HME Industry Update from AAHomecare
By: Laura Williard, Vice President, Payer Relations, American Association for Homecare
Because of strong engagement by the HME community with leaders at HHS, CMS, and on Capitol Hill, the next 12 months could see regulatory changes that are positive for HME providers. While some question marks remain, the trends indicate a promising future. Here is what I see on the horizon.
Changes in competitive bidding. Our organization plans to capitalize on the progress we have made in our outreach efforts to Federal regulators and Congressional on the negative impacts of competitive bidding-derived rate cuts on both suppliers and patients by urging politicians to provide relief to rural and noncompetitive bidding areas. Home to 42% of the nation’s Medicare beneficiaries, these rural and noncompetitive markets are served by providers who can’t possibly achieve the economies of scale to offset the drastic payment cuts sustained by the few providers large enough to be awarded contracts. AAHomecare remains confident that our efforts to build support for regulatory or legislative action to address bidding-derived rates in rural areas are gaining traction and we plan to continue solution-based discussions in the coming months.
Because these rates either directly affect or influence other payers, success in this area will have positive impacts across the entire HME sector. In addition to our efforts on rate cuts in non-bid areas, we are also continuing our work on long term-fixes to the bidding program, and we are also bringing together HME leaders to explore alternative payment models, such as value-based purchasing and pay for performance.
Medicaid MCOs. As the home care industry reacts to the rapid growth of Medicaid managed care organizations (MCO), which now make up 76% of the Medicaid marketplace, some challenges emerge. We are working with both Medicaid MCOs and state Medicaid programs to address some of the challenges and look for opportunities as well.
Audits. Although audits are good for keeping fraudulent providers out of the business, the current audit process is dysfunctional, and the appeals process is broken. We are seeking change, but we need hard data to make our case. That’s why we implemented the HME Audit Key, to help us gather the information to lobby for change. But we need more participants to ensure that our data sample is large enough to make a compelling case for change. Please consider participating, so we can work on your behalf to change the current audit and appeal process. Some findings we have learned from providers that have submitted their data through the audit key show that:
- The denial rate has increased by 9% since 2015
- 37% of all hospital beds, wheelchairs, and support services were audited in prepared audits
- 71% of the prepaid audits are paid upon review, which causes concern on why CMS is spending so much time on these audits when a large percentage of the claims get paid at the end of the day.
Regardless of the changes that HME providers could experience within the next 12 months, Mediware’s CareTend software is designed to keep providers compliant and is updated to address regulatory changes. Additionally, custom reporting tools within CareTend are designed to extract data to help HME providers respond to audits quickly, so you’re always prepared.