Providers asked to do the right thing

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Thursday, April 9, 2020

WASHINGTON – Industry stakeholders, including AAHomecare and VGM, are urging providers to use their best judgment when applying new guidance from CMS.

CMS has relaxed certain Medicare criteria to make it easier to treat patients during the coronavirus pandemic.

“It is critical that HME providers not use the relaxed requirements to engage in fraudulent and/or unethical acts designed solely to generate revenue,” stated AAHomecare in a letter to the industry. “We are all in this together, and there is no room for any type of questionable behavior.”

CMS has relaxed various criteria for respiratory and sleep orders, including eliminating the chronic stable state requirements. It has also relaxed signature, documentation and testing guidelines.

Providers are urging providers to police themselves. VGM’s Clint Geffert, in a letter to the industry, reminded providers of the Fraud Eradication Advisory Team, which has a website and electronic reporting tool for confidentially reporting suspected fraud or abuse of the Medicare program.

“If you suspect a supplier, physician, clinician, manufacturer or other entity is committing an act of fraud, we ask that you act and report them now,” he said.

Once the public health emergency declaration is lifted, Medicare policies will be reinstated, audits will return and claims submitted during this time may be scrutinized at some point in the future, says Wayne van Halem. It is likely that patients who received equipment during the PHE will have to be re-qualified.

“It is up to us to track monitor and control what we do at this time, not only for the good of the industry, but also because of our shared responsibility in protecting the Medicare Trust Fund,” he said.