Latest Updates: COVID-19 and HME

Stay tuned to this page for the latest on COVID-19 and the HME industry.

HME clients, colleagues, and friends: You remain Prochant’s number one priority during the COVID-19 pandemic. We are working hard to support you in this time of uncertainty.

To that end, we are providing you with the latest updates on COVID-19’s impact to our industry on our HME billing blog. Please tune in here for daily updates and share this link with your HME/DME coworkers and colleagues. Together, we will weather this storm.

Updates for Tuesday, May 26, 2020

Time: 2:15 p.m. EDT
Source: AAHomecare
Description: AAHomecare reports that it is collecting comments for the Interim Final Rule (IFR), which was released on April 6, 2020 and provided relief on coverage for respiratory products. CMS allows for the public to submit comments on changes.

AAHomecare’s requested changes are as follows:

  • Documentation to support the “reasonable and necessary” requirement for respiratory-related products during the PHE should include a physician’s standard written order (SWO) and documentation that the beneficiary has some type of respiratory-related acute or chronic condition.
  • Provide clarification that all beneficiaries with an initial date of service during the PHE will continue to be covered under the medical review criteria in effect during the PHE, throughout that beneficiary’s period of medical need, as determined by the physician. In addition, any beneficiary on home oxygen therapy whose 3 and/or 12-month recertification occurs during the PHE, should be deemed to have met the medical necessity requirements in place during the PHE.
  • Clarify in a FAQ that if a physician orders a CPAP for a beneficiary during the PHE, and there is some evidence of the beneficiary having a respiratory condition, then an initial sleep study is not required, and the claim would be deemed to meet the “reasonable and necessary” requirement.
  • Provide written clarification in a FAQ that the physician does not need to have an in-person meeting with the beneficiary but can utilize his/her clinical judgement and review of the patient and his/her medical records to meet this requirement, for the duration of the PHE.
  • Suspend the enforcement of the clinical conditions for coverage for hospital beds, as CMS has done for respiratory DME items, for the duration of the PHE.
  • Instead of resuming TPEs that were in process as of the beginning of the PHE, CMS should cancel those TPEs.  At the end of the PHE, CMS should instruct the MACs to begin new TPEs based on new data analysis.
  • Postpone the implementation of Round 2021 DME competitive bidding program.

Updates for Thursday, May 21, 2020

Time: 8:00 a.m. EDT
Source: ACMESA
Description: North Carolina’s Governor, Roy Cooper, has issued Executive Order No. 139, which provides additional regulatory flexibility to help prevent overloading the state’s health care system. The order also improves the state’s ability to respond to the pandemic.

View the full press release now.

Updates for Monday, May 18, 2020

Time: 12:00 p.m. EDT
Source: Great Lakes Home Medical Services Association
Description: Members of the Great Lakes Home Medical Services Association are invited to tune in tomorrow at 10:30 a.m. – 12:30 p.m. for a new webinar, “Phase into the New Normal.” The webinar is presented by VGM’s Government Relations team and Phillips Respironics for Great Lakes and OAMES members only. A variety of speaker will discuss HME best practices, “opening up” protocols, and more.

Register for the webinar now.

Updates for Thursday, May 14, 2020

Time: 8:00 a.m. EDT
Source: AAHomecare
Description: A recent survey of more than 500 home medical equipment suppliers shows that the COVID-19 pandemic is seriously impacting suppliers’ access to products on account of supply chain disruptions and rising prices from manufacturers and distributors. The survey results show a rapidly changing operational and product cost landscape that presents significant challenges for an industry already dealing with unsustainable reimbursement rates from Medicare and other payer segments.

Updates for Wednesday, May 13, 2020

Time: 10:00 a.m. EDT
Source: PAMS
Description: Carnegie-Mellon University has developed a risk-based decision support tool to help safely reopen the Pennsylvania economy and achieve the following policy goals:

  • Minimize the diffusion of COVID-19
  • Maximize a rapid return to work and revitalize key industries
  • Limit long-term economic impact of COVID-19 & the shut down
  • Achieve equitable outcomes for vulnerable residents

Access this support tool now.

Updates for Monday, May 11, 2020

Time: 11:30 a.m. EDT
Source: Handtevy Pediatric Emergency Standards
Description: COVID-19 is manifesting as Kawasaki Disease in children. Numerous reports from the UK, and now, from hospitals in NY, report that children exposed to the virus can later develop signs and symptoms of a commonly known childhood disease called Kawasaki Disease. Symptoms are fevers for at least five days, rash, lymphadenopathy, red eyes, red lips and irritability.

Updates for Friday, May 8, 2020

Time: 2:30 p.m. EDT
Source: CGS
Description: CMS announced that the CMN for oxygen claims will not be required during the COVID-19 public health emergency. This waiver is due to the interim final rule that was published on April 6.

Time: 1:00 p.m. EDT
Source: HHS
Description: The Department of Health & Human Services (HHS) has extended the period to attest to receipt of Provider Relief Fund payments and accepted its related terms and conditions from 30 to 45 days from receipt of funds. Applicants now have until May 24 to submit.

Updates for Thursday, May 7, 2020

Time: 4:00 p.m. EDT
Source: CGS
Description: On April 6, 2020, CMS issued an interim final rule with comment (CMS-1744-IFC), establishing that certain requirements for face-to-face/in-person encounters will not apply during the COVID-19 public health emergency.

