AMARILLO, TX – The DME industry is on the front line of battling COVID-19. The industry provides respiratory equipment for use in the home. The industry maintains and repairs respiratory equipment. In short, the DME industry plays an important role in keeping patients out of the hospital. In order for the DME industry to effectively do its job, it needs a relaxation of the regulations that restrict the industry. In this vein, on March 18, 2020, AAHomecare sent a letter to Seema Verma, CMS Administrator. In its letter, AAHomecare requests the following:
- Competitive Bidding – AAHomecare points out that DME suppliers need to immediately invest substantial money to purchase respiratory equipment in order to take care of patients afflicted with COVID-19. However, suppliers may be hesitant to do so because they face the prospect, beginning January 1, 2021, of not being able to serve Medicare beneficiaries in half the country. Accordingly, AAHomecare requests a delay of competitive bidding of at least one year. The letter discusses one area of particular concern: NIVs. AAHomecare points out that NIVs are expensive…and were included in Round 2021. NIVs are critical to keeping COVID-19 patients in the home. DME suppliers should feel comfortable in investing large sums of money to purchase NIVs. This comfort can only be achieved by a delay in competitive bidding.
- Coverage for Short Term Oxygen – AAHomecare requests that CMS allow coverage for short term oxygen for acute conditions to allow patients to be released from the ER and discharged from hospitals. These patients are high risk for COVID-19. Allowing coverage for short term oxygen will help alleviate hospital overflow issues. AAHomecare asks CMS to allow coverage for all respiratory equipment, medications and supplies when a patient is diagnosed with COVID-19. AAHomecare requests that CMS allow beneficiaries’ oxygen saturation levels to be tested in the ER and other emergency triage facilities and if they qualify, to be discharged and treated at home with home oxygen therapy provided by a DME supplier.
- Standard Written Order (“SWO”) – AAHomecare requests that during the COVID-19 crisis, CMS only require the SWO, oxygen saturation test results, and the positive COVID-19 test result to meet the Medicare documentation requirements. AAHomecare suggests that these streamlined documentation requirements also apply to beneficiaries who present with non-COVID-19 acute respiratory conditions (e.g., pneumonia), to enable these patients to be cared for at home and reduce the potential for hospital overflow.
- Face-to-Face Encounter – On March 17, 2020, CMS announced that physicians can use telehealth to meet the face-to-face encounter requirement for DME. AAHomecare points out that there are instances in which telehealth is not available or feasible. In those instances, AAHomecare suggests that CMS waive the face-to-face requirement.
- Alternatives for Proof of Delivery Requirements – AAHomecare requests that CMS allow flexibility to what constitutes valid proof of delivery documentation. Physicians request drop-off of nebulizers and other supplies to patients awaiting test results. However, because of the COVID-19 risk, patients do not want to allow delivery drivers access to their homes. AAHomecare suggests that proof of delivery can be a technician acknowledging delivery to a home with a photograph of the item on the porch or some other method to validate receipt.
- Extension of Expiration Date of Written Orders – As a result of the COVID-19 pandemic, physicians are reducing their patient visits. As such, it is becoming difficult for DME suppliers to obtain written authorizations to extend physician orders. AAHomecare recommends that Medicare allow an extension of the validity of a current order for an additional nine months. Doing so will allow beneficiaries to continue to receive needed medical supplies and ongoing rentals of current equipment. AAHomecare further recommends that suppliers be allowed to perform repairs on wheelchairs for beneficiaries, with a documented permanent mobility-related disability, without the physician’s confirmation of continued medical need.
- ATP Specialty Evaluations Conducted Via Video – Medicare requires an ATP to evaluate beneficiaries who are prescribed complex wheelchairs. In order to protect the health of ATPs and beneficiaries, AAHomecare recommends that Medicare allow the evaluations to be performed by video wherever possible.
