Issue link: https://read.dmtmag.com/i/50323
News 4 HME NEWS / JANUARY 2012 / WWW.HMENEWS.COM Committee's failure puts Medicare at risk BY LIZ BEAULIEU, Editor WASHINGTON – Expect a bumpy 2012 now that the super com- mittee has failed to come up with a deficit reduction plan, industry stakeholders say. The super committee announced in November that it couldn't agree on a way to reduce the deficit by at least $1.2 trillion over 10 years, triggering auto- matic cuts slated to go into effect Jan. 1, 2013. Among them: a 2% across-the-board cut to Medi- care, which represents, accord- ing to reports, a $13 billion blow to HME over 10 years. But industry stakeholders expect members of Congress to try to replace or minimize these cuts with other cuts, even if that may seem like an unpopular CMS High error rate points to 'systemic' problem BY T. FLAHERTY, Managing Editor BALTIMORE – CMS's announce- ment in November of a 61% improper pay- ment rate for home medical equipment points to the need for the agency to take a closer look at its own policies and proce- dures, say industry stakeholders. "It points to a sys- temic problem," said Walt Gorski, vice president of gov- Wayne Stanfield ernment affairs for AAHome- care. "If 61% of the class is failing, you need to look at the teacher." Other claims types, like inpatient hospi- tal and physician/lab/ ambulance, have error rates in the single dig- its. The overall error rate for Medicare fee- for-service is 8.6%. There are several key factors pushing the error rate for HME so high, ERRORS SEE PAGE 8 New chief, same story? BY THERESA FLAHERTY, Managing Editor BALTIMORE – Marilyn Tavenner took the reins at CMS in December, but expect things to be business as usual, say industry stake- holders. "I wouldn't expect any meaningful change because the policies that are in place will continue to be driven by the Obama White House," said Cara Bachenheimer, senior vice president of govern- ment relations for Invacare. "We expect her to be a fair player to deal with, but I wouldn't put hopes on any dramatic changes." President Obama in November nominated Marilyn Tavenner, CMS's principal deputy administrator and COO, to the top post. She replaces Donald Berwick, who stepped down Dec. 2, just weeks before his temporary appointment was set to expire. Ber- wick never received a confirmation hearing and had long been opposed by Republican lawmakers. TAVENNER SEE PAGE 6 move in an election year. "No one likes making cuts in an election year, but Republi- cans are determined not to have these cuts happen, because they include defense cuts," said Cara C. Bachenheimer Seth Johnson Bachenheimer, senior vice presi- dent of government relations for Invacare. "They're going to step in and try to change things." "Try" being the operative word, says Seth Johnson, vice president of government affairs for Pride Mobility Products. "They're going to try; we don't know if they're going to suc- ceed," he said. "Based on what we saw with the super commit- tee, we're not confident." Definitely not an option: Repealing the automatic cuts. President Obama has already stated he will veto any such plan. For the industry, this means two things. One, with lawmak- ers still looking for savings to not only reduce the deficit but also avoid a cut to physician pay- ments slated to go into effect Jan. 1, 2012, HME is still very much in danger. Two, without a deficit reduction bill, the best legislative vehicle for replacing competitive bidding with a market-pricing program is the "doc fix" bill. HME Revalidation Check the list twice BY LIZ BEAULIEU, Editor BALTIMORE – CMS has some kinks to iron out in a huge revalidation project that it kicked off in September, but that shouldn't stop providers from doing their part, indus- try stakeholders say. From Sept. 2 to Oct. 17, CMS mailed out its first batch of letters requesting that more than 100,000 Medicare pro- viders—everyone from docs to HME providers—revali- date their enrollment infor- mation. It also posted a list of those providers to its website. The problem: There have been numerous reports of REVALIDATION SEE PAGE 6 RAC audits don't work C BY THERESA FLAHERTY, Managing Editor MS'S ASSERTION that expanding prepay reviews by recovery auditor contractors (RACs) will put an end to its "pay- and-chase" model of collect- ing improper payments doesn't hold water with HME stake- holders. "You can't say with a straight face say that the RAC audits are a solution to pay and