In addition, CMS-1744-IFC stated that the chief medical officer or the equivalent individual of a facility may authorize a physician of a different specialty than specified in a national coverage determination (NCD) or local coverage determination (LCD) to perform a service, procedure, or portion of a procedure. The chief medical officer or equivalent may also authorize a different practitioner type than the one specified in the NCD or LCD to perform the service or procedure.

In addition, CMS-1744-IFC finalized on an interim basis that CMS would not enforce various clinical indications of coverage found in specific NCDs, LCDs, and related policy articles. These interim final policies are effective for claims with dates of service on or after March 1, 2020 and for the duration of the COVID-19 Public Health Emergency (PHE).

See the full text from CGS here.

Time: 10:45 a.m. EDT
Source: AAHomecare
Description: Updated guidance is available for Aetna, Anthem, and Carecentrix via AAHomecare’s Third-Party Payer & MCO Tracking resource page. Visit this page now for complete updates.

Updates for Monday, May 4, 2020

Time: 2:30 p.m. EDT
Source: AAHomecare
Description: AAHomecare reports that CMS has released an updated fee schedule for non-rural and non-bid area suppliers based on the CARES Act legislation.

There is a 32% increase for suppliers in non-rural, non-bid areas for the top DME items versus the former 2020 rates. In addition:

  • 39% increase for E1390 (oxygen concentrator);
  • 41% increase for E0601 (CPAP);
  • and 9% increase for E1392 (portable oxygen concentrator).

Get the updated fee schedule in full now.

Updates for Friday, May 1, 2020

Time: 3:45 p.m. EDT
Source: VGM
Description: This week, HHS opened a new portal which allows providers, including DME providers, to submit claims to be reimbursed at Medicare reimbursement rates if they provided equipment and services to uninsured patients with a COVID-19 diagnosis. Some key highlights and provisions of the program are as follows:

  • Providers can begin submitting claims May 6th
  • Dates of service can be February 4th or after are eligible for reimbursement
  • Providers must enroll in the program (obtain an Optum ID – can be done HERE)
  • Claims must be submitted electronically
  • No contracting or credentialing required (administered through United Healthcare, but you do not need to be contracted or credentialed by them to participate)
  • Claim payment will occur approximately 7-10 days after submission

More details of the program can be found at the following links or by calling the Provider Support Line at 866-569-3522.

Time: 8:00 a.m. EDT
Source: AAHomecare
Description: AAHomecare reports that CMS has released a COVID-19 Interim Final Rule (IFR) with HME-related provisions. Key points include:

  • Discusses implementation of CARES Act language on rural and other non-bid-area reimbursement rates during the COVID-19 Public Health Emergency (PHE) and affirms that the 75/25 blended rates for non-rural, non-competitive bid areas will be implemented beginning March 6, 2020.
  • It expands PTs/OTs to the list of eligible practitioners who can conduct telehealth visits.
  • CMS will not be enforcing the clinical indications for therapeutic continuous glucose monitors in LCDs during this PHE.
  • Provides clarification on the first IFR that was published on March 31 regarding waiving clinical indications for coverage for respiratory, home anticoagulation management and infusion pump NCDs and LCDs (including articles), stating that even though the clinical conditions for coverage are being waived, the items and services must still be “reasonable and necessary.”
  • Generally, these provision are effective as of March 1, 2020, unless otherwise stated.

Get the full text of the IFR now.

Updates for Monday, April 27, 2020

Time: 4:00 p.m. EDT
Source: AAHomecare
Description: Applications are now available for the additional CARES Act funds. This second disbursement of funds is based upon 2018 net patient revenue. DMEPOS suppliers and other healthcare providers will need to submit revenue information as part of the application process.

Time: 3:30 p.m. EDT
Source: AAHomecare
Description: AAHomecare has created a new online Third-Party Payer & MCO Tracking Resource to help the industry keep track of policy changes amid COVID-19. The advocacy group has also compiled a State Medicaid COVID-19 Provider Resource & Waivers page.

Time: 12:00 p.m. EDT
Source: AAHomecare
Description: AAHomecare reports that CMS will no longer accept new applications for Advance Payments. CMS is also reevaluating pending and new applications for Accelerated Payments. Both changes are due to Congress passing a $75 billion addition to the Provider Relief Fund.

Find the full CMS announcement here. 

Time: 8:00 a.m. EDT
Source: UnitedHealthcare
Description: UnitedHealthcare has shared a comprehensive list of resources to help manage the claims submission and reimbursement process during COVID-19:

  • Telehealth Coding Scenarios: This guide has helpful examples of how UnitedHealthcare might reimburse for telehealth services during the national emergency, and we have additional coding and reimbursement guidance available on our website.
  • Expanded Telehealth Access: Policies around telehealth have been expanded across all of our health plans.
  • Timely Filing: Claims with a date of service on or after Jan. 1, 2020 will not be denied for timely filing deadlines if submitted by June 30, 2020.
  • Videos to Help Guide Billing: Two videos are available for easy visual instruction on billing for COVID-19-related office visits and laboratory tests.
  • Prior Authorization Requirements: Many requirements have been suspended or eased during the national emergency period. Review specific details and dates here.
  • CARES Act Training: UnitedHealth Group has been selected to facilitate delivery of CARES Act Provider Relief funding through the U.S. Department of Health and Human Services (HHS). This user guide will help you navigate the HHS provider portal, and this quick tutorial outlines what you need to know to request or confirm additional relief funding.

Updates for Friday, April 24, 2020

Time: 4:00 p.m. EDT
Source: Great Lakes Home Medical Services Association
Description: Great Lakes continues to work with Medicaid departments and commercial payers in its states requesting COVID-19 relief. This outreach began with a joint industry letter with policy recommendations to help HME suppliers better serve patients and ease burdens on hospitals during the COVID-19 crisis.

