BALTIMORE - If you tuned into this week's Open Door Forum to find out whether you can use an advanced beneficiary notice (ABN) for a Medicare beneficiary whose ordering or referring physician refuses to register with PECOS, you were disappointed.
Three HME providers asked that question during the Q&A portion of the forum, and each time, CMS officials told them: Give us your phone number; we'll give you call.
The third provider asked, "Can't you share that here?" Nope.
The question was first asked during an Open Door Forum on Jan. 20. CMS officials told providers during that forum that they would have an answer at the next forum.
The good news: One of the providers who asked the question during last week's forum told HME News that he did get a call from, not one, but two CMS officials shortly after the forum ended.
The first official told him "the reason he didn't want to respond to the question during the forum was that he wanted to make sure he understood the question correctly and that he could route it to the right person," said Victor Lopez, an intake coordinator at Hartmann Brothers Medical in Montrose, Colo.
The second official told him "using an ABN in that situation wouldn't be appropriate."
"I anticipated that they were going to say that," Lopez said. "However, knowing there are some hard-headed providers out there who plan on using it, I wanted to know for sure."
During the forum, Lopez told CMS officials: "We have some cantankerous, old-country docs that, flat-out, don't think they need to do this"—not by the Jan. 3, 2011, deadline, not ever.
Providers can take some consolation in this: The second official who called Lopez told him that CMS is preparing a "fairly stern letter" that will be distributed to physicians explaining they must register with PECOS or risk losing their privileges of ordering or referring DME.
"It sounds good politically, but we'll see what happens," Lopez said.
The next Open Door Forum: April 14 at 2 p.m. EST. Dial 1-800-837-1935 and use the ID 61772075.
 

WASHINGTON - A bill that would require Medicare to cover compression garments and other items used to treat lymphedema began making the rounds in February, but some industry stakeholders say it needs some clarification.
Introduced Feb. 23 by Rep. Larry Kissell, D-N.C., the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, would improve the diagnosis and treatment of lymphedema under the Medicare program. Among other things, the bill, H. R. 4662, seeks to establish Medicare coverage for compression bandage systems, compression garments and compression devices.
"The garments are used every day (by patients) and they are the backbone of the treatment," said Robert Weiss, a volunteer advocate with grassroots organization National Lymphedema Network, who helped get the bill introduced.
The bill also seeks to define who can provide the garments. The list includes nurses; physicians and physician assistants; chiropractors; licensed massage therapists; licensed home health practitioners; and licensed prosthetists and orthotists. Also on the list: someone certified by the manufacturer of an item to provide that particular item.
That's where the bill gets a little gray.
"The bill in many ways limits the provision of services to those particular disciplines," said Rhonda Turner, executive director of the American Association of Breast Care Professionals. "It does have some language saying 'anyone else deemed appropriate by the DHHS secretary.' We want to see if they could have a little bit more definition of that provider list."
The bill may simply need some tweaks, she said.
Ultimately, Weiss said, the bill "attacks" a number of large problems that prevent patients from getting proper care, and proper care would save the government money.
"If you treat the lymphedema, you are avoiding very expensive and hard-to-treat cellulitis, which can require hospitalization," he said.
At the end of the day, the bill is a step in the right direction, said stakeholders.
"While H.R. 4662 leaves many unanswered questions and concerns, we are encouraged that the bill will serve to raise awareness to the issue of lymphedema and the need for services/items to be covered without exception by commercial insurances and Medicare/Medicaid," said Turner.
 

ROCKY HILL, Conn. - Therapists, clinical managers and even other complex rehab providers now have one place to go for education on all things seating and mobility.
ATG Rehab has developed a Web site, http://www.atgrehab.com/?page_id=1396, that lists not only the educational programs that it offers but also those offered by the University of Pittsburgh, and various industry manufacturers and consultants.
"It's what we call at the university a supercourse," said Mark Schmeler, an instructor in UPitt's Department of Rehabilitation Science and Technology, who helped develop the Web site. "Instead of searching multiple sites to get to the courses you want, you go to one portal."
The programs are organized by mode of delivery: online (courses, and live and interactive Webinars) or in-person (regional or on-site). Some programs are free; others, because they're for continuing education units (CEUs), are not.
ATG Rehab has offered educational programs to therapists for years, usually in conjunction with manufacturers, but it developed the Web site after hearing from therapists that they wanted more and they wanted it more conveniently.
"They'd say 'I'm too busy' or 'I can't go because my employer won't let me due to budget constraints,'" said Jerry Knight, ATG Rehab's president of western regional operations. "So we looked in the mirror and asked ourselves, 'We're trying, but what else could we be doing; what else should we be doing?'"
The Web site is another step toward ATG Rehab's goal of becoming the "go-to source" on complex rehab, Knight said.
"We want to continue to build linkages to other Web sites and other sources of information," he said.
In that vein, Schmeler says he envisions consumers also using the Web site.
"This is just another good step in the maturity of rehab technology," he said.