Providers should lean on non-assignment, Baird says

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Tuesday, October 16, 2018

ATLANTA – HME providers need to make a “tough call” on how they plan to handle an upcoming gap period in the competitive bidding program, healthcare attorney Jeff Baird told Medtrade attendees on Monday afternoon.

“This is kind of a new area,” said Baird, the chairman of the Healthcare Group at Brown & Fortunato in Amarillo, Texas. “What do we do during the gap period? The short answer is, I don’t know. I have specific ideas and suggestions, and have knowledge, but this is new to everybody.”

In a rule that is expected to be finalized in a matter of weeks, CMS has proposed implementing an any willing provider provision on Jan. 1, 2019, allowing any Medicare-enrolled provider to supply DMEPOS to beneficiaries for 18 to 24 months.

Does that mean non-contract providers should jump back into Medicare? If they’ve done a good job diversifying their business away from the government payer, not necessarily, Baird says.

“If we’ve gotten to a point where we have pretty much eliminated our financial and emotional dependence on Medicare, I would assert, ‘Don’t get back into it,’” he said.
If non-contract providers feel they must, however, Baird suggested, “jump back in, but on a non-assigned basis.”

“Those (beneficiaries) that we do accept, take cash up front, submit claims and let Medicare reimburse them,” he said. “That is a way to jump back into the market over the next two years without becoming dependent on Medicare.”

What about contract suppliers that have fulfilled their contracts but can no longer accept such low reimbursement?

“You have an absolute right to quit taking Medicare beneficiaries, or switch to taking them non-assigned,” Baird said.

Of course, Baird acknowledges that providers are still missing important information—the final rule. While he doesn’t expect it to vary significantly from what was in the proposed rule, stakeholders have lobbied CMS to provide additional relief in bid areas—not a one-time CPI-U increase of 1.9%, but a cumulative compounded increase of 8% to 9%.

“We told (CMS), these providers are losing money on every patient and they can all quit on Jan. 1,” said Mark Higley, vice president of regulatory affairs at the VGM Group. “I think (they) got the message.”

Regardless of what they decide, providers will want to have a story to tell shortly after the final rule is published, Baird says.

“Start prepping your patients and their caregivers and their doctors,” he said. “Here’s what we’re going to have to do on Jan. 1. Take an ad out in the newspaper.”