Taking Action Despite Uncertainty

Legal Grind

As you look forward to next year, suppliers of mobility products need to consider how to best position themselves for what remains an uncertain climate for your businesses. On the positive side, there is strong evidence that the mobility products market is strong and growing stronger, fueled at least in part by demographics and improvements in technology that make these products more widely accessible.


All suppliers of mobility products should make accreditation and compliance with quality standards one of their key goals for 2007.

For suppliers who bill the Centers for Medicare & Medicaid Services (CMS) and other government payors, however, there is still uncertainty about how major programs such as competitive bidding and accreditation will unfold. Part of the mix includes the day-to-day implementation and application of the new Medicare coding, coverage and pricing for power mobility in 2007. Here some of these issues and areas that you should be targeting for action in 2007:

Coverage, Coding and Pricing Changes for PMDs

All of you should know about the changes in coding, coverage and pricing for PMDs that began to unfold as part of the "Wheeler Dealer" initiative in 2003. New PMD fee schedules went into effect Nov. 15, 2006. This new pricing was revised in early December and payment changes were retroactive to Nov. 15, 2006. This CMS PMD initiative created controversy with every milestone, requiring revisions and updates to the policies as often as they were issued — resulting in a climate of uncertainty with respect to what was required and the timeline for implementing changes for most of 2006.

Mobility suppliers that have not already done so will have to incorporate the new policies into their operations in 2007. Key areas to consider are documentation and coding. New documentation requirements for PMDs were established in 2006, consequently most suppliers and their physicians should have experience with them. If not, begin with the local coverage determination (LCD) on the Web site of the Program Safeguard Contractor (PSC) for the appropriate jurisdiction/region. Documentation issues will continue to be the focus on PMD audits in 2007.

Accreditation

All mobility suppliers who are not already accredited need to begin the process in 2007. First, accreditation will be a requirement for every supplier who bills Medicare Part B for DMEPOS. Although CMS has not yet set a deadline for this requirement, you can be sure it will be required in the not too distant future. Second, accreditation will be a basic entry-level requirement to participate in competitive bidding. For those who do business in metropolitan statistical areas (MSAs) that could be designated among the first competitive bidding areas, getting accredited needs to be a priority.

Many suppliers may have been holding off because CMS had not identified the accrediting bodies with delegated "deeming" authority. Those doubts were resolved in early November when CMS published the list of accrediting bodies with deeming authority. The list of approved accrediting bodies is available on the CMS Web site.

In order to accommodate the needs of unaccredited suppliers in the competitive bidding MSAs, CMS will ask the accrediting bodies to give priority to suppliers in those areas. However, even suppliers already accredited by one of the organizations will need to demonstrate they meet the current quality standards. Accrediting bodies are expected to notify their clients of what they must do in order to meet this requirement.

All suppliers of mobility products should make accreditation and compliance with quality standards one of their key goals for 2007. For companies that are not already accredited, preparing for accreditation and the accreditation process itself will require a top-to-bottom review of the organization's processes. This comprehensive review of your company, and the ongoing review that follows, will help you to improve your performance over the long term.

Competitive Bidding

For several years now, all DME suppliers have operated with the specter of national competitive bidding lingering in the background. Every year has brought only a slightly better understanding of what competitive bidding might mean on a wide scale. Earlier this year, CMS published a proposed rule to implement the national competitive bidding program. In many ways, the proposal raised even more questions about the direction CMS was taking.

Key issues such as the products and the MSAs that would be subject to competitive bidding were not addressed in the rule and won't be addressed until after a final rule is published. Importantly, suppliers do not have a good understanding of how CMS plans to address small business issues such as supplier networks, or how the mechanics of competitive bidding will work.

The common wisdom has been that CMS would publish a final rule and identify the products and MSAs subject to competitive bidding by the end of the year. As of the press deadline in late December, CMS had not published the final rule.

One legitimate question that mobility suppliers should ask is whether it makes sense to include power mobility devices (PMDs) among the products subject to competitive bidding in 2007. Given the complete revamping of the PMD benefit and pricing, it may be reasonable to allow the supplier community to absorb the changes before subjecting this benefit to more changes under competitive bidding. Even so, every mobility supplier should be reviewing cost structure, product and payor mix in 2007 to prepare for the challenges of competitive bidding.

Even with appropriate planning, it is not possible to anticipate the changes that may result from the final rule on competitive bidding, but suppliers who begin to incorporate the coverage policy revisions and focus on compliance and quality issues in 2007 will establish the necessary foundation.

This article originally appeared in the January 2007 issue of Mobility Management.

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