the COVID-19 pandemic, CMS also decided in mid-April to remove non-invasive ventilators (NIV) from Round 2021 of competitive bidding — a policy change AAHomecare and industry advocates had been fighting for a year to stop.
In March of 2019, CMS announced that part of the changes brought with Round 2021 would be the addition of NIVs to the round, which immedi- ately drew industry concern. This was followed by Congressional sign-on letters calling on CMS to reverse the addition, but CMS essentially turned a deaf ear to those concerns. This led to the introduction of H.R. 4945, which called for the removal of NIVs from competitive bidding.
By removing NIVs from Round 2021 of competitive bidding, any Medicare- enrolled DMEPOS supplier can provide any of the types of ventilators covered under the Medicare program, including NIVs.
In addition to the COVID-19 pandemic, CMS also said its decision was due to President Trump’s exercise of the Defense Production Act; the public concern over access to ventilators; and the NIV product category being new to competitive bidding.
PRIOR AUTHORIZATION AND AUDITS
Perhaps one of the top relaxed policy guidelines is that signature require- ments have been completed suspended on any document that a supplier might need a patient to sign, according to Kim Brummett, the vice president of Regulatory Affairs for AAHomecare. Be that an ABN or a delivery tick, a signature isn’t necessarily required.
Moreover, prior authorization for HME claims is suspended as well. Right now, that procedure is entirely voluntary.
“You don’t have to do it,” Brummett says. “You can do it if you’d like to do it. We have many suppliers that really want to continue getting prior authori- zation because it keeps them from being audited in the future.
“And then the other option is the suspending all face-to-face require- ments for any of the policies, except of course for PMD, which is statutory,” she adds. “But CMS is allowing telehealth and audio-only telehealth to meet those requirements as well.”
And when it comes to audits, nearly all audits have been temporarily suspended. That includes TPE audits, RACs, CERT and SMRC audits. The bottom line is that HHS is placing a whole lot of trust in the industry.
“Really, the only contractor that is not suspected is the UPIC,” Brummett adds. “And those are trickier to really fight because the theory is that
they are fighting fraud as opposed to just randomly auditing to check on documentation.”
PROTECTING NEWFOUND CREDIBILITY
Almost as quickly as CMS began relaxing guidelines and Congress ensured the industry would be able to tap into support funds, many industry stakeholders started to realize what this meant: lawmakers, program admin- istrators and regulators were clearly seeing HME as a key component in the
8 HMEBusiness | May/June 2020 | hme-business.com
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