Great Lakes recently heard back from the vice president of Provider Network Management & Operations at Molina Healthcare of Michigan in a general response to the “asks” outlined in the letter.

The following is Molina’s response:

  • Implemented the MDHHS order on DME/oxygen.
  • Extended all prior authorizations until 9/01/2020 in case members could not obtain the services.
  • Molina does not require authorization for care until after evaluation plus 6 visits to allow for smooth hospital discharge planning.
  • Recently began daily claims check runs for providers to keep payments flowing for providers.
  • Molina allows 365 days for claims submissions.
  • As an HMO serving primarily government contracts, we are highly regulated by CMS, State Medicaid agency and Dept of Insurance & Financial Services.  With regards to audits, we are required to monitor services and conduct audits. We are being reasonable with time-frames to return medical records if an audit does occur.

Time: 11:00 a.m. EDT
Source: AAHomecare
Description: The House of Representatives has passed H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act, which provides additional funding for hospitals and health care providers, testing, and replenishing small business loan programs including the Paycheck Protection Program. The Senate approved the legislation on Wednesday.

The bill provides an additional $75 billion in funding for healthcare providers. Businesses seeking relief need to submit an application that demonstrates a need for funding. Read the full bill text now.

Time: 8:00 a.m. EDT
Source: PAMES
Description: The Compliance Team, in association with the Region D DAC, Big Sky, and PAMES, invites all members to a webinar, “COVID-19 Tips for DMEPOS Suppliers” on May 7, 2020, at 11:00 a.m. PDT.

Register for this webinar now.

Updates for Thursday, April 23, 2020

Time: 3:00 p.m. EDT
Source: HME News
Description: VGM Heartland announced that it will take its annual Heartland Conference online. The virtual event, called Heartland at Home, will take place June 15th through July 10. Tracks will include billing and reimbursement, business operations and leadership, respiratory, rehab, and accessibility. The finalized schedule will be available May 4th.

Updates for Wednesday, April 22, 2020

Time: 1:30 p.m. EDT
Source: Brown & Fortunato
Description: Brown & Fortunato have developed a detailed summary of the provisions in H.R. 266 that relate to the $75 billion in funding for providers.

Time: 12:00 p.m. EDT
Source: AAHomecare
Description: AAHomecare reports that the Senate has passed HR 266, legislation that provides additional funds for hospitals and health care providers, testing, and replenishing small business loan programs including the Paycheck Protection Program.

The bill provides an additional $75 billion for the Public Health and Social Services Emergency Fund, which recently provided funding for healthcare providers, including HME suppliers. For the new round, suppliers will need to submit an application demonstrating a need for funding.

Updates for Tuesday, April 21, 2020

Time: 8:00 a.m. EDT
Source: AAHomecare
Description: Today is the last day to take AAHomecare’s Operating Cost & Supply Chain Survey. The advocacy group will use the data to push for a competitive bidding delay of at least one year. Only one response is needed per company.

Take the supplier survey.

Take the manufacturer survey.

Updates for Monday, April 20, 2020

Time: 1:00 p.m. EDT
Source: ACMESA
Description: Industry veteran Ty Bellow will host a webinar, “Developing a Post COVID-19 Sales Strategy (Part I),” on Tuesday, April 21, at 2:00 p.m. EDT.

Register for the webinar now.

Updates for Saturday, April 18, 2020

Time: 8:00 a.m. EDT
Source: ACMESA
Description: ACMESA reports that the North Carolina Department of Health and Human Services and NC Medicaid are reaching out to beneficiaries about the benefits of telehealth services. To help beneficiaries learn more about telehealth, visit the Beneficiary COVID-19 Guidance and Resource webpage.

Updates for Friday, April 17, 2020

Time: 11:30 a.m. EDT
Source: Waystar
Description: On Wednesday, April 22, at 2 p.m. EDT, Waystar will host 3M Information Systems telemedicine coding expert, Colleen Deighan, to address provider FAQs about managing telehealth claims.

Register for the webinar now.

Time: 8:00 a.m. EDT
Source: MAMES
Description: MAMES reports that AAHomecare requests all suppliers, manufacturers, and distributors to fill out a survey on operating costs and the supply chain. The advocacy group will use the data to push for a delay in the competitive bidding program for at least one year. Only one response is needed per company.

Take the supplier survey now.

Take the manufacturer/distributor survey now.

Updates for Thursday, April 16, 2020

Time: 4:00 p.m. EDT
Source: AAHomecare
Description: The attestation portal for provider relief funds is now available. As AAHomecare noted last week, providers receiving these funds are required to sign an attestation that they are in compliance with the terms and conditions of the relief.

Time: 1:30 p.m. EDT
Source: AAHomecare
Description: AAHomecare will host a free webinar, “Payers in the Pandemic: Policy Updates from State and Commercial Payers,” on Tuesday, April 21, at 2:00 p.m. EDT. The webinar will feature payer relations experts in a discussion of the efforts around and policy updates from Medicaid and commercial payers during COVID-19.

Register for the webinar now.

Updates for Tuesday, April 14, 2020

Time: 11:30 a.m. EDT
Source: HME Business
Description: HME Business will host a webinar on May 12, 2020, on “Telehealth and HME: New Opportunities & New Realities.” Below is an overview of what attendees will learn.

  • What telehealth is and how it is used;
  • The core benefits of telehealth, including reimbursement;
  • How providers can implement telehealth with an eye on patient and referral satisfaction;
  • How does telehealth integrate with remote patient monitoring;
  • Why telehealth is a *must* during COVID-19;
  • Why telehealth will remain a requirement after the COVID-19 pandemic.

