Hope Springs Eternal

In a series of recent delays and rule changes, this industry has won a few lately in the ongoing battle over regulatory issues.

HME providers working frantically to get physicians enrolled in the Provider Enrollment, Chain and Ownership System (PECOS) got some relief when CMS announced it would delay implementation of the requirement. Claims were originally scheduled to reject beginning Jan. 4, 2010, if the prescribing physicians or non-physician practitioners listed were not registered in the nationwide enrollment system.

CMS first pushed that date out to April 5 but, facing overwhelming enrollment problems (the AMA estimated 30 percent of all Medicare physicians and other health care practitioners were not in PECOS), announced last month it would delay again until Jan. 3, 2011.

In August, CMS unexpectedly added a section to its Program Integrity Manual revising the rules governing loan closets, or “stock-and-bill” arrangements, as the agency called them. The new provisions essentially would have prohibited providers' participation in closet arrangements by limiting billing for items only to the physician or non-physician practitioner. The new rules were to take effect in September of 2009 but were subsequently delayed until March of this year. Then, in an instruction to its contractors last month, CMS rescinded the new closet rules for further review.

After the Office of Inspector General issued a special fraud alert on telemarketing in January, AAHomecare pointed out the OIG's interpretation would have prohibited an HME provider from contacting a Medicare beneficiary unless the beneficiary had given consent to do so. That meant even after a doctor prescribed an item of medical equipment, an HME provider couldn't call the beneficiary to arrange for its delivery without violating the telemarketing prohibitions.

But in an FAQ published in February, CMS clarified that HME providers actually don't engage in unsolicited telephone communication when they call beneficiaries to fill orders for DME (as long, of course, as certain stipulations are met).

In each case, the industry's providers ultimately got a reprieve. But these examples also point up how little regulators seem to understand about the home medical equipment business and the way it really works.