What’s up with this ‘What’s Covered’ app?

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01/31/2019

CMS this week has made much ado about its new “What’s Covered” app that allows beneficiaries to see whether Medicare covers a specific medical item or service, which of course includes HME.

The launch of the app paralleled the agency’s CMS Quality Conference, or #CMSQualCon19 as it’s known on twitter. CMS’s coverage of the event on the social media platform has included photos of attendees, including these patient advocates, giving the app a whirl.

The initial reaction to the app by those in the HME industry has been, well, tepid. The gist of their reaction: The app doesn’t go nearly far enough.

Here’s one industry stakeholder: “If you put oxygen into the app, it essentially says the doctor needs to order it. Yet we have a 20-page coverage determination document, a Program Integrity Manual, etc., for oxygen, and that’s what they have in the app?”

Of course, the app is meant for bennies, so there’s a delicate balance, I’m sure, between enough information, making the app usable; and too much info, making it unusable.

But as some providers pointed out on twitter: It’d sure be helpful if the app included more information on pricing.

Here’s provider Gary Sheehan explaining this on twitter, via a hypothetical conversation with a bennie:

Patient: Why do I have this bill? My (pick one) doctor/insurance company/neighbor/goldfish told me it was covered?
(For the purposes of this blog, we could add the “What’s Covered” app to the list? My app told me it was covered!)
Rep: It is covered, but you have a $3,000…
Patient: If it’s covered, why do I have a bill? I pay $900 a month for this policy…everything is covered.”

It turns out that, while the app does have cost information (for oxygen, it includes information on the 20% co-pay, 36-month cap, competitive bidding program, grandfathering), it’s missing one crucial piece of information: what Medicare pays suppliers for equipment and services.

Sheehan again on twitter: “It’s an essential determinant of out-of-pocket expenses, yes. And if that’s too complicated, what does that say about the fee schedules?”

Woody O’Neal chimed in on twitter, too: “Specific costs could be achieved by clicking the product and then entering bennie zip code, and a pretty accurate estimate of cost would be easy. My staff performs these functions every day in Brightree, so I know the technology for price estimates exists.”

To give CMS the benefit of the doubt, perhaps, as Sheehan pointed out, this is only version 1.0 of the app and, perhaps, future versions of the app will include additional information.

If so, CMS, when you’re ready, I know a few people you can talk to.