WASHINGTON – Last month, CMS implemented a fix that impacts suppliers who provide disposable medical supplies to Medicare beneficiaries, laying the groundwork for ongoing engagement with the Agency to address denials triggered by unknown Part A episodes.
For years, suppliers who provide medical supplies often received denials on their claims due to unreported open Part A home health episodes that were not visible when the supplier checked eligibility to provide supplies to the beneficiary. Often the products had already been provided, so there was little recourse. AAHomecare estimates the supplier community loses approximately $11.5 million/year according to the 2022 Medicare FOIA data.
This issue was raised by a member in AAHomecare’s Woundcare Work Group meeting and prompted a hybrid initiative of the Regulatory Council and Medical Supplies Council to engage The Alliance and ultimately CMS.
CMS determined there was an incorrect claims edit that denies the DMEPOS claims if the date of service was the same as the discharge date from the home health agency claim. CMS has told us the fix went into effect in October.
Senior Vice President of Regulatory Affairs Kim Brummett (pictured) explains: “This is an important first step in our engagement with CMS about suppliers’ challenges. While it addresses the issue of those who have the date of service as the same date of discharge from a home health agency, conversations continue with CMS to explore potential alternatives for suppliers to mitigate the losses and to know there is a potential home health episode open.”
Power of Collective Efforts
Frustrated by this recurring issue and unable to work with her local home health agencies to resolve it, Medical Supplies Council Vice Chair Pam Jones of Home Medical Supplies Inc. played a leading role in elevating the issue and working with the AAHomecare stakeholder group on resolution.
“AAHomecare was able to get a team of people together to work on this to find out how and why this was happening,” she reflects. “It has been such a privilege for me because they were able to get answers I could not have gotten myself.”
Watch Pam’s story about the importance of community and how her company has benefitted from AAHomecare’s collaborative advocacy efforts to address the denials issue here. AAHomecare continues to engage CMS on options to assist DME suppliers facing denials for home health episodes and SNF stays and will keep members abreast of developments.
For more information on AAHomecare’s Medical Supplies Council and opportunities to get engaged, contact the Council staff liaison, Stephanie Legree – AAHomecare’s Project Manager, at [email protected].
AAHomecare Editorial – 118th Congress Returns: 75-25 Remains in the Balance
WASHINGTON – The House and Senate returned from their election-season recess yesterday to wrap up work for the 118th Congress, which will include passing legislation to continue government funding beyond December 20. The duration of the funding package and room for inclusion of additional provisions, such as 75-25 rate measures H.R. 5555 and S. 1294, remains an open question.
The duration and scope of the funding legislation is currently being negotiated by Congressional leadership and predictions for “skinny” or more substantial bills are being made in political media. Prospects for seeing our measures enacted increase if leadership allows a larger bill.
Our lobbying team and other HME advocacy leaders continue to work with our champions and meet with Hill staff to make the case for including H.R. 5555 and S. 1294 in the funding legislation or as a stand-alone bill.
When it goes, it’s going to go fast. Whatever the direction Congressional leaders take, our chances to see 75-25 rates restored are bolstered by your grassroots advocacy.
Please take the opportunity to reach out to House and Senate healthcare staffers to make a post-election connection, congratulating those who are returning or making one more connection with offices who are not returning, to ask for support in including our relief in the funding package or any other vehicles.
AAHomecare Senior Vice President for Public Policy Jay Witter asked for strong grassroots engagement now from the HME community in a recent call with our State Leaders Council when he remarked “When it goes, it’s going to go fast – there’s not going to be a lot of time to make our case once the basic structure of the bill takes shape.”
See our messaging guidance to help you make one more connection on Capitol Hill. Contact Gordon Barnes at [email protected] for contact info for your legislators’ healthcare staffers. A pre-drafted Voter Voice message is also available; please share that link with your colleagues.
