Page 18 - HME Business, January/February 2022

Business Solutions
PLAYING THE WAITING GAME
The HME industry waited a long time for CMS to unveil its final payment rule for DMEPOS suppliers. Now that CMS has released the rule, where does the industry stand, and how does it move forward to secure better reimbursement?
By David Kopf
CMS has a funny way of timing things. Way back in October 2020, when the nation was reeling with some of the worst of the Covid-19, the Centers for Medicare and Medicaid Services made two announcements that seemed particu- larly well-timed for their near-Halloween announcement dates: The first was the eyebrow-raising decision to forego awarding contracts for 13 categories of Round 2021 of its competitive bidding program. The second was that it released a proposed rule on DMEPOS payment policy.
While the decision to essentially punt most of Round 2021 set tongues wagging, the proposed rule was of equal import, given that it addressed reimbursement. Key provisions in the proposed rule were:
• It would continue the 50/50 blended rate for rural HME suppliers. Other non-bid area suppliers would be paid at 100 percent of the adjusted fee schedule.
•It excluded complex rehab manual
wheelchairs, some additional manual wheelchairs, and certain manual wheel- chair accessories from the bid program.
• It made changes related to the Healthcare Common Procedure Coding System (HCPCS) Level II Code Application Process.
• It included changes to the process for making Benefit Category Determinations and Payment Determinations for DME and other Items and services under Part B.
• It would change the classification and payment for Continuous Glucose Monitors under Part B.
• It expanded the classification of external infusion pumps as DME.
NOT FAR ENOUGH
Naturally, the big concern on a DME pay- ment rule is reimbursement. And while CMS’s proposed rule offered some help, it didn’t go far enough. The 50/50 rate that CMS originally proposed was a good start;
it helps a lot of providers, according to Kim Brummett, vice president of regulatory affairs
Photo © VitalikRadko/depositphotos.com
for the American Association for Homecare. “Well, it obviously helps any rural supplier, but it’s not limited to only those that exist in rural areas,” she says. “We have lots of suppliers that take care of patients in all three distinct areas. Be that the old CBAs, non-rural, or rural. So anywhere there’s a patient population, those suppliers
benefit from that 50/50 blend.”
However, the 50/50 rate didn’t go far
enough given that CMS’s single payment amount (SPA) rates are founded on old rates from 2016, according to Brummett. Furthermore, they don’t acknowledge the market realities providers face, particu- larly in the era of the Covid pandemic and supply chain problems, adds Tom Ryan, the president and CEO of AAHomecare.
So, when CMS opened the window for public comments, AAHomecare then submitted its comments for the proposed rule, which included the following recom- mendations on reimbursement:
• Rates in former CBAs should be based
on a 90/10 blended payment formula.
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