Issue link: https://read.dmtmag.com/i/56191
News 4 HME NEWS / MARCH 2012 / WWW.HMENEWS.COM Q&A: Cramton goes behind the numbers BY THERESA FLAHERTY, Managing Editor P ROF. PETER Cramton set the competi- tive bidding debate on fire in January when he reported that the number of claims submitted for home medical equip- ment in Round 1 areas plunged in 2011. Cramton, an economist with the Univer- sity of Maryland and an outspoken critic of the program, obtained the data through the Freedom of Information Act (FOIA). He spoke with HME News about some of his preliminary conclusions. HME NEWS: Did you expect to see such a steep decline in claims in Round 1 bid areas? Peter Cramton: I would have expected some drop, but I am surprised it's as large as it seems to be. The biggest explanation, as we learned from the auction outcome, is that Peter Cramton the whole market was radically transformed, with the vast majori- ty of providers being removed from the supplier list. HME: The data shows that there are claims being made by non- contract suppliers. Cramton: I suspect that is the grandfather- ing aspect. For most of the products, there was a period where (the beneficiaries) could continue with their existing supplier. That, to me, is cause for concern because grandfathering will end, and when it does end, if they haven't found a new supplier, that's going to be a serious issue. CRAMTON SEE PAGE 6 CMS weighs in on data BY THERESA FLAHERTY, Managing Editor BALTIMORE – No sooner had Prof. Peter Cram- ton released a report that showed 60% to 80% declines in Medicare claims for home medical equipment in Round 1 competi- tive bidding areas (CBAs), than CMS was dismissing the data. At a Jan. 25 Jurisdiction C council meet- ing, Medical Director Dr. Paul Hoover said he hasn't seen any such decline in claims, according to Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association, who attended the meeting. Hoover suggested that perhaps Cramton didn't ask "the right questions" in his Freedom of Information Act (FOIA) request for the data, said Hamilton. "He said if you don't ask the right ques- tions you get misleading data," Hamilton said. "It seems to me it would be a pretty simple process for somebody as experi- enced at statistics as Cramton must be." CMS SEE PAGE 10 5010 TRANSITION Light at end of the tunnel, sources say BY LIZ BEAULIEU, Editor YARMOUTH, Maine – The transition to HIPAA version 5010 on Jan. 1 has been fairly smooth for Medicare, but there have been bumps in the road for commercial payers, resulting in delayed payments to home medical equipment providers, industry sources say. Even if HME providers and their software vendors are up to speed with 5010, when they send their claims to commercial payers that haven't made the transition yet, those claims are getting rejected by clearinghouses, sources say. "This has been my biggest priority since Jan. 1," said Sylvia Tosca- no, owner of Professional Medical Administrators, a billing and con- sulting firm in Boca Raton, Fla. "In general, I don't think anyone has been fully prepared for this, and the call volumes at the clearinghouses have been three times higher than they usually are, but everyone is working together." Although Jan. 1 was the implementation date for 5010, a new stan- dard for electronic claims submission, for Medicare, at least, there's a grace period until March 1. 5010 SEE PAGE 11 Honk for home care Montana may not be included in the first two rounds of competitive bidding, but providers there aren't content to sit back and do nothing. On Feb. 2, members of Big Sky AMES joined forces with The VGM Group for a "push-back" demonstration outside the offices of Sens. Max Baucus and John Tester, both Democrats. Back in 2009 Baucus, you may recall, proposed expand- ing the number of Round 2 bid areas from 79 to 100. Industry ready for audit relief 'We'll take anything we can get' BY THERESA FLAHERTY, Managing Editor ALEXANDRIA, Va. – For providers struggling with oxygen audits, CMS's promise to mod- ify certain aspects of the process has been welcome news. "We'll take anything we can get," said Robin Pow- ers, billing supervisor for Friendship Home Medical Equipment in Wise, Va. In January, AAHomecare announced CMS plans to focus on auditing oxygen claims with initial dates of service within the last few Walt Gorski months, rather than the last few years. It also plans to give providers 45 days instead of 30 days to respond. Provider John Kaiser says that extra time will help. He received letters on Jan. 31 requesting documentation on claims from 2008-2009. CMS sent the letters Dec. 31. "That gives us only two weeks to respond," said Kaiser, president of Walnut Medical in Johnston, Pa. "Forty-five days would be helpful when it takes them two weeks to get their stuff out." Despite these modifications, some prob- lems will persist, stakeholders predict. For example: Auditors may look at more cur- rent claims, but what if those claims are for continued use of oxygen, meaning the AUDITS SEE PAGE 11 BRIEFS Provider gets to have his day in court: April 20 PHILADELPHIA – A court date has been set in the case of Nichole Medical Equipment & Supply vs. TriCenturion: April 20. Nichole Medical, which fought an audit and won, is now suing the CMS contractor that con- ducted the audit for $10 million in dam- ages. The U.S. Court of Appeals in Phila- delphia will hear oral arguments from the two parties on that date. Previously, the U.S. District Court for the Eastern District of Pennsylvania ruled that TriCenturion, as a government agency, has "official immu- nity," from Nichole Medical's claims, even though the administrative law judge, and then the Medicare Appeals Council, ruled in the provider's favor. CMS extends licensure deadline... BALTIMORE – CMS will push the licensure deadline for Round 2 of competitive bid- ding to May 1, it announced in February. Providers are required to meet all applica- ble licensure requirements for all product categories and in all states in a competitive bidding area in which they plan to bid. Bids still must be submitted in DBidS by 8:59:59 p.m., EST, on March 30; all required hard- copy documents must be received by the Competitive Bidding Implementation Con- tractor (CBIC) on or before March 30. ...and asks providers to report licensure issues... BALTIMORE – CMS is asking providers who have problems related to out-of- state licensure requirements in Round 2 competitive bidding areas to contact the Competitive Bidding Implementation Contractor. Providers in the Philadelphia CBA, which includes Pennsylvania, Del- aware, Maryland and New Jersey, have had a difficult time obtaining the required Residential Service Agency license for Maryland. Report concerns by calling 877-577-5331. ...and clarifies credit report requirement BALTIMORE – After several days of confu- sion, CMS in January clarified the credit report requirement for Round 2 of com- petitive bidding. A bulletin from the agen- cy stated: "Credit reports and scores must not be prepared earlier than 90 days prior to the opening of the bid window, but they can be prepared after bidding opens as long as they are received by the competi- tive bidding implementation contractor (CBIC) by the close of the bid window." Mixon, Brant honored ALEXANDRIA, Va. – AAHomecare in February named Mal Mixon, chairman of the board at Invacare, and Rob Brant, founder of AMEPA, as the recipients of its new Leg- islative Advocate Award. The award rec- ognizes association members who have worked to advance the industry's legisla- tive goals and motivated others. Round 2 bid window opens ......................... 1 NewsPoll: Fight audits to prevent them ............... 6 HME News TV: Patients as couriers .................. 8 State news: Fla., Iowa. . . . . . . . . . . . . . . . . . . . . . . . . . .10-11 ■ Wayne Stanfield and other industry stakeholders say they have complete confidence in Round 1 data. See story this page.