NAIMES Key Legislative Priorities For 2010

Register

Login

NAIMES Key Legislative Priorities For 2010

#1 - Repeal Competitive Bidding

NAIMES continues to work with key legislators and industry supporters to permanently repeal the ill-conceived bidding program that guarantees decreased patient access to medical equipment at home, competition and eliminates choice. NAIMES continues to aggressively support H.R. 3790, to repeal competitive bidding. Bidding will eliminate 90% of small suppliers from the market, which will result in the loss of over one million jobs. The 2008 delay in implementation of Competitive Bidding was paid for with 9.5% cut to all DME . That cut alone has resulted in reducing Medicare’s DME expenditures nearly twice 2003's projected savings of the administrative costs. Given the growing demographic of aging Americans, further cuts under the guise of “Medicare spending reductions” are penny wise and pound foolish.

#2 - Seek Repeal of the Oxygen Cap.

NAIMES fully supports HR 2373, a bill to repeal the 36-month cap on oxygen payments. To achieve this repeal in a “budget neutral” manner, NAIMES will propose that Congress revise the payment policy for home oxygen therapy. A reduction in payments for Nocturnal Oxygen Therapy and the "redeployment" of those dollars for Portable Oxygen Therapy will better align supplier costs with reimbursements and neutralize Congressional and CMS perceptions of concentrator overpayments. Cessation of the cap will also allow patients more freedom and mobility, while stabilizing the small home health business community, maintaining jobs, and building a cost effective alternative to expensive hospital stays.

#3 – Mitigate Effects of PECOS Edits

Medicare has delayed PECOS edits CR6417 and CR6421, the implementation of DME claims edits that deny claims for patients whose physician has failed to register on the PECOS system as required by CMS, to Jan. 3, 2011. CMS intends to expand the editing process for DME claims. Its contractors will compare the NPIs of a claim’s ordering physician against a national list of Medicare-approved physician NPIs in a “PECOS” database. As a result, many providers have been receiving warning messages on GenResponse reports. Until the delay was announced, these warnings would have turned to rejections beginning April 5, 2010. Presumably, CMS has announced this further delay of the physician registration requirement to allow physicians and non-physician practitioners who order services or items for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers enough time to enroll in Medicare or to take the necessary actions to establish a current enrollment record in Medicare.
Under current regulation, physicians are at no risk for their failure to complete this administrative requirement. While serving patients and families, DME suppliers will be financially penalized for the noncompliance of another licensed healthcare professional, over which they have no enforcement authority. NAIMES will be working with key leaders of Congress to issue a letter to HHS Secretary Sebelius requesting relief from this unorthodox approach to compliance and insist that the appropriate penalties and ultimate responsibility be placed on the physicians and practitioners themselves.

#4 - Require CMS Audit Contractors to Follow Current Medical Policy

Every DME supplier is now facing an unprecedented number of administrative and regulatory audits. The Recovery Audit Contractors (RAC) audits, Comprehensive Error Rate Testing (CERT) audits, and Zone Program Integrity Contractors (ZPIC) audits are all looking at various aspects of DME claims with the reasonable and appropriate aim of reducing improper payments and fraud. Suppliers are being overwhelmed with requests for medical documentation that is not required by current Medicare medical policy. Many auditors are requiring documentation from DME supplier records that is not required by statue or regulation and for which suppliers have no authority to obtain. NAIMES will provide Congress with detailed information showing that many of these audit contractors are overstepping regulatory authority. NAIMES will ask Congress to require that CMS demand that its audit contractors limit their demands to regulatory guidelines and obtain the additional documentation from the appropriate medical sources. It is these ordering physicians and medical entities who should be held accountable for documentation errors and omissions. Recouping legitimate payments from DME suppliers based on those orders is a misuse of the auditor’s authority and irrationally penalizes DME suppliers who have no control over or access to the ordering entity’s medical records.