ATLANTA — Changing policies regarding accreditation and lawful Medicare billing are threatening the very existence of some home medical equipment companies, stakeholders said this week.
HME providers who voluntarily withdrew their Medicare numbers because they could not meet the deadlines for mandatory accreditation and/or surety bonds are discovering they cannot bill the program for services until the date their application for reinstatement has been approved. Their billing numbers are not retroactive to the date of accreditation, as providers and others had been told.
"We hear this over and over and over and people are saying the same thing: They only want to be retroactive to their accreditation date — that's when they met the standards," said Mary Nicholas, executive director of the Healthcare Quality Association on Accreditation. "The accreditation organizations turn in the reports that identify those acceditation dates, so the records show that that is the case."
The time lapse between the accreditation date and when the NSC approves the reinstatement application can be significant — a matter of months even, stakeholders said, and that is creating significant problems for the affected providers. (Despite requests from various organizations, including HomeCare, CMS has yet to release the number of those who voluntarily pulled their Medicare numbers because of accreditation and/or surety bond issues.)
"Some of the stories that I've heard have been, 'My house in is hock, my car is in hock, my relatives have loaned me money just so I can stay in business,'" Nicholas recounted. "It's bad."
John Allen, C.Ped, president and CEO of Tyler, Texas-based Allenmed Inc., a company specializing in mail-order diabetic supplies, is one of the providers caught in the squeeze. In an email to HomeCare, Allen said he had voluntarily withdrawn his supplier number because it became apparent his company would not be surveyed in time to meet the Oct. 1 accreditation deadline. The company was subsequently surveyed and approved on Nov. 24.
About Nov. 1, Allen had contacted the NSC to determine when Allenmed would be allowed to bill again after accreditation was awarded.
"I was told our number would be retroactive to the day we became compliant with supplier standards, which, in our case, was the day of accreditation," he said. "However, we would not be able to submit those claims until our application for reinstatement was approved, which would take the standard 45-60 days. This I could live with and made business decisions accordingly."
Allen called the NSC again two weeks ago to make sure the agency had received all the correct documentation for the company's application for reinstatement.
"As an afterthought, I asked for reaffirmation of our number being retroactive to the date of accreditation. I was told no, that was not the case any longer and that Medicare recently sent the NSC a policy revision that stipulated no providers applying for reactivation will be retroactive. The billable date of service is the day our application is approved," Allen said.
"I was also informed it was taking longer to complete this process! In short, I have to now figure out a way to supply our patients for an additional two months or longer with no reimbursement. Obviously, had I been made aware of this policy from the beginning it could have greatly impacted my decisions on how to proceed, including the possibility of closing the door and marketing our database."
The Midwest Association for Medical Equipment Suppliers also noted the NSC's apparent change of policy in its Monday newsletter, saying, "Per the NSC Web site and in meetings with the NSC, suppliers were told that once they became compliant with the standards, meaning they received their accreditation, the date they were compliant would be the effective date of their reactivation.
"This apparently has recently changed. Per recent CMS direction, suppliers reactivated after voluntary termination due to accreditation/surety bonds, will have the reactivation effective the day the NSC completes processing (just like a new application). Suppliers will be able to submit claims for dates of service on or after the reactivation date."
The issue has become serious enough over the past few weeks that Joan Cross, chair of the National Supplier Clearinghouse Advisory Committee, requested a clarification of the change in the effective date.
CMS responded:
"Federal regulations found at 42 CFR 424.57(b) state that a DMEPOS supplier must meet certain conditions in order to be eligible to receive payment for a Medicare-covered item, and 42 CFR 424.57(b)(2) states, 'The item was furnished on or after the date CMS issued to the supplier a DMEPOS supplier number conveying billing privileges.' As such, the NSC is not able to establish a retrospective billing date for those DMEPOS suppliers who made the business decision to voluntarily terminate their Medicare supplier billing privileges."
MAMES said since the CMS response did not explain why providers were told that the effective date would be when they became compliant with the standards, NSCAC "is exploring the options of fighting this change by going back to CMS and possibly educating members of Congress on this issue."
Allen said he has read the general rule and doesn't believe that "there is any regulation that prevents making the number retroactive to the date of compliance, including the one quoted in their response."
He said he is contacting his federal legislators to alert them to the issue, which became even more confused after he made two more calls to the NSC. The third time he called, he was told that "the determination about whether [the billing number] would be retroactive or not would be made after the application was processed."
A fourth call elicited the response from the NSC that providers could only bill on or after the reactivation date — there was no retroactivity.
"This is arbitrary," according to Cross, who said she knows of some providers who were reinstated on the date they were accredited — before CMS' policy change. "How can this be fair in any way? I lay the blame at the feet of CMS," she said. "This is just as confusing and messed up as how they have handled PECOS."
Cross said she and other volunteer members of the NSCAC have worked to open the lines of communication with the NSC "so we can get the necessary information to providers so they can do the right things — but you have to know what the right thing is before you can do it." She said she is also encouraging providers to contact their members of Congress about the situation.
"Here's my issue with the whole thing," Allen said. "I know there are a lot of people that have no knowledge of what's going on, and they are billing right now with the thought that they are going to get reimbursed. I can tell you the NSC is making no effort to tell you anything different, and those people are going to be in trouble. They were already in trouble, and now they are really in trouble. [The NSC] has no empathy for that whatsoever. The people on the phone were rude; they didn't really care one way or the other."
Allen said if he had been aware from the beginning that his billing number would not be retroactive, he would have made significantly different business decisions.
"I know few businesses that can survive four to five months without any measurable revenue," he wrote in his email. "I might have also considered focusing on developing other sources of revenue, but considering our survey was imminent, [we] decided to simply wait it out."
Was it the right decision? Allen doesn't yet know. What he does believe is that the NSC and CMS are putting providers in jeopardy.
"They put up a gauntlet for everybody, and it's tough to make it through," he said.
