Late this afternoon, CMS published the long anticipated July Fee Schedule Update for the DME Medicare program. These rates materialize the full impact of national pricing expansion derived from competitive bid rates. The official file can be downloaded by visiting the CMS website.
We have prepared a sample chart to help you evaluate the reductions in the context of common HCPCS over the 2015 fee schedule reimbursement rates. The cuts range between 45-59% on common respiratory products, but reached 82% on TENS units and Enteral IV Poles. (You may find it easier to read the chart by copying and pasting the image into a Word document or other program that allows you to stretch the image).
We have prepared a sample chart to help you evaluate the reductions in the context of common HCPCS over the 2015 fee schedule reimbursement rates. The cuts range between 45-59% on common respiratory products, but reached 82% on TENS units and Enteral IV Poles. (You may find it easier to read the chart by copying and pasting the image into a Word document or other program that allows you to stretch the image).
The only means to delay these cuts will rest in the hands of lawmakers. Yesterday, the Senate passed S 2736, a bill to delay the Medicare DME cuts for one year. The bill includes a three month escalation of the mandatory Medicaid cuts to now take effect on October 1, 2018 instead of January 1, 2019. The Medicaid Cuts mandated in previous legislation force Medicaid to lower their reimbursement to no higher than active Medicare rates. To put this into perspective, to sell a box of diabetic test strips to a Medicaid recipient, current reimbursement might be as high as $33 or more a box, but when Medicare rates become the ceiling, they will only reimburse Medicaid providers $8.32 a box. All of the rates above will be further forced on Medicaid agencies as well.
The next step will be to get House buy-in. Unfortunately, the House had adjourned until July 5 and will not be conducting business until after the recess. Details are just coming to light, but if the bill moves to the House of Representatives for a vote under suspension, it will require a two thirds vote to pass the House. This equates to 290 “Yes” votes. The House version of the bill, HR 5210, currently sits at 117 Co-Sponsors – that doesn’t mean we won’t get more votes, but we need more committed representatives to reach the magic number of votes and ultimately get the bill on the President’s desk. In the latest update from Capitol Hill, the House may be considering an amended version which will grant only a three month delay to the Medicare cuts. The change stems from concerns about the Medicaid "payfor" provision. There is no time like the present to voice your concerns directly to your congressman (especially in the House) to garner support for substantive relief. To email your member of Congress visit http://www.house.gov/ then enter your zip code. Click the envelope icon next to your representative's name to send electronic correspondence and express your desire to speak with someone from their office after the recess. You may also dial the US Capitol Switchboard at (202) 224-3121 and request to be routed to your congressman's office to speak with their office or leave a message. Encourage your staff, family and customers to light up the lines, too.
In the interim, if you need help digesting the numbers or discussing other aspects of your operations that may need a boost, please know that our firm is here to help.
The next step will be to get House buy-in. Unfortunately, the House had adjourned until July 5 and will not be conducting business until after the recess. Details are just coming to light, but if the bill moves to the House of Representatives for a vote under suspension, it will require a two thirds vote to pass the House. This equates to 290 “Yes” votes. The House version of the bill, HR 5210, currently sits at 117 Co-Sponsors – that doesn’t mean we won’t get more votes, but we need more committed representatives to reach the magic number of votes and ultimately get the bill on the President’s desk. In the latest update from Capitol Hill, the House may be considering an amended version which will grant only a three month delay to the Medicare cuts. The change stems from concerns about the Medicaid "payfor" provision. There is no time like the present to voice your concerns directly to your congressman (especially in the House) to garner support for substantive relief. To email your member of Congress visit http://www.house.gov/ then enter your zip code. Click the envelope icon next to your representative's name to send electronic correspondence and express your desire to speak with someone from their office after the recess. You may also dial the US Capitol Switchboard at (202) 224-3121 and request to be routed to your congressman's office to speak with their office or leave a message. Encourage your staff, family and customers to light up the lines, too.
In the interim, if you need help digesting the numbers or discussing other aspects of your operations that may need a boost, please know that our firm is here to help.
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