Editor's Note:

Something’s Rotten

Is CMS overloading HMEs for an NCB win?

• By David Kopf
• Oct 01, 2010

As I look back at the past several months, I’m increasingly suffering from the nagging suspicion that CMS has been waging a war of attrition against HME providers. Bear with me: My thought process is that if CMS can constantly put barrier after barrier in front of providers — especially when it comes to them getting their funding — then CMS will drastically undercut the industry’s ability to fight to repeal competitive bidding.

It would be one thing if all the recent CMS roadblocks were on a deadline that providers were aware of and could have planned for, such as accreditation, but some of CMS’s recent hits have come as complete surprises to HMEs. Add to that nebulous language and shifting deadlines, and it’s almost impossible to not start wondering just what in the heck is CMS up to. Some recent examples:

PECOS

When CMS announced in October 2009 that providers needed to ensure that Medicare claims coming from referral sources such as physicians would not be funded if those sources were not enrolled in its Provider Enrollment, Chain and Ownership System by Jan. 1 of this year, it shocked to the industry. No providers were aware of the initiative, let alone the incredibly tight deadline. Work was done to delay the deadline until April, then July and then January 2011, but CMS confused matters on multiple occasions by refusing to clearly state what the actual deadline was.

The closest CMS came to clarity was saying that it would not automatically reject claims from referrals that had not yet had their PECOS applications approved by July 6, but that it could retroactively recoup payment on those claims. That’s not exactly confidence inspiring language, and many providers accordingly began working as though July 6 was the hard deadline, even though the actual implementation deadline was Jan. 3, 2011

CMS made things even worse by initially not providing access to the PECOS database at all; then giving providers a titanic PDF document containing thousands of providers that had to be searched with a time-consuming find; and then finally providing PECOS access to check sources.

Audits

Some industry watchers have observed that CMS’s unleashing of a host of RAC, CERT and ZPIC audits could be worse than competitive bidding. Even providers with perfect documentation must still go through the audit processes, which are time consuming and freeze their funding until complete. So, whatever cash-flow gains a provider might make in one aspect of their business, they might see Medicare funding further bottlenecked through the audits. (One step forward and one step back.)

Worse yet is the fact that the audits are performed by firms contracted by CMS, so it is in their interest to perform as many audits as possible for their federal client. Once again, even the most ship-shape and honest providers will become unnecessarily and unfairly saddled by an audit process that should be targeting probable offenders.

CEDI

The latest shocker is that free, direct access to the Common Electronic Data Interchange will be shut down and that providers will need to pay to electronic submit claims through one of six vendors. No sooner were CEDI’s direct connections up and running then they got scheduled for shut down. The removal of the connection and the ensuring cost came as a complete surprise to 88 percent of providers answering an HME-Business.com poll.

While these are just three examples of roadblocks CMS has put in front of providers that diminish their efforts to fight competitive bidding, they are major obstacles indeed. Each represents a direct threat to providers’ funding that requires time and money to address. Is the timing of these efforts the result of mere random chance, or a pre-planned campaign to overload HMEs? I’ll say this: just because I’m paranoid doesn’t mean CMS isn’t out to get you.

This article originally appeared in the October 2010 issue of HME Business.