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.
Currently, the NSC is reviewing applications for DME suppliers. The speed with which an application is processed will depend on the NSC review of the application, results of site visits and background checks of owners and managing employees. Providers only need to ensure that their applications to CMS are complete.
Where Do We Stand Now?
The easing of the moratorium does not signify an end to all delays in the processing of provider applications. Providers applying for the first time will still be subject to heightened scrutiny and, therefore, will experience significant delays in the application process. We encourage all providers to be patient, because easing the moratorium is a tremendous step in the right direction.
This announcement is proof positive of the results that the home care industry can achieve when its members work together. The DME industry worked proactively to tell the good news of home care. We demonstrated that the few unscrupulous doctors in Houston who defrauded taxpayers out of millions of dollars are not the norm in an industry that faithfully serves millions of patients every day.
The DME industry embraced new federal quality standards and proved that honest DME providers are part of the solution to Medicare fraud, not part of the problem. We applaud the acknowledgement by CMS that in any reform, patients and law-abiding providers must not be the victims.
Kay Cox is president and CEO of the American Association for Homecare, Alexandria, Va. For more information about AAHomecare, visit www.aahomecare.org, or call 703/836 - 6263.
