During November, which is National Homecare Month, the American Association for Homecare celebrates the thousands of dedicated professionals who provide cost-effective and consumer-preferred homecare.
Among the eight million Americans who depend on homecare for medically required services or equipment are people with chronic obstructive pulmonary disease (COPD), multiple sclerosis, Lou Gehrig’s disease, spinal cord injuries, congestive heart failure, diabetes, and other conditions. Homecare services include oxygen therapy, wheelchairs, skilled nursing, sleep therapy, infusion therapy, diabetes supplies, hospice, and other medical services, supplies, and equipment at home.
The home is the most cost-effective setting for medical care. To learn more about homecare and the benefits of the services offered, visit the AAHomecare newsroom to read the full Homecare Month press release (http://www.aahomecare.org/displaycommon.cfm?an=2).
Wednesday, November 12, 2008
Friday, October 31, 2008
Candidates Views on Homecare
This historic election and the past year of policy changes related to homecare has prompted many within the HME community to ask which candidates and parties will be friendlier toward the durable medical equipment sector. The American Association for Homecare doesn’t endorse candidates, but we do work closely with and contribute to both Democrats and Republicans because HME issues are not usually partisan.
To help in your research, AAHomecare has gleaned information from both of the presidential candidates’ websites, the debates, and from the Kaiser Health Foundations 2008 Presidential Candidates Comparison website (http://www.health08.org/healthissues_sidebyside.cfm).
Both Senators consider homecare to be important and want to strengthen long term care policies. Barack Obama’s website state’s he supports the Community Choice Act of 2007 which would allow Americans with significant disabilities the choice of living in their community rather than having to live in a nursing home or other institution. He also supports Community Living Assistance Services and Supports (CLASS) Act which creates a voluntary budget-neutral national insurance program to assist adults with functional disabilities, allowing them to remain independent and in their communities. During the Republican ABC-Facebook debates which took place early in January, in Manchester, NH, John McCain advocated for home healthcare: “We need incentives for home healthcare as opposed to long term care. In my state of Arizona we adopted a proposal which incentivizes health care providers to keep people in home health care settings. It’s dramatically less expensive than long term care. In Arizona we have one half the numbers of people per capita in long term care facilities as the state of Pennsylvania. Incentives to keep cost down…there are no incentives in the system today.”
Both have made statements on Medicare fraud as well. Obama says he would empower the HHS Inspector General to fight fraud, implement anti-fraud measures in CMS contracting, expand the scope of Medicare and Medicaid audits, strengthen the federal False Claims Act, encourage states to go after fraud, and increase funding for Justice Department prosecutors and FBI agents to fight fraud. McCain simply states he advocates a zero tolerance policy towards Medicare fraud.
This is an important election year for congressional seats as well. Homecare has very strong champions in both political parties and we encourage DME providers to introduce themselves to the candidates and make sure new members of the Senate and House understand the value of homecare to their local communities. This is particularly important since most of the homecare policy has come out of Congress (not necessarily the White House) over the years.
AAHomecare encourages you to read both candidates healthcare plans and pay close attention to the congressional races. And don’t forget to vote on November 4!
To help in your research, AAHomecare has gleaned information from both of the presidential candidates’ websites, the debates, and from the Kaiser Health Foundations 2008 Presidential Candidates Comparison website (http://www.health08.org/healthissues_sidebyside.cfm).
Both Senators consider homecare to be important and want to strengthen long term care policies. Barack Obama’s website state’s he supports the Community Choice Act of 2007 which would allow Americans with significant disabilities the choice of living in their community rather than having to live in a nursing home or other institution. He also supports Community Living Assistance Services and Supports (CLASS) Act which creates a voluntary budget-neutral national insurance program to assist adults with functional disabilities, allowing them to remain independent and in their communities. During the Republican ABC-Facebook debates which took place early in January, in Manchester, NH, John McCain advocated for home healthcare: “We need incentives for home healthcare as opposed to long term care. In my state of Arizona we adopted a proposal which incentivizes health care providers to keep people in home health care settings. It’s dramatically less expensive than long term care. In Arizona we have one half the numbers of people per capita in long term care facilities as the state of Pennsylvania. Incentives to keep cost down…there are no incentives in the system today.”
Both have made statements on Medicare fraud as well. Obama says he would empower the HHS Inspector General to fight fraud, implement anti-fraud measures in CMS contracting, expand the scope of Medicare and Medicaid audits, strengthen the federal False Claims Act, encourage states to go after fraud, and increase funding for Justice Department prosecutors and FBI agents to fight fraud. McCain simply states he advocates a zero tolerance policy towards Medicare fraud.
This is an important election year for congressional seats as well. Homecare has very strong champions in both political parties and we encourage DME providers to introduce themselves to the candidates and make sure new members of the Senate and House understand the value of homecare to their local communities. This is particularly important since most of the homecare policy has come out of Congress (not necessarily the White House) over the years.
