A feather in Medicare’s cap for rooting out more fraud. No matter how the publicity angle appears, this is good news for the HME industry.

You’re thinking, “Brian’s finally gone over the edge,” right? Maybe. (Of course, maybe you’d been thinking that for quite some time!)

For at least two reasons, I believe this is positive for legitimate HME providers.

#1 – You didn’t participate in this fraudulent activity, did you? So how can you be held responsible? Don’t fret over what you can’t control. We can’t control whether someone else decides to commit federal crimes.

#2 – Medicare did its job by uncovering these crimes using the current tools available to it. Rather than continuing to tighten the screws on law-abiding, beneficiary-serving HME providers, CMS went after the bad guys. And it worked.

If CMS continues this strategy, other bad guys may decide that bilking Medicare isn’t as profitable as they’d hoped. The result is that more of the Medicare budget will go toward the beneficiaries who deserve a certain level of care.

CMS looks good for its stewardship over our tax dollars. Real HME providers look good for continuing to lawfully provide the products, services and intangibles that you provide every day. Now, that story has potential for a mutual happy ending.

Sound familiar?

“What does this mean for Medicare beneficiaries? Limited access, no choice, substandard equipment and services. What good can come from low bid providers being awarded contracts with Medicare? Savings sure, but at what cost? Extended hospital stays, patients’ safety concerns, restricted number of providers, elimination of 90% of small business providers.

“HME is the most cost-effective and slowest-growing portion of Medicare spending according to the most recent National Health Expenditures data from CMS. HME accounts for less than 1.5% of the Medicare budget; and, CMS hopes to expand CB to physicians, hospitals and other health care providers in order to cut costs and ration health care to seniors and people with disabilities.

“CB will likely increase spending because it will shift cost from Medicare Part B (Home) to Part A (Hospital). Longer hospital stays and cost shifting from home to the institutional setting will surely follow service disruption and limited access for beneficiaries. Currently under Medicare, a day of oxygen therapy costs less than $7 per day while a day in the hospital costs more than $5500.

“Home care is the most cost effective way to treat most patients; and, home is where most people would rather be. HME is one solution to rising health care costs; but, once again the Federal government has put our Medicare beneficiaries at risk in order to eliminate providers, because they cannot control costs, fraud or abuse in the system. Once again they want to say that providers are the crooks when they [the Feds] are the ones that issued the provider a supplier number and are responsible for policing the behavior.

“There are numerous home care heroes that are out at all hours of the day and night providing in-home services so that patients can live independently in their homes where they prefer to be. These heroes appear at a moment’s notice ready to discharge you from the hospital, follow you home to install equipment, educate/instruct patients and caregivers on proper use, and then leave only to provide 24 hour, 7 day per week on-call services and follow-up to those that need it. Congress is clueless about the services component involved with HME and only reimburses for the equipment. HME is so much more than that and deserves the recognition that HME is the solution and NOT the problem.

“Crook or Caregiver? You be the judge! Call your representatives and ask them to protect HME by sponsoring HR3790 to repeal Medicare Competitive Bidding.”

Thanks to Todd for his contribution. He’s touched on several valid points. Please comment if you have anything to add.

A well-respected HME provider and ten-year CAU client, Todd Tyson, recently authored his thoughts regarding the recurring NCB nightmare and what you can do about it. Here’s Part 1:

“Atlanta will soon begin the bidding process for the second round of Competitive Bidding (CB) for Medicare Home Medical Equipment (HME) slated to begin in Atlanta in 2011. CB was part of the Medicare Modernization Act (MMA) of 2003 that most of us recognize as the prescription drug bill which mandates that Medicare bid for home medical equipment and services. CB was originally supposed to begin in 10 Metropolitan Service Area (MSAs) in 2009 and expand to 80 more in 2010 including Atlanta however the program was so fatally flawed that Congress passed the Medicare Improvement for Patients and Providers Act (MIPPA) to postpone the implementation until 2010 so that the Centers for Medicare and Medicaid Services (CMS) could fix the problems inherent in the MMA.