- Suspension of Certain Supplier Standards – AAHomecare requests that CMS suspend the Medicare supplier standard related to minimum hours of operation and physical access to facilities during the COVID-19 pandemic as staffing levels are strained and there is a need for social distancing. AAHomecare also requests that CMS allow DME suppliers to utilize one or more cell phone numbers in lieu of a primary business telephone. And AAHomecare requests that CMS temporarily suspend site inspections to allow employees of DME suppliers to focus on increased patient care needs.
- Prioritization of Personal Protective Equipment (“PPE”) for DME Suppliers – AAHomecare requests that CMS prioritize the provision of PPE for DME suppliers that are providing products to COVID-19 patients in their homes.
- Essential Services – Due to the importance of keeping patients healthy in their homes, AAHomecare requests that DME suppliers be categorized as “essential services.”
- In-Home Assessment – Medicare requires DME suppliers furnishing mobility devices to conduct an in-home assessment to ensure that the devices can be used in the beneficiaries’ homes. Consistent with the direction to “social distance,” and in line with CMS’s March 17, 2020 telehealth announcement, AAHomecare recommends that CMS allow home assessments to be conducted via video or phone.
- Suspension of Audits – As the pandemic continues to unfold, it is important that DME suppliers stay focused on emergency operating procedures and taking care of the increasing number of beneficiaries in their homes. Setting aside those activities that are not focused on patient care will allow suppliers to focus on activities that are focused on patient care…and that are focused on the safety of the employees of suppliers. For this reason, during the course of the pandemic, AAHomecare recommends that audits be suspended.
- Patients Admitted to Hospital – As the strain on hospitals continues to increase, it is important that patients be able to utilize the equipment and supplies they have in their homes…rather than rely on the hospitals to provide them. Therefore, AAHomecare recommends that CMS allow for payment of DME claims when (i) the “place of service” indicated on the claim is not listed as the beneficiary’s home or (ii) the supplier was not aware that the patient entered a hospital (taking the supplier’s equipment/supplies)…and a future hospital claim crosses the date of service during the COVID-19 crisis.
- Extension of the Current 50/50 Blended Payment Methodology – There are unique challenges and costs for caring for beneficiaries who are spread out over a wide geographical area. These beneficiaries often have less access to hospitals and clinicians. AAHomecare recommends a continuation of the current 50/50 payment rates in rural areas until at least December 31, 2021.
In its letter, AAHomecare points out that many DME suppliers are already implementing these types of measures to ensure that beneficiaries have access to care in their homes. One of the final statements made by AAHomecare in its letter, and a statement that sums up the letter, is: “DME suppliers are in a unique position to provide home ventilation and oxygen therapy that can make a significant difference in alleviating hospital overloads, and facilitate the ability of beneficiaries to recover in their homes….”
AAHOMECARE’S EDUCATIONAL WEBINAR
Billing on a Non-Assigned Basis
Presented by: Jeffrey S. Baird, Esq., Brown & Fortunato, P.C. & Lisa K. Smith, Esq., Brown & Fortunato, P.C.
Wednesday, March 24, 2020
2:30-3:30 p.m. EASTERN TIME
It is obvious that Medicare intends to pay as little as possible for DME. As a result, many DME suppliers are electing to become “non-participating” suppliers and are selling/renting Medicare-covered items on a non-assigned basis. This means that the Medicare beneficiaries pay cash up front to the suppliers. This interactive program will discuss the multiple issues arising out of billing non-assigned, including the following: (i) What does it mean to bill non-assigned? (ii) If the supplier bills an item non-assigned, then can the supplier set the price without limitation? (iii) Must the supplier submit a claim to Medicare so that the beneficiary can be reimbursed? (iv) Can the supplier sell a capped rental item for cash? (v) Does the supplier need to obtain documentation supporting medical necessity? (vi) Is the supplier at risk of having to repay Medicare and/or the beneficiary in the event of a subsequent audit?
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato, PC, a law firm based in Amarillo, Texas. He represents pharmacies, infusion companies, HME companies and other health care providers throughout the United States. Baird is Board Certified in Health Law by the Texas Board of Legal Specialization, and can be reached at (806) 345-6320 or firstname.lastname@example.org.