chase," said John Shirvinsky, executive direc- tor of the Pennsylvania Associa- tion of Medical Suppliers. "It still isn't nipping the problem in the bud." CMS on Jan. 1, 2012, will roll out a three-year demonstration project in 11 states to identify improper claims before they've been paid. RACs will be paid contingency fees from the money saved by denying improper claims. Financial incentives for the RACs have been a major bone of contention for stakeholders with CMS's fraud efforts all along. "The whole idea of bounty hunters—it only leads to abuse when the auditor has so much discretion," said Walt Gorski, vice president of government affairs for AAHomecare. Compounding the situation, stakeholders say: CMS's lack of oversight of the RACs. "The RACs have an incentive to maximize recovery wherever they can justify the decision," said Neil Caesar, president of the Health Law Center in Greenville, S.C. "If CMS doesn't police well, they can get away with more." In a report issued in July by CMS, the agency stated that the majority of providers who appeal RAC audits (64.4%) win. Only 12.7% appeal. HME Add HIPAA audits to list 'Initially, these audits will be more corrective in behavior than collective in reimbursement' BY LIZ BEAULIEU, Editor WASHINGTON – There's yet another type of audit that HME provid- ers need to have on their radar screens, healthcare attorneys say. In November, the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) launched a pilot program to perform up to 150 audits of covered entities to assess HIPAA compliance. "There's been a lot of talk about HIPAA, but no one's really been worried about it," said Neil Caesar, president of the Health HIPAA SEE PAGE 11 BRIEFS WellPoint backs off accreditation restriction ATLANTA – Blue Cross Blue Shield of Geor- gia stated in a Nov. 11 letter that it will not terminate contracts with currently con- tracted HME providers that have not met new standards by March 1, 2012. BCBS of Georgia, which is owned and admin- istered by WellPoint, notified providers in May that they must be accredited by one of three agencies: The Joint Commis- sion, ACHC or CHAP. "We will continue to examine our credentialing requirements, including evaluation of the numerous ac- crediting bodies," it stated in the letter. AAH: Respond to all documentation requests WASHINGTON – In the wake of CMS's No- vember announcement of a 61% error rate for HME, AAHomecare encourages all providers to respond to all additional doc- umentation requests, even if they're for products with low dollar amounts. Why? To help reduce the error rate. "One rea- son why HME error rates remain so high is providers who do not respond to an audit or submit any requested documentation," the association stated in a bulletin. "As many as 50% of denials resulted because the provider did not respond." CMS: Where are your physician orders? BALTIMORE – Missing physician orders have led to an increase in comprehensive error rate testing (CERT), CMS stated in a message in November. The physician order is required for diagnostic tests to be performed. Written orders can be hand- delivered, mailed, emailed or faxed to the testing facility or phoned in, and must be documented by both physician and test- ing facility in the patient's medical record. OIG releases semiannual report WASHINGTON – The Office of Inspector General's Fall 2011 Semiannual Report to Congress, released in November, details a 61% error rate for power wheelchair claims. The report describes reviews, in- vestigative outcomes, outreach and other activities from April 1, 2011, through Sept. 30, 2011. Other items included in the re- port: Medicare has not received any DME overpayments through surety bonds; and Medicare has made inappropriate pay- ments for lower limb prostheses, includ- ing $43 million for certain prostheses. Senior Patrol program gets grant WASHINGTON – The Department of Health and Human Services (HHS) on Nov. 22 announced a $9 million grant from CMS to Senior Medicare Patrol (SMP) pro- grams across the country. SMPs are run by the Administration on Aging in part- nership with the HHS Office of Inspector General and CMS. RAC audits just don't work, say stakeholders .......... 4 FAST Act gets companion bill ....................... 6 Providers struggle to communicate industry issues ..... 8 Are ZPIC audits working? Who knows? .............. 11 ■ Industry attorney Neil Ceasar says there's a new kind of audit on the horizon. See story this page.