Register for the free webinar now.

Updates for Monday, April 13, 2020

Time: 3:00 p.m. EDT
Source: AAHomecare
Description: AAHomecare reports that suppliers receiving COVID-19 relief are required to accept the terms and conditions of their funds within 30 days. In addition, the advocacy group suggests that suppliers seek legal guidance if they are unsure about complying with these conditions.

Time: 2:30 p.m. EDT
Source: AAHomecare
Description: Noridian and CGS will be releasing all pending TPE reviews and will be paying those claims. Suppliers who have completed a TPE round prior to COVID-19 and have a scheduled education session may move forward with the scheduled session or request to reschedule it.

Updates for Friday, April 10, 2020

Time: 11:30 a.m. EDT
Source: Department of Health and Human Services (HHS)
Description: HHS announced that that it will distribute $30 billion of a $100 billion fund as part of the CARES Act to compensate Medicare suppliers/providers for expenses incurred and revenue lost due to the COVID-19 pandemic.  Most HME providers should qualify for these payments. HHS also emphasizes that these funds are payments, not loans, to healthcare providers, so they will not need to be repaid.

Time: 8:00 a.m. EDT
Source: CBIC
Description: CMS has removed non-invasive ventilators (NIVs) from the next round of the competitive bidding program due to the COVID-19 pandemic. Round 2021 marked the first time that NIVs were to be included as part of the program. More information is available here.

Updates for Thursday, April 9, 2020

Time: 3:00 p.m. EDT
Source: MiraVista
Description: MiraVista has reported on how DME order data can assist patients and physicians during the COVID-19 crisis. That is, although DME suppliers are seeing declines in new orders, they can help themselves, as well as patients and physicians, by offering insightful assistance to their patients and referral sources. Suppliers can send work to referral sources. For more details, read MiraVista’s blog.

Updates for Wednesday, April 8, 2020

Time: 8:00 a.m. EDT
Source: AAHomecare
Description: UnitedHealthCare has released key, new guidance to help HME providers during the COVID-19 pandemic. These guidelines apply to Medicare Advantage, Medicaid, and Individual Group Market health plan members with dates of delivery between March 31, 2020 and May 31, 2020.

Get more details here.

Updates for Tuesday, April 7, 2020

Time: 5:00 p.m. EDT
Source: CareCentrix
Description:  CareCentrix is working with its health plan clients to facilitate policy updates amid COVID-19. The policy changes here apply to DME providers through May 31st and are subject to extension as the pandemic evolves. CareCentrix will continue to update its providers on any policy changes.

Time: 1:00 p.m. EDT
Source: Washington State Health Care Authority (HCA)
Description: The HCA reports that it purchased a limited number of licenses for Zoom, the video conferencing technology that helps healthcare providers care for patients virtually. HCA has made those licenses available to providers through an application process and assures that these HCA-purchased licenses are as secure as possible.

HCA is taking the following security measures;

  • The licenses HCA purchased are under the Zoom for Healthcare. This is under a Health Insurance Portability and Accountability Act (HIPAA)-compliant business associate agreement.
  • We have configured the licenses to protect against video conference intrusions. This includes:
    • Clients coming into an appointment enter a virtual waiting room and can only be admitted by the provider.
    • Only the provider can share content via video screen.
    • Providers sending links only to patients.
    • Recording is disabled.

Updates for Monday, April 6, 2020

Time: 4:30 p.m. EDT
Source: CGS Medicare
Description: CMS recently published direction concerning the Targeted Probe and Educate (TPE) review strategy for their Medicare Administrative Contractors (MACs) in light of the COVID-19 Public Health Emergency (PHE).  As such, CGS Medicare wants to alert its supplier community to the actions CGS is taking immediately:

  • Suspension of all current TPE reviews until further notice.
  • Release of all pending claims for payment, including those in which a response was received but a decision not yet rendered.
  • Reversal of claims denied for non-response on or after March 1, 2020, unless a redetermination has been filed.

Time: 3:00 p.m. EDT
Source: Prochant (Internal)
Description: Prochant will be attending several events this week, including webinars from CMS and VGM to obtain clarification surrounding waived face-to-face requirements. We will then evaluate existing holds and other related tasks to build a client-by-client action plan.

Time: 12:00 p.m. EDT
Source: Becker’s Hospital Review
Description: Becker’s Hospital Review has conducted a state-by-state analysis to determine when each state will see the COVID-19 virus peak. Prochant recommends this as a good resource for providers trying to assess supply levels and needs.

Updates for Friday, April 3, 2020

Time: 2:00 p.m. EDT
Source: Center for Medicare & Medicaid Services (CMS)
Description: CMS released an Interim Final Rule (IFR) that covers various healthcare issues related to COVID-19.

While the IFR provides several pieces of DMEPOS relief, it does not include the one-year delay for the implementation of Round 2021 of competitive bidding.

DMEPOS provisions in the IFR:

  1. CMS won’t enforce clinical indications for coverage for respiratory, home anticoagulation management and infusion pump National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), including articles. CMS will resume enforcement of these clinical indications for coverage once the COVID-19 emergency has ended.

