**This is a snippet from an article in the February 2013 edition of Vista Notes**
The most substantial provision affecting DME providers in the American Tax Payer Relief Act of 2012 (ATRA) is the provision to reduce all diabetic supplies (including strips, lancets and control solution sold in retail stores) to mail order rates effective 4/1/2013. This equates to a 14% cut in the upcoming months. More devastating than this is the next provision to subject retail diabetic supplies to national mail order rates as soon as that program goes into effect on 07/01/2013. We know now that this will equate to a 72% cut across the board even if you did not participate in the bid program.
Medicare providers that are enrolled as ”participating providers” will most likely have to take the supplies off the shelf and cease selling them in their stores because the prices are not sustainable. “Non-participating providers” will be left with no choice but to file claims non-assigned. While non-participating providers can CHOOSE to accept assignment on a case-by-case basis, they also have the right to file claims on a non-assigned basis. Non-assigned claims allow providers to collect the retail price up front and, after the claim is filed, Medicare remits payment to the beneficiary directly. Beneficiaries will likely come out of pocket only a few times before they switch to a much cheaper, contracted, mail-order provider that will be forced to accept the cuts.
Because of the doc-fix provisions in ATRA and ensuing fee schedule changes for physicians, Medicare did extend the deadline to change participation status through 02/15/2013. If you intend to change your participation status with Medicare, you must submit a letter signed by the Authorized Official to the National Supplier Clearinghouse and have it postmarked no later than today 02/15/2013. Normally the Open Enrollment deadline would have already been closed effective 12/31/2012. If you are a participating provider selling retail diabetic supplies and you do not want to accept assignment on these products, you may want to consider changing your status. However, if you have multiple lines of business, such as a hospital-owned DME, the participation status must be the same for all entities… if the hospital is participating; the DME line of business must also remain participating. To quickly see if you are listed as a participating supplier, visit this link, and enter the zip code where you are located along with a product you sell, then hit search. If you see a green “P” next to your business, you are registered as a participating provider and must accept Medicare fee schedule rates on any covered product you sell to Medicare beneficiaries (unless you file the paperwork to change your participation status). If there is no green “P” next to your business, there is no need to worry about the deadline and you already have the flexibility to choose assignment on a case-by-case basis. Your final decision to participate or not should be heavily weighted on your product mix and the Medicare fee schedule viability as it relates to your business. For additional questions, arrange to speak with Reimbursement Consultant Andrea Stark at (803)-462-9959 ext. 246.