CMS Relaxes the Date for CURES Act Changes for Durable Medical Equipment (DME) Billing

CMS has now backed off from the initial date of Dec 31, 2017, and stated that it will work with state Medicaid programs for different compliance and reimbursement plans. CURES ACT related to Medicaid update was first released in early December. In view of various physicians and surgeons, CMS has now revised the ruling stating that Medicaid directors will not have an impossible deadline and will look to seek a more collaborative approach related to compliance.

The original letter dated Dec 27, 2017, stated that state Medicaid programs had to notify CMS of their decision of aggregate payment comparisons or alternative approach to compliance. This gave state programs a few days to make an important decision on medical billing.

The new guidance issued by CMS on 4th Jan gave in a more flexible structure of guidelines for the state programs to follow.

  1. State facilities that decided to change their state Medicaid plan for the DME payment. For this the facilities who pay at or less than Medicare rates for the DME products or the facilities who have amended the state developed fee schedules, all the above facilities must submit a state amendment plan by March 31, 2018. The implementation day for the amendment plan should be before Jan.1, 2018.
  2. For all the state programs which went in for the APM or aggregate payment comparison. CMS has stated that it will work with such programs to determine the best option which will be used to calculate the state expenditure for the period of Jan.1, 2018 to Dec. 31, 2018.
  3. If the state makes any changes in the compliance method they should notify the CMS on or before the Dec.31 of that year. The submitted demonstration could be completed by Jan.1 to Dec.31 of the year and will be submitted by March 31.

A Durable Medical Equipment (DME) Provider from Ohio who was communicated the Cures Act changes were pleased and issued a statement saying “ The change by CMS is quite welcoming for us we can take a better-informed decisions on how to allocate resources and maintain the access for Medicare beneficiaries depending on Home Medical Equipment and related services we provide.”

The Cures act currently offers a relive for the HME facilities that depend on the state Medicare reimbursement but this might be a time for you to look for a change.

The Cures Act which was passed in 2016 to provide relief to various state DME providers and patients affected by the national expansion of competitive bidding for all the new non-bid areas. The act was also passed to help accelerate the plan to limit the federal matching of Medicaid reimbursements for HME. This was done for all the Medicare HME which had Fee-for-Service payment rates including the items whose price derived from competitive bidding.

As the Cures Act would implement reimbursement based on the competitive bidding where derived pricing which is set to start impacting Medicaid beneficiaries. There is a popular belief that HME suppliers are struggling to serve the vulnerable patient population. According to one of our Home Medical Equipment (HME) provider at Alabama, “Home Medical Equipment community will need relief soon with most of our population who require HME are highly vulnerable patient population.”

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Medical Billers and Coders (MBC) is a foremost Durable Medical Equipment Billing company in the U.S. serving over 40 DME clients. We have reduced the billing time to less than 30 days for 90 percent of the claims without affecting the billing practice. We at MBC have a certified team of coders and skilled billers who are preparing for any regulation changes in your DME billing.