The LCDs and NCDs include:

  • NCD 240.2 Home Oxygen. NCD 240.4 Continuous Positive Airway Pressure for Obstructive Sleep Apnea.
  • LCD L33800 Respiratory Assist Devices (ventilators for home use).
  • NCD 240.5 Intrapulmonary Percussive Ventilator.
  • LCD L33797 Oxygen and Oxygen Equipment (for home use).
  • NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management.
  • NCD 280.14 Infusion Pumps.
  • LCD L33794 External Infusion Pumps.
  1. Face-to-face exams are not required for items that otherwise require them due to NCD or LCD. This does not apply to power mobility devices (PMDs), but telehealth is already allowed to be used to meet the face-to-face requirements of PMDs.
  2. The rule ensures that Medicare and Medicaid regulations are the same in terms of who can order medical supplies, equipment, and appliances.
  3. Advance payments are available for Part B providers.

The IFR regulations are applicable starting March 1, and immediately effective.

Time: 12:30 p.m. EDT
Source: AAHomecare
Description: AAHomecare reports that Humana and Anthem insurances have made key updates to their policies. These policy updates may be viewed here.

Time: 11:00 a.m. EDT
Source:
HME Business
Description: The President has employed the Defense Production Act to order Health and Human Services and the Department of Homeland Security to increase ventilator production via six manufacturers: General Electric, Hill-Rom Holdings, Medtronic, ResMed, Royal Philips and Vyaire Medical.

Time: 8:00 a.m. EDT
Source: Center for Medicare & Medicaid Services (CMS)
Description: CMS has reported on a quarterly update for the temporary gap period of the DMEPOS competitive bidding program, which takes effect on July 1, 2020. You may access the update here to see changes to HCPCS, zip codes, and supplier files.

Updates for Thursday, April 2, 2020

Time: 2:00 p.m. EDT
Source: ACMESA
Description: ACMESA members and non-members are invited to attend “COVID-19 & HME: An Update on CMS’ Interim Final Rule and HME Policy Changes,” a free webinar, on Tuesday, April 7, at 1:00 p.m. EDT. You may register for the webinar here. Speakers include Cara Bachenheimer, Kim Brummett, Miriam Leber, and Wayne van Halem.

Time: 8:00 a.m. EDT
Source: OAMES
Description: The Ohio Department of Health has announced a mandatory, statewide inventory of ventilators other breathing devices. This inventory must be reported by 5:00 p.m. each day until further notice. You may access the full announcement here.

Updates for Wednesday, April 1, 2020

Time: 4:00 p.m. EDT
Source: Regional Homecare
Description: Effective today, Harvard Pilgrim Commercial policies no longer require authorization for PAP supplies.

Time: 11:00 a.m. EDT
Source: U.S. Department of Health & Human Services (HHS)
Description: The HHS reports that the Office of Civil Rights (OCR) will not impose penalties for non-compliance with the regulatory requirements surrounding telehealth during the COVID-19 pandemic. Typically, there are concerns about HIPAA-covered health providers not fully complying with the requirements of HIPAA rules. However, OCR Director Roger Severino has emphasized the importance of using telehealth to reach those most at risk: the elderly and people with disabilities.

Time: 8:00 a.m. EDT
Source: Center for Medicare & Medicare Services (CMS)
Description: CMS has opened access to respiratory therapy, with Medicare covering devices and equipment for any medical reason during COVID-19.

In particular,

  • Clinicians have more flexibility in determining patient needs for respiratory-related devices and equipment;
  • The current NCDs and LCDs that restrict coverage of these devices and services to patients with certain clinical characteristics do not apply during the public health emergency;
  • Waiving signature requirements for DME when a signature cannot be obtained because of the inability to collect signatures related to COVID-19.

Updates for Tuesday, March 31, 2020

Time: 12:00 p.m. EDT
Source: AAHomecare
Description: AAHomecare reports that the Center for Medicare & Medicaid Services (CMS) has streamlined regulations for DME in its COVID-19 Interim Final Rule (IFR).

AAHomecare has identified the following provisions pertaining to Durable Medical Equipment included in the IFR:

1) CMS will not enforce clinical indications for coverage across respiratory, home anticoagulation management and infusion pump National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) (including articles). Enforcement of these clinical indications for coverage will resume once the COVID-19 emergency has ended.

  • NCD 240.2 Home Oxygen. NCD 240.4 Continuous Positive Airway Pressure for Obstructive Sleep Apnea.
  • LCD L33800 Respiratory Assist Devices (ventilators for home use).
  • NCD 240.5 Intrapulmonary Percussive Ventilator.
  • LCD L33797 Oxygen and Oxygen Equipment (for home use).
  • NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management.
  • NCD 280.14 Infusion Pumps.
  • LCD L33794 External Infusion Pumps.

2) Face-to-face exams are not required for items that otherwise require them due to NCD or LCD. This does not apply to Power Mobility Devices (PMD), but PMD is already allowed to use telehealth to meet face-to-face requirements.

3) Aligns Medicare and Medicaid regulations on who can order medical supplies, equipment, and appliances.

4) Advance payments are available for Part B providers.

The IFR specifically notes, “During the PHE for the COVID-19 pandemic, it is possible that patients receiving services for respiratory related indications will be required to receive care in unexpected settings, including the home. This may be necessary as COVID-19 and other patients are shifted across healthcare settings to accommodate an increase in patient volume.”

The Interim Final Rule regulations are applicable as of March 1, 2020, and effective immediately.

Time: 9:30 a.m. EDT
Source: Region D DAC
Description: The U.S. Small Business Administration is providing disaster loan assistance to disadvantaged businesses or businesses with fewer than 500 employees. Loans are only available to those businesses that are currently certified.

Time: 8:00 a.m. EDT
Source: Centers for Medicare & Medicaid Services (CMS)
Description: CMS has published a special document that details the temporary regulatory waivers
and new rules that will equip the American healthcare system with maximum flexibility to respond to COVID-19. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration.