AAHomecare encourages you to read both candidates healthcare plans and pay close attention to the congressional races. And don’t forget to vote on November 4!
Monday, October 27, 2008
Thirteen Recommendations for Eliminating Medicare Fraud
Tough new steps must be taken to prevent fraud and abuse in Medicare. The American Association for Homecare announced 13 specific recommendations that could eliminate most of the Medicare fraud attributed to the home medical equipment (HME) sector. The Association has been working with Congress and regulators over the past year to adopt tougher, more effective measures to combat Medicare fraud.
The specific recommendations made by the American Association for Homecare include:
Mandate Site Inspections for All New Home Medical Equipment Providers
A July 2008 GAO report underscored the need for CMS to ensure that its contractors are conducting effective site inspections for all new applicants for a Medicare supplier number.
Require Site Inspections for All HME Provider Renewals
All renewal applications should require an in-person visit by the National Supplier Clearinghouse (NSC), the contractor that CMS uses to ensure integrity in the Medicare program.
Improve Validation of New Homecare Providers
Additional validation of new providers should be included in a comprehensive and effective application process for obtaining a Medicare supplier number.
Require Two Additional Random, Unannounced Site Visits for All New Providers
Two unannounced site visits should be conducted by NSC during the first year of operation for new HME providers.
Require a Six-Month Trial Period for New Providers
The NSC should issue a provisional, non-permanent supplier number to new suppliers for a six-month trial period. After six months of demonstrated compliance, the provider would receive a “regular” supplier number.
Establish an Anti-Fraud Office at Medicare
CMS should establish an office with the sole mandate of coordinating detection and deterrence of fraud and improper payments across the Medicare and Medicaid programs.
Ensure Proper Federal Funding for Fraud Prevention
Increase federal funding to ensure that NSC completes site inspection and other anti-fraud measures.
Require Post-Payment Audit Reviews for All New Providers
Medicare’s program safeguard contractors should conduct post-payment sample reviews for six months worth of claims submitted to Medicare by new providers.
Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Medicare must analyze billings of new and existing providers in real time to identify aberrant billing patterns more quickly.
Ensure All Providers Are Qualified to Offer the Services They Bill
A cross-check system within Medicare databases should ensure that homecare providers are qualified and accredited for the specific equipment and services for which they are billing.
Establish Due Process Procedures for Suppliers
CMS should develop written due process procedures for the Medicare supplier number process, including issuance, denial and revocation of the Medicare supplier number. The procedures must include, for example, an administrative appeals process and timelines.
Increase Penalties and Fines for Fraud
Congress should establish more severe penalties for instances of buying or stealing beneficiaries’ Medicare numbers or physicians’ provider numbers that may be used to defraud the government.
Establish More Rigorous Quality Standards
Ensure that all accrediting bodies are applying the same set of rigorous standards and degree of inspection to their clients.
For more information, visit the Newsroom at www.aahomecare.org.
The specific recommendations made by the American Association for Homecare include:
Mandate Site Inspections for All New Home Medical Equipment Providers
A July 2008 GAO report underscored the need for CMS to ensure that its contractors are conducting effective site inspections for all new applicants for a Medicare supplier number.
Require Site Inspections for All HME Provider Renewals
All renewal applications should require an in-person visit by the National Supplier Clearinghouse (NSC), the contractor that CMS uses to ensure integrity in the Medicare program.
Improve Validation of New Homecare Providers
Additional validation of new providers should be included in a comprehensive and effective application process for obtaining a Medicare supplier number.
Require Two Additional Random, Unannounced Site Visits for All New Providers
Two unannounced site visits should be conducted by NSC during the first year of operation for new HME providers.
Require a Six-Month Trial Period for New Providers
The NSC should issue a provisional, non-permanent supplier number to new suppliers for a six-month trial period. After six months of demonstrated compliance, the provider would receive a “regular” supplier number.
Establish an Anti-Fraud Office at Medicare
CMS should establish an office with the sole mandate of coordinating detection and deterrence of fraud and improper payments across the Medicare and Medicaid programs.
Ensure Proper Federal Funding for Fraud Prevention
Increase federal funding to ensure that NSC completes site inspection and other anti-fraud measures.
Require Post-Payment Audit Reviews for All New Providers
Medicare’s program safeguard contractors should conduct post-payment sample reviews for six months worth of claims submitted to Medicare by new providers.
Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Medicare must analyze billings of new and existing providers in real time to identify aberrant billing patterns more quickly.
Ensure All Providers Are Qualified to Offer the Services They Bill
A cross-check system within Medicare databases should ensure that homecare providers are qualified and accredited for the specific equipment and services for which they are billing.
