LET ME PROCEED straight to the point: I continue to be amazed at how few providers bother keeping abreast of industry regulatory and legislative changes.

It seems like a no-brainer. State and federal governments, along with regulatory agencies, are constantly shifting the playing field by introducing new rules and regulations — some of which can greatly impact a provider's business. Given that, one would believe providers would be the most plugged-in to the HME information pipeline. Then came the passage of the upgrade provision.

Not wanting to beat the proverbial dead horse, I shied away from stressing the potential value and opportunity CMS' Advance Beneficiary Notice's Upgrade Provision holds for home medical equipment providers.

Because of the exposure the passage of the provision has been receiving, I simply didn't feel it warranted yet another praise-filled article. “Surely HME providers are all well aware by now of the provision, particularly because this is an issue for which the HME industry has fought long and hard,” I thought to myself. Wrong! Allow me to illustrate.

I received a call from a provider who questioned the validity of an article regarding using the upgrade provision. She told me she had been a provider in this industry for more than 10 years and had never heard of such a thing. Six or seven more calls of similar ilk followed over a two-week span, and as I hung up the phone from the last call, I realized the upgrade provision horse still is twitching and needs a few more swift kicks.

So, for those providers who have been otherwise engaged while talk of the upgrade provision has been swirling, here's a news flash: There is a new provision to the Advance Beneficiary Notice called the Upgrade Provision that allows HME providers give their patients what they need and want by allowing them to “upgrade” equipment from what Medicare will cover, as long as the beneficiary agrees to be financially liable for the price difference between the Medicare-covered item and the upgraded item.

At long last, providers can work with customers to help customers receive features and functions on equipment that might exceed the their medical needs but meet their personal and lifestyle needs more fully.

Of course, as with anything associated with Medicare, providers need to follow certain rules when using the upgrade provision. On pg. 106 of this issue, health care attorney and HomeCare columnist Cara Bachenheimer walks through all the basics a provider needs to know to use the provision.

But a provider can't use the provision if a provider doesn't know about it, and there's only so much industry advocates can do to spread the word about important regulatory and legislative changes before these advocates begin to feel like they're screaming at a stump.

Now, if you'll excuse me, I need to go buy some new steel-toed boots. There are a lot more horses where this one came from.