In particular, please see the “patients over paperwork” section:

  • Waiver of replacement requirements when supplies are lost, destroyed, irreparably damaged, or otherwise rendered unusable;
  • PAs paused for certain items;
  • Signature requirements relaxed;
  • Accelerated/advance payments.

Updates for Monday, March 30, 2020

Time: 2:45 p.m. EDT
Source: AAHomecare
Description: AAHomecare has developed a rate increase analysis tool for non-rural/non-bid suppliers during the COVID-19 pandemic. As part of the new stimulus bill, suppliers servicing Medicare beneficiaries in these areas will receive relief.

The reimbursement rate for items that have been receiving 100% of the competitive bidding adjusted fee schedule will be a blended rate of 75% adjusted and 25% unadjusted (2015 fee schedule) rates. According to AAHomecare’s estimates, suppliers in these areas areas will see a rate increase of about 30%.

AAHomecare analyzed the new rates for the top 25 HCPCS codes for each region. Their region-by-region analyses are below:

Time: 1:30 p.m. EDT
Source: AAHomecare
Description: The stimulus bill passed and signed into law last week contains provisions that will permanently allow physician assistants, nurse practitioners, and clinical nurse specialists to order DMEPOS for Medicare and Medicaid beneficiaries. Prior to this legislation, these healthcare providers were only allowed to order DMEPOS for Medicare beneficiaries.

**Please note: This relief will go into effect in approximately 6 months.**

Time: 10:00 a.m. EDT
Source: Centers for Medicare & Medicaid Services (CMS)
Description: CMS has announced an expansion of its accelerated and advance payment program for Medicare-participating providers/suppliers to ensure they have resources to combat COVID-19.

Time: 8:00 a.m. EDT
Source: PAMS
Description: PAMS was contacted by the Governor’s Critical Medical Supplies Procurement team to assist with supplies needed due to the COVID-19 pandemic. If your company has access to any items that are critically needed, please fill out the Critical Medical Supplies Procurement Form. Right now, PPE, hand sanitizer and ventilators are critically needed.

Updates for Friday, March 27, 2020

Time: 3:00 p.m. EDT
Source: HME News
Description: HME News reports that a stimulus package passed by Congress will provide a financial boost to HME providers caring for patients during the current coronavirus pandemic.

Time: 8:00 a.m. EDT
Source: OAMES
Description: The Ohio Department of Medicaid has tentatively committed to address and accommodate the issues raised in AAHomecare’s commerical payor letter. These requests include:

  • Provide coverage for short term oxygen for beneficiaries with acute conditions to ease hospital overflow issues. (item 1)
  • Waive prior authorization requirements for exceeding quantity limitations on gloves, incontinence, urological, ostomy, oxygen, suction, ventilators. (item 4)
  • Waive any face-to-face requirements if prescriber couldn’t or wouldn’t do an office visit and allow telehealth visits to meet requirements while waiving the video component. (item 6) **See info below specific to Ohio’s emergency telehealth rule.
  • Allow additional oxygen, PAP, ventilator, and suction supplies for patients who become sick or diagnosed with COVID-19.  (item 9)
  • Waive signature requirements for proof of delivery on HME items; including allowance of text, email, photographic, or confirmed shipment receipt from third-party carrier evidence to validate proof of delivery during COVID-19 crisis. (item 10) **This is consistent with an ODA directive and couriers such as FedEx and UPS no longer requiring signatures.
  • Waive all place of service edits that would normally result in a claim denial for HME while a patient is placed in an in-patient facility related to COVID-19. (item 11)
  • Allow any requirements for clinician and/or Assistive Technology Professional (ATP) in-person engagement for complex rehab wheelchairs and accessories to be met through the use of remote technology. (item 15)
  • Allow that DMEPOS suppliers be categorized as “essential services” to allow delivery to quarantined areas. (item 16)
  • Allow prescribers not currently enrolled in Medicaid program to order DMEPOS (item 17)
  • It is imperative that provider cashflow is not interrupted to ensure providers are able to continue servicing patients in this time of need.  Claims adjudication and processing must occur on normal schedule.  (item 19)

Updates for Thursday, March 26, 2020

Time: 1:00 p.m. EDT
Source: Medicaid
Description: DHCS submitted an extensive waiver request last week to eliminate certain requirements for the Medi-Cal program. Of interest is the waiving some of the “face-to-face” requirements, provider documentation for TARs, and more to authorize and reimburse for services.

Time: 12:00 p.m. EDT
Source: Northwood
Description: Northwood has released a provider bulletin with frequently asked questions about DMEPOS and COVID-19. Click here to access these FAQs.

Time: 9:30 a.m. EDT
Source: Sleep Services of America (SSA)
Description: Due to the state of emergency declared in New York State, Local 1199 will not require authorization for outpatient services.  Sleep testing both in-lab and home testing HST are outpatient services.  SSA must still verify benefits and eligibility during this time by calling a 24-hour automated phone line 888-819-1199.

Time: 8:00 a.m. EDT
Source: AAHomecare
Description: AAHomecare reports that the Senate stimulus bill eliminates the 2% sequestration reduction during the COVID-19 pandemic. This bill passed in the House last night and will likely be signed by the President today.

Updates for Wednesday, March 25, 2020

Time: 2:00 p.m. EDT
Source: AAHomecare
Description: 
The final version of the commercial payor letter was sent yesterday by AAHomecare. Prochant is proud to be one of the supporting organizations.

