COVID-19 continues to dominate the headlines as it wreaks healthcare havoc, but there are 8 strategic trends poised to impact your business in the coming weeks and months. Are you monitoring them? Are you prepared?
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Each year, HMEB surveys several members of its editorial advisory board to learn about the top-priority trends, strategic considerations, and healthcare issues facing providers. Obviously, the overriding trend continues to be the COVID-19 public health emergency, with the Delta variant ensuring that U.S. healthcare will be dealing with the coronavirus for months.
However, providers must know about eight other trends they must integrate into their business planning and management. So, while the PHE might continue to dominate healthcare headlines, let’s examine these eight critical HME trends:
In September, a collection of HME industry entities formed DMEscripts LLC, a healthcare technology e-prescribing company that provides a platform for prescribers to electronically transmit HME/DME orders to any participating provider. The DMEscripts alliance includes the American Association for Homecare, VGM & Associates, AdaptHealth LLC, Apria Healthcare Group LLC, Lincare Inc. and Rotech Healthcare Inc.
DMEscripts will utilize proprietary e-prescription software to operate an open network so any HME provider can enroll in the network at no cost to prescribers or patients. The fee for the services will be on a transaction fee basis (that is considerably lower than the cost to process orders manually, AAHomecare’s Ryan notes).
For Ryan, this represents a crucial opportunity to accelerate the widespread adoption of an electronic ordering application for DME and improve care, access and business performance as a result. The current, time- and money-consuming fax ordering process will be a thing of the past if DMEscripts achieves its vision.
“I am bullish on the DME Industry and am very excited about the opportunity we have to drive large-scale adoption of e-prescribe in the industry,” he says. “The goal is to drastically improve the current order to delivery process. The industry now has a solution and an opportunity to accelerate widespread adoption of an electronic ordering application for DME.”
On the patient and referral partner side of the scenario, e-prescribing will improve the patient and referral experience, reducing the time required to refer a patient and allow DME suppliers to reduce administrative costs, Ryan adds.
“Widespread adoption of digital communications is transforming the healthcare industry — and the DME community needs to make sure we’re taking full advantage of these technologies,” Ryan notes.
The industry is currently operating under higher reimbursement from the CARES Act, which will last as long as the COVID-19 public health emergency, which could last into 2022. However, Bachenheimer warns there is one reimbursement-related ball in the air that providers must continue to keep their eyes on over the next several months: CMS’s DMEPOS Payment Rule.
Released in November 2020, that proposed rule included a number of top-level reimbursement items. Notably, it continued current relief for rural HME suppliers via the 50/50 blended rate. Other non-bid area suppliers would be paid at 100 percent of the adjusted fee schedule. It also made changes related to the HCPCS Level II Code Application Process. It also included changes to the process for making Benefit Category Determinations and Payment Determinations for DME and other Items and services under Part B.
The industry “has waited with bated breath to see what the Biden administration would do with these proposals,” Bachenheimer explains, but two things have delayed progress: “The first is, when the Biden administration came in January, it put a halt on all regulatory initiatives because they wanted to because they wanted to review everything that was in process during the previous administration,” Bachenheimer says. “The second is the Biden administration took a long time to get its CMS Administrator approved through the Senate.”
For now, it’s a waiting game, she advises: “[CMS] could start from scratch, they could revise it, they could finalize it as it was proposed, and we really don’t have an indication at this point what it will be. … The rule could be substantially the same or substantially different. We just don’t know.”
The Backlog of audit cases at the Administrative Law Judge level is almost resolved, but audit expert van Halem asks, is that actually good or bad for suppliers?
We certainly know that the previous situation at CMS’s Office of Medicare Hearings and Appeals (OMHA) was almost Kafkaesque.
“A backlog that grew at its peak to nearly $1 million claims – a majority of which at one point (54 percent) were related to durable medical equipment claims,” van Halem explains. Despite the 90 days mandated by federal law, hearings were not occurring for over 1,000 days in many cases. ”
However, OMHA’s implementation of some strategies for attacking the caseload as well as the QIC Telephone discussion pilot as well as the Settlement Conference program resulted in a significant decline in cases pending, he notes.
“Most recent data released by OMHA showed about 85,000 DMEPOS appeals still pending,” van Halem says.
News like that should make providers want to do a jig, but van Halem warns they should hold off on strapping on their dancing shoes.
“The onslaught of the RAC auditors back in 2011 to 2015 is what led to the ALJ backlog,” he explains. “To reduce the number of claims getting into the Medicare appeal system, CMS began limiting RACs significantly in the volume of claims they can review.
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