WASHINGTON, DC – Last week, AAHomecare submitted comments to CMS’ Interim Final Rule (IFR) titled Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC).
The IFR provided significant relief for suppliers in treating patients during this pandemic. AAHomecare took this opportunity to thank CMS for their efforts and recommended further clarification on reliefs that are already in place and additional regulatory relief to help the HME industry during and after the pandemic, such as:
- Documentation to support the “reasonable and necessary” requirement for respiratory-related products during the PHE should include a physician’s standard written order and documentation that the beneficiary has some type of respiratory-related acute or chronic condition.
- Clarify in a FAQ that if a physician orders a CPAP for a beneficiary during the PHE, and there is some evidence of the beneficiary having a respiratory condition, then an initial sleep study is not required, and the claim would be deemed to meet the “reasonable and necessary” requirement.
- Suspend the enforcement of the clinical conditions for coverage for hospital beds, as CMS has done for respiratory DME items, for the duration of the PHE.
- Instead of resuming TPEs that were in process as of the beginning of the PHE, CMS should cancel those TPEs. At the end of the PHE, CMS should instruct the MACs to begin new TPEs based on new data analysis.
- Postpone the implementation of Round 2021 of the DME competitive bidding program. AAHomecare’s April 2020 survey of more than 500 HME companiesdetails the impacts of supply chain challenges, increased costs, and drastic changes in workflow due to the pandemic on the supplier community and points to potential serious beneficiary access concerns for the next round.
You can read AAHomecare’s comments here. This is an excellent opportunity for membership to also provide feedback to CMS. Membership is welcomed to use points highlighted in AAHomecare’s comments and/or share AAHomecare’s comments. Comments can be submitted at Regulations.gov by June 1. If the link does not take you directly to the IFR comments page, copy and paste CMS-2020-0032-0013 in the search field.
CRT Manual Accessories Claims Update
Last year’s Omnibus Bill included a provision to exempt manual CRT accessories from bidding derived prices for an 18-month period starting January 1, 2020. Late last week, CMS published guidance on reprocessing the manual CRT accessories claims with dates of service between January 1-June 30, 2020.
The list of codes that can be reprocessed starts on page 9 of the Change Request 11635. In the new guidance, suppliers are directed to fill and submit the Reopening Request forms available on the DME MAC websites. Suppliers need to fax the completed forms to the appropriate DME MAC fax numbers that is listed at the bottom of the form. CMS published the following instructions on filling out the forms:
- For “Supplier Information“ – Complete all fields
- Important– list all PTANs for which you request these reopenings
- For “Beneficiary Information” – Complete only as follows:
- Reason for Adjustment: Check “Other”
- Comments: State “Please adjust my previously processed claims for the PTAN(s) listed above for the HCPCS covered in CR 11635”
Below are the links to the DME MAC Reopening Request Forms:
You can find the full announcement under, “Update regarding Implementation of Section 106 of the Further Consolidated Appropriations Act, 2020” on CMS’ website.