Will someone please help me understand this?


I had a conversation this morning that left me shaking my head.

Here's the deal. A company that introduced a cash product to the HME market last year recently received a HCPCS code for that product. Why did they get a HCPCS code for the product? Because a whole bunch of HME providers asked them to get a HCPCS code for the product.

Here's what a company official told me: "We kept hearing from the DMEs that they had to have a code to bill it. We're selling it around the world and people around the world are paying cash because they don't have reimbursement codes. Here in America, everyone wanted a HCPCS code so we went for it."

I may be missing something here, so if I am, please let me know. But why would a provider rather bill Medicare for a product than have customers pay cash?

Aren't providers supposed to be increasing their cash business and decreasing their reliance on Medicare? If that is the case, it seems really dumb to take a cash product--a product that retails for $24.99--and stick it in the Medicare fee schedule.

Like I said, I may be wrong, but on the surface this seems to be one of those little tiny stories that demonstrates a very big point: Way too many providers don't have a clue about retail/cash sales.

If competitive bidding and other reimbursement cuts don't push providers to get serious about cash sales, I don't know what will. Do you?

Mike Moran


Similar in Europe (Germany, France, UK) . Many consumers can afford the $25 so don't bother with reimbursement environment. Saves the manufacturer / dealer / provider a fortune in regulatory / reimbursement accreditation fees and formalities.

Everybody wins - except the consumer that needs the product but depends on some sort of state / federal reimbursement (something that they have been contributing through payroll deductions for 30 or 40 years).

On a limited fixed (and diminishing) income 25 bucks can mean the difference between leaving the house - or not.

So what's the item?

A code doesn't automatically guarantee reimbursement.

Its amazing that those of us who have been serving this industry as providers for 30 or more years have recommended a policy that no one whats to follow. #1 let CMS set a price and allow us to charge the difference to the customer if we feel we can not make a profit at medicare pricing. Then if the patient does not like it and wants to shop he can and the competition really begins. Why is CMS spending huge amount of tax payer money on a simple fix to the problem?. Where is the leadership from our industry? I know we old guys don't get the press because we do not advertise in HME magazine but come on HME look at what needs to be done. OBUMBA CARE is a huge failure and we need to show some backbone and say no to the higher powers and lead our industry into a new direction. That direction will be one that shows some backbone and leadership not now found in our industry. Vince