Time: 1:00 p.m. EDT
Source: UnitedHealthcare
Description: UnitedHealthcare has announced several updates to its programs in response to the COVID-19 national emergency.

Specific to HME:

  • Suspension of prior authorization requirements to a post-acute care setting through May 31, 2020; and
  • Suspension of prior authorization requirements when a member transfers to a new provider through May 31, 2020.

UHC will temporarily suspend or relax additional policies as needed in regions where inpatient capacity is most compromised and most at risk. Providers should consult www.UHCprovider.com for specifics on policies and guidelines.

Time: 12:45 p.m. EDT
Source: Office of Inspector General (OIG)
Description: The HHS OIG Headquarters Offices in the Cohen Building in Washington, D.C., will be closed starting Tuesday, March 24, 2020. This decision protects the population OIG serves and its employees during the Coronavirus (COVID-19) pandemic.

OIG is still able to provide critical services while working remotely. Please check the website for the latest contact information before submitting requests.

Many offices that traditionally accept mail or delivery services may only be reached electronically at this time, such as:

  • Advisory Opinion Requests
  • Self-Disclosure Submissions
  • Requests for Review of State False Claims Acts
  • Responses to Notice of Intent to Exclude
  • Requests for Reinstatement
  • Reinstatement Applications
  • General Inquiries to the Office of Counsel
  • FOIA Requests

OIG will not send out notices for future updates, so please continue to check the website for the latest information.

Time: 10:00 a.m. EDT
Source: Prochant (Internal)
Description: Prochant’s corporate headquarters in Charlotte, North Carolina, are being impacted by Charlotte’s shelter-in-place order. Prochant will remain open to maintain minimum basic operations, ensuring that critical HME claims and appeals continue to be mailed daily.

Time: 8:00 a.m. EDT
Source: Universal Software Solutions
Description: Universal Software Solutions, makers of the HDMS billing system, have published an article about software features to assist providers during COVID-19.

Updates for Tuesday, March 24, 2020

Time: 2:45 p.m. EDT
Source: PAMES
Description: PAMES notified its members of a memo from the U.S. Department of Homeland Security that details “the essential infrastructure workers” in Washington state amid the COVID-19 pandemic. This list includes the HME industry: those distributing medical equipment, those managing health care and billing, and those who provide support to vulnerable populations.

Time: 12:00 p.m. EDT
Source: Centers for Medicare & Medicaid Services (CMS)
Description: Today, in keeping with its commitment to ensure states have the necessary tools to respond to the COVID-19 pandemic, CMS approved an additional 11 state Medicaid waiver requests under Section 1135 of the Social Security Act (Act), bringing the total number of approved Section 1135 waivers for states to 13.

These waivers, which were announced earlier today during a White House conference call with the governors, provide relief on a number of fronts, such as prior authorization and provider enrollment requirements, suspending certain nursing home pre-admission reviews, and facilitating reimbursement to providers for care delivered in alternative settings due to facility evacuations.

Today’s approved waivers include the following states:

Time: 11:30 a.m. EDT
Source: Prochant (Internal)
Description: Prochant has learned from business partners that GoToMeeting is limiting the number of attendees in certain GoToWebinar events. In one event, meeting capacity should have been 250, but was limited to 100. This is likely being done to throttle bandwidth. Services like GoToMeeting, Zoom, and MS Teams are exploding in the current environment.

Time: 11:00 a.m. EDT
Source: Reuters / Prochant (Internal)
Description: India’s prime minister has ordered the people to shelter in place for 21 days. Prochant has activated its business continuity plan (BCP) and has already mobilized a large work-from-home team, expected to double in size over the next several days.

Time: 8:30 a.m. EDT
Source: MAMES
Description: Last Friday, Senator John Thune (SD) staff, Danielle Janowski, Health Policy Director, shared an update with MAMES that DME language, below, was included in the opening offer for Phase III of COVID19 relief legislation from the Senate Finance Committee:

  • Extend the 50/50 blended rate for DME in rural and non-contiguous, non-competitively bid areas and establishes new 75/25 blended rate for all other non-competitively bid areas during COVID19.

Non-rural areas would see a small bump in their reimbursement, which would be in effect during the COVID-19 pandemic. If this pandemic continues beyond 12-31-20, when the rural relief is slated to expire, reimbursement would continue.

Update: The Senate legislation went to a vote on Sunday and did not pass.

Time: 6:30 a.m. EDT
Source: Prochant (Internal)
Description: Due to the COVID-19 pandemic, the following payors are closed due to insufficient resources:

  • Blue Cross Alliance
  • Blue Cross Medicare Advantage of Oklahoma
  • United Healthcare – Student Resources
  • Physicians Mutual
  • Healthsmart (Healthcare Highways Network)
  • Benefit Management – Missouri
  • Healthcare Highways Health Plan

Updates for Monday, March 23, 2020

Time: 1:00 p.m. EDT
Source: DME Advisory Council
Description: Performant RAC Region 5 is following guidance from CMS during COVID-19. They will not send any new additional documentation request (ADR) letters for 30 days. However, they will be flexible with providers and suppliers with returning medical documentation. If a supplier has difficulties gathering documentation, please have them contact Performant. They will grant an extension.

Update: Automated reviews are not impacted; however, a provider can request a discussion period. If providers have difficulty gathering or submitting records for an automated review, contact Performant’s customer service number or email. They will grant an extension.

Time: 11:00 a.m. EDT
Source: Centers for Medicare & Medicaid Services (CMS)
Description: CMS reports that medically necessary uses of home oxygen for patients diagnosed with COVID-19 will be covered by Medicare.