“Sadly CMS has decided to move forward again with CB in 9 MSAs without any real improvement to the initial plan or process. The first round of bidding awarded contracts to providers that were not appropriately qualified or licensed to satisfy the regulatory requirements established by CMS supplier standards. Many winning bidders had never provided the services that they bid for and were awarded. Most did not have the credit necessary to fund the business and the growth required to satisfy the capacity that they were legally obligated to provide. One manufacturer was even quoted as saying that of the 380 winning bidders he would not extend credit to, more than 50% and several of the other 50% were already on credit hold.

“The original bid process was to yield a 27% saving to Medicare HME only because non-qualified underfunded bidders bid way below Medicare allowed fees. Some local providers bid low for fear that they would be barred from participation and other non-local providers bid even lower in order to eliminate local providers and gain new markets. No one truly understands why providers were willing to low ball bids, but the reality of the contracts was unsustainable for most bid winners.

“What does this mean for Medicare beneficiaries?” We’ll find out next time as we continue with Todd’s guest post. Meanwhile, you’re welcome to add your opinion to the conversation.

How long does it take you to get the eligibility/deductible information you need? With Web Edition HME Software, you’ll get every detail on your screen within a few seconds!

Maybe you can already do that using another online method. Well, here are three areas where Web Edition’s built-in eligibility software leaves the others in the dust:

+ No telephone, no modem, no time lost in a maze of phone or online menus. You never need to leave your Web Edition HME software.

+ When you’re regularly checking deductible amounts, you don’t want to waste time re-keying all of the same required patient information into other software. We allow you to select a patient from your existing Web Edition customer file, click the Check Eligibility button, and the results display as an easy-to-read PDF in a new browser tab. You can save the PDF locally, print it locally, or …

+ Team your Web Edition HME software with our built-in Document Imaging and the eligibility/deductible results will automatically drop into the patient’s electronic file!

Online instant Medicare eligibility and deductible results are included with your Web Edition HME software at no additional charge. Contact me if you’d like to see how easy it is.

The interesting blog post explains the details, including quotes from a provider and a beneficiary. Maybe, just maybe, this independent analysis will catch the attention of more of our representatives in Congress.

The flawed NCB plan really has no redeeming value. It hurts beneficiaries; will only (potentially) save from DMEPOS to exponentially increase hospital stays (and costs); loses jobs; and, basically tells small business owners to go away. All of this flies in the face of our current domestic economic challenges and will create undue harm to our aging population.

Having CRE on the same sideline isn’t the knockout blow, but it could help for Congress to hear these same messages from another independent source.

We’re already weary with the culprits: national competitive bidding, additional paperwork, PECOS, surety bonds, mandatory accreditation. Then there’s another little disincentive called reimbursement cuts.

Where’s the HME provider’s line in the sand? How much more can we take before we shout, “Enough?”

Sadly, many providers have declared, “Enough.” They’ve either left the Medicare program or dropped out of the business altogether.

Either way, too many beneficiaries will be left without providers. Senior citizens must scramble to find a new source for luxury items such as oxygen.

Where will it all end? At this point, there’s no news in sight that will reverse the trend toward less service and fewer providers.

Will voting seniors need to join HME providers with a consistent message? If so, what will that message need to convey?

Chris has taken the initiative once again to help his fellow HME suppliers. Here’s how to find Chris’ new Get PECOS site:

http://getpecos.com.

You’ll find everything you need related to PECOS, plus updates from CMS at the top of this page.

This week represents our industry’s big push in Washington, DC. AA Homecare offers details on its’ home page.

Hopefully, we’ll all see some positive news by the time you read this post. Truly, I expected daily updates from our media friends. Of course, in their defense, I always set a goal to communicate daily while traveling, but realistically, it just doesn’t happen.

I look forward to reading about the impact this week’s efforts will have on our lawmakers. In concert with your grassroots efforts and the raw savings that home care provides, our brand of health care should once again become a large percentage of the solution in the eyes of our government.

In light of current budgetary challenges, the fiscal state of Medicare, and the pressure from all taxpayers, I don’t believe Congress can continue to take the most expensive route. Do you?