Opinion Re: [OANDP-L] Government Relations Update regarding CMS

Opinion Re: [OANDP-L] Government Relations Update regarding CMS

Morris Gallo

9/5/2008

OPINION

CMS has finally done something right, even if it was unintentional.

You can bet the accreditation organizations, especially ABC and BOC were
against this exemption. When mandatory facility accreditation became
the rule CMS essentially gave the credentialing organizations a blank
check, drawn on your bank account.
This onerous rule was foisted upon us under the guise of fraud
prevention. Instead of tying a provider number to an individual who
has the education and training to provide the service, CMS required you
to spend thousands of dollars to make sure the facility is clean, you
have all sorts of operations manuals, and you have a sign on the door.
This is paper shuffling at its best and a clear case of CMS practicing
CYA in light of news reports detailing millions of dollars in fraud.

The majority of reported fraud involving P&O has come from DME dealers
billing, and getting paid, for items they should not be able to
provide. Until CMS ties reimbursement to an individual who is qualified
to provide the service this type of fraud will continue. You never hear
of fraud involving physical therapy services being performed by a
non-PT. Why? Because to get a provider number for those specific
services you must show you are a PT. The service is tied to the
individual's qualifications.

What are the chances the certifying bodies will fight to keep this
exemption? Slim and none. It is in their financial best interest to
keep facility accreditation in place. They have received manna from the
CMS gods.

Qualified practitioners need an organization willing to buck the
self-serving industry powers to fight for meaningful reform of the CMS
provider rules in regards to P&O. The organization needs to delineate
to the practitioners who they will represent, what are the goals, and
set out a plan to achieve these goals. Who will step up and take on the
fight.
Morris Gallo, LPO


NAAOP wrote:
> Congress and CMS Carve Huge Exemption for DME from Accreditation
> Requirements and Quality Standards: New Regulations for O&P to be Proposed
>
> Congress passed a Medicare bill in July by overriding a Presidential veto,
> granting physicians a fee schedule update rather than a 10% cut in fees. The
> bill also contained another provision pushed by physicians, a grant of
> authority to the Secretary of Health and Human Services to exempt them and
> other professionals from the accreditation requirements and quality
> standards established for Durable Medical Equipment, Prosthetics, Orthotics
> and Supplies (DMEPOS). CMS was given discretion to exempt these
> professionals if CMS determined that the accreditation requirements and
> quality standards were not specifically designed with them in mind. In other
> words, if CMS determined that the standards were primarily designed for DME
> and other suppliers, rather than physicians, they could be exempt.
>
> Since the passage of this summer's Medicare bill, numerous stories in major
> newspapers have highlighted the problem of fraud and abuse in the DMEPOS
> benefit. CMS was recently embarrassed by revelations that they grossly
> underestimated and under-reported to Congress the amount of fraud and abuse
> occurring in the Medicare program. The accreditation requirements and
> quality standards were intended to reduce fraud and abuse and improve the
> quality of care.
>
> However, on September 3rd, CMS held an Open Door Forum by teleconference and
> announced that they essentially abandoned their discretion to make
> individual interpretations for each type of professional. Instead, CMS
> imposed a blanket exemption from the DMEPOS accreditation requirements and
> quality standards for all physicians as well as a whole host of other
> professionals, including therapists, but also including orthotists,
> prosthetists, and pedorthists. This means that the quality standards
> described in Appendix C that apply to the provision of orthotics,
> prosthetics, and pedorthics will not apply to these practitioners going
> forward. This also means that the DMEPOS quality standard and accreditation
> requirements, including Appendix C, will primarily apply to DME suppliers,
> pharmacies, and similar suppliers.
>
> CMS made great efforts to state that they are currently undergoing
> rulemaking to implement new provider qualification requirements for those
> who provide orthotic and prosthetic care, pursuant to the Benefits
> Improvement and Protection Act (BIPA) of 2001, a law that was never
> implemented. CMS expects to propose these new regulations in the first half
> of 2009, but with the change in Administration, this timeline is subject to
> question. During the CMS conference call, CMS repeatedly acknowledged the
> arguments made by the O&P field and warned participants in the call that
> more O&P regulations are yet to be announced, but, unfortunately, CMS's
> track record in establishing meaningful consumer protections for O&P
> patients has not been impressive to date.
>
> NAAOP will continue to make the O&P case with CMS and Congress and to work
> in concert with the other O&P organizations to establish, once and for all,
> appropriate quality standards and accreditation requirements for all
> providers and suppliers of O&P care.
>
>