DME and O&P testimonies heard at SBA Hearing

WASHINGTON—The Small Business Administration’s National Regulatory Fairness Hearing April 27, 2015 gave small business owners, including HME providers and O&P practitioners, a forum to comment on unfair enforcement actions, government audits, and excessive fines or regulations. Testifying on behalf of the medical equipment and prosthetic and orthotic industry were Sara Beck of San Joaquin Orthotics and Prosthetics; David Chandler of Liberty Medical Specialties and president of the North Carolina Association of Medical Equipment Suppliers; Dan Fedor of VGM Group, Inc.; John Tyo of Syracuse Prosthetics and his guest patient David Lewis; Colleen Brabec of Mobilis Inc.; and Wayne Sale, formerly of Health First. The group addressed the two primary areas of concern in the DME and O&P community: Medicare’s audit and appeal process and expansion of competitive bidding to rural areas. Medicare’s audit and appeal process has had crippling effects on medical suppliers all across the country. They are experiencing excessive and unreasonable audits by the contractors hired by CMS to analyze claims. Once a supplier receives an audit on an already-supplied piece of medical equipment, the money is recouped and the supplier has the ability to file an appeal. The average review timeline is almost two years due to the sizeable backlog of appeals. Suppliers cannot have their businesses tied up in recoupment proceedings for years. Many have already gone out of business, further limiting access to home health needs. To add to the suppliers’ burdens, last year CMS announced that the competitive bidding program would expand to include all areas of the country in 2016. This announcement struck a nerve, particularly with rural area suppliers. Reimbursement rates will be significantly reduced. If these suppliers choose to accept Medicare assignments, they will have to accept reimbursement rates of up to 50 percent less than the current fee schedule. After the hearing, the National Ombudsman Brian Castro spoke with the group of medical suppliers and discussed their issues in depth. He assured the group that he work with its federal agency partners to address the concerns, reduce regulatory burdens and help small businesses grow.