Stark, Baird on post-Jan. 1

They address referral source re-education, capped rental conundrums, and outdated agreements
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Friday, September 14, 2018

YARMOUTH, Maine – The Medicare landscape could look very different on Jan. 1, 2019, but industry watchers don’t expect any knee-jerk reactions from HME providers.

In a recent proposed rule, CMS outlined its plans to implement an “any willing provider” provision when the current competitive bidding contracts expire on Dec. 31, allowing any Medicare-enrolled provider to serve beneficiaries while it overhauls the program.

“The guns will go off on Jan. 1, but I don’t expect anyone to lunge to make drastic changes,” said Andrea Stark, a reimbursement consultant for MiraVista. “There are too many things providers need to be thinking about logistically.”

Jeff Baird, chairman of The Health Care Group at Brown & Fortunato, agrees, saying, while he expects more providers to accept Medicare business post-Jan. 1, he doesn’t expect a “sea change,” because they’re “rooted in old habit.”

Re-education of referral sources

If non-contract suppliers do decide to accept Medicare business, they’re going to have the tall task of reaching out to referral sources to let them know they can now send business their way, Stark says.

“Referral sources have been told for years now, ‘You can only send referrals to these 10 contract suppliers,’” she said.

This process will likely be easiest for purchased items like walkers and commodes, Stark says.

Capped-rental conundrums

For capped-rental items, however, it will be more complicated, Stark says.

“In many cases, these items capped more than a year ago and the supplier is no longer in contact with the beneficiaries,” she said. “Suppliers must be careful how they re-engage beneficiaries so they don’t violate Supplier Standard 11, which allows suppliers to contact beneficiaries regarding previously covered services but requires them to have provided a covered service in the last 15 months to market new products.”

If you’re a non-contract supplier that has continued to serve beneficiaries as a grandfathered supplier, for example, you’ll want to look at where your customers are in the useful lifetime of their equipment, Stark says.

“Once you get to the 36-month marker, you can’t bill for a rental, but you get to bill again at the 60th month,” she said. “You’ll want to make sure you’ve collected all 36 payments before restarting. Maybe it’s only 32 payments because the patient was in a skilled facility—capture those missed payments first, then get restarted.”

Relationship status

Baird says if there’s one thing that providers will likely change right out of the gate, it’s common-ownership agreements—where you have one company with a bid contract and one without, and one company buys 5% or more of the other company, allowing both companies to serve beneficiaries.

“I anticipate a number of suppliers who are going to undo these,” he said.

Providers will also rethink subcontracting agreements, Baird says.

“There may be a number of providers that are subcontractors today who will no longer want to subcontract and will want to participate on their own or who will not want to participate at all,” he said.