Establish Due Process Procedures for Suppliers
CMS should develop written due process procedures for the Medicare supplier number process, including issuance, denial and revocation of the Medicare supplier number. The procedures must include, for example, an administrative appeals process and timelines.
Increase Penalties and Fines for Fraud
Congress should establish more severe penalties for instances of buying or stealing beneficiaries’ Medicare numbers or physicians’ provider numbers that may be used to defraud the government.
Establish More Rigorous Quality Standards
Ensure that all accrediting bodies are applying the same set of rigorous standards and degree of inspection to their clients.
For more information, visit the Newsroom at www.aahomecare.org.
Monday, September 22, 2008
AAHomecare Takes a Stand Against Medicare Fraud
In recent months the media and Congress have been focusing on Medicare fraud and initiatives to help curtail the rising cost associated with fraud. The American Association for Homecare (AAHomecare) supports Congress efforts. Fraud hurts all legitimate home medical equipment providers.
AAHomecare is currently working on a legislative strategy that will help keep criminals out of Medicare. The Association staff is reviewing specific measures that could be used by the Centers for Medicare and Medicaid Services (CMS) to stop fraud at the front-end of the payment process rather than relying on the current pay-and-chase system. The measures focus on increased scrutiny of new HME providers, real-time claims analysis, and accreditation, among other topics.
Over the past year, AAHomecare has worked closely with congressional offices on two separate anti-fraud efforts, including a rational approach to implementation of surety bond requirements for home medical equipment. In addition, AAHomecare staff provided input to Senators drafting the STOP Act, (Seniors and Taxpayers Obligation Protection Act of 2008, S. 3164) which requires the Secretary of Health and human services to change the Medicare beneficiary identifier used to identify Medicare beneficiaries under the Medicare program.
The Association has gone on record opposing the exemption from accreditation requirements for “eligible professionals” as outlined in section 154 (b)(F) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). According to CMS, this includes physicians, physical or occupational therapists, qualified speech-language pathologists and practitioners are exempt as “eligible professionals.” This list also includes physician assistants, certified registered nurse anesthetists, and clinical social workers, among others. Home medical equipment providers are not exempt. AAHomecare has also opposed an earlier announcement by CMS to postpone the accreditation deadline for providers taking part in Round Two of the DMEPOS Competitive Bidding Program.
Tyler J. Wilson, president and CEO of AAHomecare has commented that “accreditation helps to ensure that patients receive high-quality homecare, and it is also an important tool in preventing fraud in the Medicare program.”
AAHomecare is currently working on a legislative strategy that will help keep criminals out of Medicare. The Association staff is reviewing specific measures that could be used by the Centers for Medicare and Medicaid Services (CMS) to stop fraud at the front-end of the payment process rather than relying on the current pay-and-chase system. The measures focus on increased scrutiny of new HME providers, real-time claims analysis, and accreditation, among other topics.
Over the past year, AAHomecare has worked closely with congressional offices on two separate anti-fraud efforts, including a rational approach to implementation of surety bond requirements for home medical equipment. In addition, AAHomecare staff provided input to Senators drafting the STOP Act, (Seniors and Taxpayers Obligation Protection Act of 2008, S. 3164) which requires the Secretary of Health and human services to change the Medicare beneficiary identifier used to identify Medicare beneficiaries under the Medicare program.
The Association has gone on record opposing the exemption from accreditation requirements for “eligible professionals” as outlined in section 154 (b)(F) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). According to CMS, this includes physicians, physical or occupational therapists, qualified speech-language pathologists and practitioners are exempt as “eligible professionals.” This list also includes physician assistants, certified registered nurse anesthetists, and clinical social workers, among others. Home medical equipment providers are not exempt. AAHomecare has also opposed an earlier announcement by CMS to postpone the accreditation deadline for providers taking part in Round Two of the DMEPOS Competitive Bidding Program.
Tyler J. Wilson, president and CEO of AAHomecare has commented that “accreditation helps to ensure that patients receive high-quality homecare, and it is also an important tool in preventing fraud in the Medicare program.”
Friday, September 12, 2008
Orlando Sentinel Publishes Industry Response to Fraud and Abuse Column
Home care can help fix Medicare
Tyler J. Wilson, September 12, 2008
The Orlando Sentinel's Sept. 4 editorial, "Congress needs to crack down on Medicare fraud to protect the program," states the obvious by using the word "outrageous" to describe the billions of dollars lost each year to Medicare fraud. There is plenty of blame to go around.
Yes, Congress needs to insist that the federal agency that oversees Medicare receives and wisely spends a greater proportion of resources on fraud prevention.
Yes, the federal agency, Centers for Medicare & Medicaid Services, needs to do a much better job of using its authority and resources that Congress has already approved and implement some fraud-prevention measures that Congress approved more than 10 years ago.
