VGM Letter to HHS’s Price Outlines Action Items

Organization’s formal letter to HHS Secretary identifies three regulatory priorities needed to protect beneficiaries’ access to HME.

HME member service organization The VGM Group Inc. sent a formal letter to the Secretary of Health and Human Services Tom Price, M.D., outlining a list of regulatory priorities needed to protect Medicare and Medicaid beneficiary access to DME.  

Available at VGM’s DC Link, the letter identifies three urgent items the organization called on Price and HHS to address immediately:

1. Bump up the CURES Act-mandated reimbursement to claims filed in non-bid areas between July 1, 2016 and Jan. 1, 2017. CMS said it would provide a revised fee schedule to the DME MACs on or after May 1, with an an implementation date of July 3. VGM's letter said CMS's delay was “unnecessary as more suppliers are forced to close their businesses on a weekly basis while waiting for payments on services provided nearly one year prior,” and urged Price to direct the DME MACs to immediately disperse the reimbursements.

2. Immediately delay the resumption of the full reimbursement cuts to claims in non-bid areas, which went back into effect on Jan. 1. The CURES Act mandated that CMS perform and release a study of the impact of those full cuts on beneficiary access, but CMS did not perform such a study and simply re-implemented the cuts. The letter calls on Price to instruct CMS to halt application of the full cuts until it can perform such an assessment.

3. Fix the “double dip” cuts to reimbursement for oxygen concentrators. Oxygen providers in rural, non-bid areas began cutting oxygen concentrator service after CMS incorrectly applied a budget neutral “offset” to 2017 rural fee schedules for oxygen concentrators, which mistakenly cut reimbursement for HCPCS E1390 by an extra 11 percent, on average. This in turn sent reimbursement in rural, non-bid areas into a tailspin due to the bid expansion cuts. The letter urges Price to direct CMS to cease the practice and correct error.

“These challenges must be addressed immediately as there has been more than a 34 percent reduction in the number of HME suppliers from 2013 to 2017,” said John Gallagher, vice president of VGM Government Relations. "[HME providers’] patient-centric care leads to improved health outcomes while offering large savings to the federal government compared to the alternative of that patient being admitted into a hospital." 

Additionally, the letter also lists four, non-urgent reforms that it advises HHS to undertake in order to protect beneficiary access:

  • Replace competitive bidding with the Market Pricing Program.
  • Implement a broader, improved prior authorization processes in order to ensure clean claims and reverse the audit appeal backlog.
  • Establish a separate benefit for complex rehab technology.
  • Work with the Department of Veterans Affairs and TRICARE so that reimbursement rates match the Medicare fee schedule. 

About the Author

David Kopf is the Editor of HME Business.

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