ARLINGTON, Virginia—Last month, the Centers for Medicare and Medicaid Services (CMS) implemented a fix that will impact suppliers who provide disposable medical supplies to Medicare beneficiaries, the American Association for Homecare (AAHomecare) wrote in a recent newsletter to members. This fix aims to lay the groundwork for ongoing engagement with CMS in order to address denials triggered by unknown Part A episodes.
AAHomecare said that for years, suppliers who provide medical supplies have often received denials on their claims, due to unreported open Part A home health episodes that were not visible when the supplier checked eligibility to provide supplies to the beneficiary. Additionally, these products had often already been provided, resulting in little recourse. AAHomecare estimated the supplier community loses were approximately $11.5 million per year, according to the 2022 Medicare Freedom of Information Act data.
This claims issue was raised by a member of the AAHomecare Woundcare Work Group meeting, which prompted a hybrid initiative of AAHomecare's Regulatory Council and Medical Supplies Council to engage the National Alliance for Care at Home and, ultimately, CMS.
In response, CMS determined there was an incorrect claims edit, which denies the durable medical equipment (DME), prosthetics/orthotics and supplies claims if the date of service was the same as the discharge date from the home health agency claim. Additionally, CMS told AAHomecare that the fix went into effect in October.
“This is an important first step in our engagement with CMS about suppliers’ challenges,” said Kim Brummett, senior VP of regulatory affairs at AAHomecare. “While it addresses the issue of those who have the date of service as the same date of discharge from a home health agency, conversations continue with CMS to explore potential alternatives for suppliers to mitigate the losses and to know there is a potential home health episode open.”
Pam Jones, medical supplies council vice chair at Home Medical Supplies, helped elevate this issue and worked with the AAHomecare stakeholder group in order to find a resolution.
“AAHomecare was able to get a team of people together to work on this to find out how and why this was happening,” Jones said. “It has been such a privilege for me, because they were able to get answers I could not have gotten myself.”
AAHomecare aims to continue engaging CMS on options that will assist DME suppliers who are facing denials for home health episodes, as well as keep members informed of any developments.
