A toll for thee

A bellwether is ringing in Tennessee. True, Georgia cast the mold when state Medicaid began to require that you had to either be a member of NRRTS or hold RESNA's ATP or ATS credential if you wanted to provide rehab to its beneficiaries. But Tennessee is the first state to make that law. The legislation's boosters plan to export efforts to bring rehab credentialing to other states, ensuring that the people who provide high-end wheeled mobility have sat for a clinical exam that's no piece of cake. Just ask the surgeon (see profile) that sat for the exam in Atlanta last fall. Although the RESNA exam is no walk in the park, the same can't be said for all the bars raised in this industry — bars that are supposed to set standards for responsible business. Specifically, I'm referring to the dispensing of Medicare supplier numbers and state licensure initiatives. Licensure, first. We've reported in the past that the implementation of licensure in a state has a negligible impact on the number of new suppliers who gain admission to Medicare. These are the facts on the ground at the National Supplier Clearinghouse. It may be that the presence of licensure means unscrupulous dealers are not hanging shingles. But let's be skeptical. If licensure really does mash the bad apples, we'll want that confirmed in some measurable fashion. We also need to hear more about businesses whose licenses are pulled. In the last eight years, I have heard about only one company that's had its licensed yanked, maybe. I'm not sold on licensure. I'm not an opponent. But I'm a skeptic. And that's healthy. Similarly, I'm also not sold on NSC site surveys as an effective screening device for participation in the Medicare program. It's better than nothing, to be sure, but why are dealers in Houston upset about the rash of new dealers pushing power mobility in their market — dealers who can't service what they sell, who spring to life in suspicious proximity of one another, and who only bill Medicare (See story)? Are the NSC site surveyors to blame? Probably not. They follow guidelines. Are the NSC guidelines to blame? Maybe. They're not tough enough. They need more mettle. The industry wants action on the national stage. Medicare's the most significant payer in the business. Because Medicare's loopholes for DME are so wide, grumblings like the grumblings sounding in Houston keep flaring. And this becomes a problem when the House and Senate take note, and the Senate — as they did in their tax-cut package May 15 — propose reimbursement cuts to DME. Short of national action, we're getting local action, as in Tennessee. So listen to the winds blow. And ask whether you hear the bell tolling, and whether it should toll for thee. HME