Up to Standard

They're baaaak. CMS has decided to take yet another stab at revising its supplier standards for home medical equipment providers. The agency has proposed a number of clarifications and revisions to the existing 21 supplier standards as well as a handful of new standards for Medicare DMEPOS enrollment.

CMS is couching its revisions as supposed enhanced tools for the fight against fraud and abuse. However, many of the changes seem to pigeonhole suppliers into a specific storefront retail operation with a showroom, general business hours and significant public traffic. This push toward homogenocity may be a particular hardship for small suppliers and those who cater to specialized markets.

The Implications

HME providers should strive to understand the implications of these revisions before they become official. (The comment period on the new standards proposal was slated to end March 25, 2008.)

First, these proposed changes reflect issues that CMS believes are important. Whether the change reflects a clarification, a revision or a new standard, CMS has addressed these issues because the agency deems them to be of immediate importance. This also means that these changes may likely reflect a focus from the National Supplier Clearinghouse on its investigation and enforcement activities over the next few years.

Second, some of the modifications implicate the anti-fraud rules. Standard No. 11, for example, concerns cold-calling and certain inappropriate marketing activities by home care companies. Violations of these rules will subject a supplier to potential revocation of its supplier number. But, it will also likely subject the supplier to challenge because of abusive marketing practices and to potential repayment of revenues and penalties.

Third, a number of the changes are characterized as “clarifications.” This means that CMS intends that the standard that is being “clarified” already means what the clarification states. It is not a new rule; it is the same rule, just worded more clearly. Therefore, CMS' position is that the rule as restated in the “clarification” already is in effect, and suppliers are already subject to its provisions.

A supposed clarification can be challenged, of course. But that is a difficult procedure, and it is important to appreciate which modifications to the standards CMS considers already to be in force.

Clarifications Vs. Revisions

For example, let's take a look at the differences between “clarifications” and “revisions” by examining the proposed revisions to Standard No. 1.