CMS Eases Supplier Number Moratorium

The home care industry recently received some positive news. Thomas A. Scully, administrator of the Centers for Medicare and Medicaid Services, authorized the National Supplier Clearinghouse to begin approving applications for those providers who have submitted their enrollment application and have passed their site visit, signaling an ease in the provider-number moratorium. This development is the culmination of months of hard work by the entire home care industry, and marks a significant victory for law-abiding durable medical equipment providers and the patients we serve every day!

Earlier this fall, CMS announced “Operation Wheeler Dealer” to help prevent Medicare fraud and abuse. The initiative came on the heels of an isolated Houston-based wheelchair scam, in which corrupt doctors submitted Medicare claims for power wheelchairs that were then substituted for a less expensive model or, in some cases, were never delivered at all. This led to a moratorium on the issuance of any new provider numbers — a moratorium that harmed many honest, hard-working DME providers.

Unintended Consequences

While AAHomecare applauded the initiative at the time, and reaffirmed a commitment to work with CMS to “root out” Medicare fraud and abuse, we also expressed concerns regarding the unintended and adverse consequences of the initiative.

The initiative was intended to deal with fraud and abuse engaged in by fly-by-night operations, but AAHomecare was concerned that it would adversely impact honest and dedicated DME providers. For example, the moratorium precluded long-standing providers who have met the supplier standards not only from opening a new branch location but also from acquiring an existing company.

Patient access to quality care was also a chief concern. Providers are required to have a billing number before they can enter into provider agreements with Medicaid and private payers. Because providers can only service Medicare beneficiaries if they have a provider number, the moratorium threatened to jeopardize the quality and availability of patient care in those places where it was most needed.

Finally, in October, AAHomecare expressed concern that the moratorium might not have its intended effect, and that CMS should consider smart and efficient alternatives to the outright moratorium, including heightened, ongoing monitoring of and training for new suppliers.

AAHomecare worked diligently to urge CMS not to penalize providers who strictly adhere to Medicare regulations.