The home-medical-equipment and services industry, which criminals have targeted because it's easy to obtain Medicare-provider credentials, is doing its part to stop fraud. The industry insists on accreditation and other means of raising the bar for entry into Medicare as a provider of equipment and services.
However, some might conclude from the Sentinel's editorial that the decision by Congress to delay the controversial competitive-bidding program in order to reform and improve it was an effort by the industry to postpone or water down fraud prevention.
That is outrageous. Medicare fraud hurts the overwhelming majority of law-abiding home-medical-equipment providers who carefully comply with the crushing volume of Medicare paperwork and the dramatically declining reimbursement rates. The paperwork and declining reimbursement rates are making it harder and harder to provide the level of service that elderly and disabled home-care patients need.
When Congress recently enacted the Medicare Improvements for Patients and Providers Act of 2008, it strengthened the anti-fraud measures for the home-medical-equipment sector, and it closed a loophole that would have allowed unaccredited providers to serve Medicare patients. The Sentinel's editorial also failed to point out that the industry agreed to another large reimbursement cut in order to save taxpayers the more-than $1 billion they would have saved had the flawed bidding program gone forward.
There are many more steps that need to be taken to prevent fraud. The American Association for Homecare is developing an aggressive, comprehensive plan that it will share with concerned lawmakers such as Sen. Mel Martinez and regulators at CMS to prevent fraud.
It's important to avoid smearing the home-care sector in order to draw attention to the criminals who have been allowed to abuse Medicare.
The ultimate victims are Medicare beneficiaries and taxpayers who benefit from high-quality, cost-effective medical equipment and services provided in the comfort of the home rather than in more-expensive institutional settings. Fraud steals away resources that seniors and people with disabilities need. Lawmakers and regulators respond by punishing the entire home community.
Homecare is part of the solution to the Medicare crisis; it's not the problem. Lawmakers, regulators and the media should keep that in mind.
Tyler J. Wilson is president of the American Association for Homecare in Arlington, Va.
To view the Orlando Sentinel version please visit: http://www.orlandosentinel.com/news/opinion/letters/orl-myword12bwilson08sep12,0,1327223.story
Tyler J. Wilson, September 12, 2008
The Orlando Sentinel's Sept. 4 editorial, "Congress needs to crack down on Medicare fraud to protect the program," states the obvious by using the word "outrageous" to describe the billions of dollars lost each year to Medicare fraud. There is plenty of blame to go around.
Yes, Congress needs to insist that the federal agency that oversees Medicare receives and wisely spends a greater proportion of resources on fraud prevention.
Yes, the federal agency, Centers for Medicare & Medicaid Services, needs to do a much better job of using its authority and resources that Congress has already approved and implement some fraud-prevention measures that Congress approved more than 10 years ago.
The home-medical-equipment and services industry, which criminals have targeted because it's easy to obtain Medicare-provider credentials, is doing its part to stop fraud. The industry insists on accreditation and other means of raising the bar for entry into Medicare as a provider of equipment and services.
However, some might conclude from the Sentinel's editorial that the decision by Congress to delay the controversial competitive-bidding program in order to reform and improve it was an effort by the industry to postpone or water down fraud prevention.
That is outrageous. Medicare fraud hurts the overwhelming majority of law-abiding home-medical-equipment providers who carefully comply with the crushing volume of Medicare paperwork and the dramatically declining reimbursement rates. The paperwork and declining reimbursement rates are making it harder and harder to provide the level of service that elderly and disabled home-care patients need.
When Congress recently enacted the Medicare Improvements for Patients and Providers Act of 2008, it strengthened the anti-fraud measures for the home-medical-equipment sector, and it closed a loophole that would have allowed unaccredited providers to serve Medicare patients. The Sentinel's editorial also failed to point out that the industry agreed to another large reimbursement cut in order to save taxpayers the more-than $1 billion they would have saved had the flawed bidding program gone forward.
There are many more steps that need to be taken to prevent fraud. The American Association for Homecare is developing an aggressive, comprehensive plan that it will share with concerned lawmakers such as Sen. Mel Martinez and regulators at CMS to prevent fraud.
It's important to avoid smearing the home-care sector in order to draw attention to the criminals who have been allowed to abuse Medicare.
The ultimate victims are Medicare beneficiaries and taxpayers who benefit from high-quality, cost-effective medical equipment and services provided in the comfort of the home rather than in more-expensive institutional settings. Fraud steals away resources that seniors and people with disabilities need. Lawmakers and regulators respond by punishing the entire home community.
Homecare is part of the solution to the Medicare crisis; it's not the problem. Lawmakers, regulators and the media should keep that in mind.
Tyler J. Wilson is president of the American Association for Homecare in Arlington, Va.
To view the Orlando Sentinel version please visit: http://www.orlandosentinel.com/news/opinion/letters/orl-myword12bwilson08sep12,0,1327223.story
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