More from PPACA

This is the third of a 4-part series on the provisions of the Patient Protection and Affordable Care Act (PPACA) and how the health reform law affects DME providers. Series: Part 1 | Part 2 | Part 3

There are a number of provisions that directly affect DME suppliers in the Patient Protection and Affordable Care Act, including offsetting payments to suppliers with the same tax ID numbers and the requirement that a supplier implement a compliance program.

Under the health reform law, the Department of Health and Human Services can adjust payments to a provider or supplier that has the same tax ID number as one that owes past-due obligations under Medicare, Medicaid or CHIP, regardless of such providers' or suppliers' Medicare billing number or NPI.

For example, assume that an HME company has three HME locations (each with a Part B supplier number), a sleep lab and a home health agency. Assume these are divisions of the HME company (they are not separate subsidiary corporations). Assume that one of the HME locations ends up owing a substantial recoupment to CMS.

In order to recover the recoupment, CMS may now offset not only against the supplier number for the one HME location but also against payments to be made under the other two HME supplier numbers, the sleep lab local carrier Part B number and the home health agency provider number.

The right given to HHS to look at multiple supplier and provider numbers under the same corporate entity for offset is consistent with CMS' goal of not allowing a company or individual to escape its/his obligations by “hiding” behind a separate supplier number or corporate entity.

PPACA states, for example, that providers or suppliers enrolling or re-enrolling in Medicare, Medicaid or CHIP will be subject to new disclosure requirements. Applicants will be required to disclose current or previous affiliations, directly or indirectly, with any provider or supplier that owes money to a government program, has been excluded from participating in federal health care programs or has had billing privileges denied or revoked.

In another of the law's directives, by a date to be determined by HHS, certain providers and suppliers will be required to establish a compliance program. The compliance program must contain core elements that will be established by HHS in consultation with the Office of Inspector General.