On January 31, 2020 the US Department of Health and Human Services (“HHS”) declared a public health emergency surrounding the COVID-19 coronavirus pandemic, which was renewed again for a period of 90 days effective July 25, 2020.
In an attempt to focus on patients over paperwork and to remove obstacles from access to patient care, HHS relaxed or suspended certain healthcare provider requirements. Several such changes directly impact current or prospective providers of durable medical equipment (“DME”) to Medicare Part B beneficiaries.
Here’s a high-level breakdown of some of those changes:
- Provider Enrollment Process for New Medicare Providers:
- Toll free hotlines to expedite processing of new enrollment applications, with shorter enrollment timeframes.
- Waived enrollment application fee, site visit requirement and postponed reaccreditations*.
- *Note: Effective July 6, 2020, CMS resumed all accreditation and reaccreditation activities for DMEPOS suppliers, to include surveys. Surveys may be conducted onsite, virtually or a combination of both depending on the state’s reopening plan where the provider is located. All survey activities will be conducted in accordance with the Center for Disease Control (CDC) and local guidelines.
- Suspended Accreditation Organization Requirement**: From ~March 2020 – early July 2020, Medicare waived the requirement that DMEPOS providers enrolling in Medicare Part B must be accredited by an approved accreditation organization prior to enrollment; this window has since closed.
- **Note: New DME suppliers enrolled after 3/1/2020 without the appropriate accreditation shall submit a completed application to the accrediting organization with all required supporting documentation within 30 days of notification from the National Supplier Clearinghouse, to apply or accreditation. Failure to obtain accreditation, will result in the deactivation of the provider’s Medicare billing privileges. DME suppliers who originally received an extension of their expiring supplier accreditation due to the Public Health Emergency will be contacted by the NSC to begin the reaccreditation process.
- New Services: Access to additional services & provider types (e.g., physical therapy, speech pathology, etc.).
- HIPAA: Enforcement relaxed so long as provider is making good faith effort at compliance.
- Patient Eligibility: Medicare began covering the costs of telehealth visits without the beneficiary having to reside in a rural health area or present to a qualifying originating practice site, as was required prior to the public health emergency declaration.
- Note: These relaxed telehealth standards are not an invitation for DME providers to engage in inappropriate marketing or telehealth practitioner arrangements, which continue to seemingly run rampant despite the on-going regulatory enforcement actions in that regard.
3. Practitioner Licensure/Record Requirements:
- Licensure reciprocity in certain states for practitioners.
- Relaxed (LCD) Coverage Criteria for Certain DME (respiratory/O2/sleep disorders).
- Where DME is lost, destroyed, or otherwise rendered unusable contractors have the flexibility to waive replacements requirements such as the face-to-face requirements, new physicians order, and new medical necessity documentation.
- Additional Notes:
- Audits (other than fraud, waste, and abuse) were relaxed/suspended, but resumed back on August 3.
- Competitive Bidding Round 2021?- What began as rumblings and some movement on the Hill early summer to potentially delay the implementation of Medicare’s Competitive Bidding Program Round 2021 resulted in over 100 congressional signatures in a late July letter being sent to the heads of HHS, requesting that CBID Round 2021 be postponed for either one year or until the end of the public health emergency. Only time will tell what ultimately happens, but the impacts are tremendous for DME suppliers.
Where the only thing constant is change, there is never a dull moment in the DME industry.
Staying informed and compliant is not optional.