Page 24 - HME Business, January/February 2022

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lost 11.3 million units of production in 2021 and will likely lose 7 million more units in 2022.
What’s causing the shortage? The two central factors are that the United States doesn’t make many chips these days, and the pandemic’s impact on the supply chain. But there are other factors, such as the recent U.S.-China trade war, fires at some key production facilities, and weather- related manufacturing problems.
So what are the fixes? There are a couple approaches: First, the United States needs to implement legislation that will foster the domestic manufacturing of semiconductors and microchips. To that end, key pieces of legislation such as the America COMPETES Act and the U.S. Innovation and Competition Act to create and fund grand programs to help manufacturers restart U.S. production.
However, that production won’t reverse the current supply problem overnight. So, the second fix must be for the federal government to implement some kind of triage for determining which manufacturers getfirstdibsonmicrochips.Wecanexpect to see various segments of U.S. health- care, including HME, push for legislation or regulation that would implement that during 2022.
5. CMS’S CPI-U ADJUSTMENT
In December 2021, CMS published its DMEPOS fee schedule adjustments for the calendar year 2022, and while the adjust- ments differed depending on whether the items serviced were competitive bidding program items or in former competitive bidding areas (CBAs), they were generally higher than in the past.
Based on the Bureau of Labor Statistics’ Consumer Price Index for Urban Consumers (CPI-U), CMS’s rate increases were:
• Competitive bidding program items in
former CBAs increased 5 percent.
• Competitive bidding program items in
non-CBAs increased 5.4 percent.
• Non-competitive bidding program items
were up 5.1 percent.
The adjustments are made to ensure
DMEPOS reimbursement adjusts for infla- tion. Typically, CMS’s CPI-Y increases for DME come in between 1 percent and 3 percent. Last year, for example, the inflation adjustment was less than 1 percent.
Those increases might at first seem like
good news for 2022, but when factoring in the aforementioned cost increases ushered in by Covid-19 and the supply chain prob- lems, HME providers are working under much stiffer cost structures this year.
6. THE DME PAYMENT RULE
items in the 13 product categories whose bid results were not implemented in Round 2021. These increased rates would apply from Jan. 1, 2022 to Dec. 31, 2023.
AAHomecare has started a campaign calling on providers to help support draft legislation by urging their Representatives to become original co-sponsor of the nascent legislation. Providers can help by visiting action.aahomecare.org.
The HME industry might consider offering
orthodontia services, because getting CMS
to release its final DME payment rule was
like pulling teeth. As the story starting on Concurrently, AAHomecare has
page 18 shows, the industry had to wait a very long time — from October 2020 to December 2021 — to get CMS to release its final payment rule.
Finally unveiled at the tail end of 2021, the final rule offered the following:
• 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 did not finalize CMS’s earlier HCPCS coding recommendation limiting manu- facturers to only two submissions; a win for DME makers.
•It did not finalize CMS’s earlier Continuous Glucose Monitors coding and payment recommendations that would have changed the classification and payment for CGMs under Part B
• It expanded the classification of external infusion pumps as DME. However, the final rule didn’t include two key provi- sions the industry had asked for during the public comment period when the rule was first proposed:
• Extend the 75/25 blended rate for non- rural areas beyond the end of the PHE.
• It did not base rates in former CBAs on a
90/10 blended payment formula.
Given the aforementioned cost structures and reimbursement rates the industry must currently contend with, the industry must now move to secure those two objectives by
other means.
7. REIMBURSEMENT LEGISLATION
So, industry advocates including the Ameri- can Association for Homecare (aahomecare. org) have worked with lawmakers to start moving legislation down the road that would secure those two reimbursement goals.
Firstly, Reps. Markwayne Mullin (R-Okla.) and Paul Tonko (D-N.Y.) have drafted legis- lative language that would apply the 90/10 blended Medicare reimbursement rate for
launched discussions with its Senate champions to develop legislative language that would keep some of the 75/25 relief rates for non-rural areas from the CARES Act in place beyond the end of the public health emergency, since the challenges impacting providers are not going to go away. The 75/25 reimbursement would represent a significant reimbursement gain for non-rural providers. CMS did an esti- mate that was published by non-partisan analysis group Medicare Payment Advisory Commission (MedPAC), and the analysis showed that the 75/25 blend represented a 33percentreimbursementincrease.
Supporting those legislative efforts will be a key feature of 2022 for advocacy- minded HME providers.
8. INCREASED AUDITS
While CMS only offered a brief pause on audits during the public health emergency, it has quickly resumed and, in some cases, expanded its program integrity efforts.
CMS indicated that it intends to audit claims filed during the COVID-19 pandemic. That said, it has instead been auditing mostly non-pandemic related claims such as wheelchairs, hospital beds and urological supplies. Audit expert Wayne van Halem, president and founder of the audit consulting firm The van Halem Group, believes that is changing this year, and understanding what could happen will be important for suppliers who have filed claims with CR modifiers during the PHE.
There are other audit factors that will impact HME providers in 2022, as well. First, the ALJ backlog is nearly caught up, and the chances are high that once it is, CMS might loosen some of the restric- tions it has had in place with the Recovery Audit Contractors causing an increase in audit activity. Also, a new SMRC contract with CMS’s Program Integrity Group hit
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