Updates for Sunday, March 22, 2020

Time: 4:15 p.m. EDT
Source: AAHomecare
Description: Prochant encourages all providers to utilize the AAHomecare Commercial Payor Letter, linked above from ACMESA, to send to their major commercial payors. HME plays an important role during the COVID-19 pandemic, supplying home oxygen therapy, ventilator services, and more. This role is anticipated to increase as the virus spreads.

Updates for Saturday, March 21, 2020

Time: 2:45 p.m. EDT
Source: Brightree
Description: All collections agencies in Chicago and the state of Nevada have been required to suspend phone collections activities amid the COVID-19 pandemic.

Updates for Friday, March 20, 2020

Time: 3:00 p.m. EDT
Source: Prochant (Internal)
Description: Sleep labs across the country are closing their doors due to COVID-19 concerns. To help curb the coming reduction in orders, some providers are evaluating home sleep testing (HST) as a safer alternative to in-lab sleep tests. The combination of telemedicine and HSTs could help sustain this market segment. 

Time: 1:45 p.m. EDT
Source: Universal Software Solutions
Description: The Universal Software team is available to help clients. The team is mostly remote right now, but their service hours remain the same. Below are ways to contact USS:

  • Customer Hub for Live Chat or Ticket Entry
    Multiple agents are logged in to handle live chat during normal support hours.
    8:00AM – 6:00PM EDT Mon-Fri
    Can’t log into Customer Hub? Email academy@universalss.com.
  • Phone
    A volunteer support staffer is reporting to the office until a quarantine becomes mandatory.
    Call hours modified to: 8:30AM-12:00PM and 1:00PM-5:00PM

All staff has access to email, meeting services, and client tickets.

Time: 12:30 p.m. EDT
Source: Northwood
Description: Effective immediately and until further notice, Northwood requests that clients please fax all administrative denial appeals to 586-755-3878. Faxed appeals should be submitted in letter format, including any additional information or details deemed necessary. When submitting a faxed provider appeal, please be sure to include the necessary supporting documentation.

Time: 11:30 a.m. EDT
Source: Prochant (Internal)
Description: Our representatives working prior authorizations and accounts receivable continue to report extended hold times. They are also experiencing hang-ups and/or difficulty hearing.

Payor Hold Time
Meritain Health 1.5 hrs
Humana 1 hr
Cigna Healthspring 1.5 hrs
Blue Cross Blue Shield of Texas 1 hr, 45 mins
McLaren Insurance 45 mins
Priority Insurance 30 mins
Blue Cross Blue Shield (All states) 1.5 hrs
Homelink*GEHA 35 mins
Louisiana Healthcare Connections 20 mins
Magellan Complete Care of VA 1.5 hrs
Anthem Blue Cross Blue Shield 1.5 hrs
NTC 45 mins
Wellcare Of NE 30 mins
Medica 20 mins
Tricare 45 mins
Tufts Senior Care 1 hr+
Harvard 15+ mins
BCBS/Anthem Home Plan 1 hr+
Health Plan 1 hr+
BCBS Vermont 1 hr+

The following message has also been posted by a number of Blue Cross Blue Shield payors:

Our representatives were informed that due to short staffing and high call volumes, they will not be providing claim status/denial status, and will only be available to assist with appeals and reconsiderations. BCBS is requesting that all inquiries be submitted through the BCBS web portal, and committed to 30-day response time.

Time: 9:30 a.m. EDT
Source: Blue Cross Blue Shield of Louisiana
Description: Authorization is required for many services. However, BCBSLA will automatically approve all services related to the diagnosis or treatment of COVID-19 without medical review.

This automatic approval will be triggered by including the appropriate ICD-10 code for COVID-19:

  • B97.29 for dates of service prior to April 1, 2020
  • U07.1 for dates of service on and after April 1, 2020

Providers can electronically submit authorization requests for BCBSLA members through iLinkBlue
(www.BCBSLA.com/ilinkblue) using the BCBSLA Authorizations tool under the “Authorizations”
menu option, or you can call the number on the member ID card.

Updates for Thursday, March 19, 2020

Time: 10:00 p.m. EDT
Source: Cigna Medicare Advantage
Description: 
Cigna has waived referrals and authorizations in full for 30 days in all impacted counties. 

Time: 5:30 p.m. EDT
Source: MassHealth
Description: If a DME provider or oxygen and respiratory equipment provider is unable to complete the required paperwork for the continuation of an existing prior authorization due to COVID-19, the provider must submit an extension request to MassHealth Long Term Services and Supports (LTSS).

Such extension requests must have the following note in the comments field: “COVID-19.” Extension requests related to COVID-19 will be approved for periods up to 90 days.

Time: 3:00 p.m. EDT
Source: Local 1199
Description: Local 1199 (payor) has closed due to COVID-19. The following message is posted on their website: As we continue to monitor coronavirus (COVID-19) developments and follow CDC, New York State and New York City guidelines, the Funds’ offices are closed, but we are maintaining essential services. However, if you need assistance, your Outreach Coordinator can help you. For urgent matters, you may call (646) 473-9200, although wait times will be long. 

Time: 12:00 p.m. EDT
Source: U.S. Department of Health & Human Services (HHS)
Description: The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 pandemic.

Time: 11:45 a.m. EDT
Source: Centers for Medicare & Medicaid Services (CMS)
Description: CMS has temporarily relaxed certain restrictions that previously prevented most patients from using telehealth visits to qualify for DME orders. The DME councils reached out to Dr. Hoover at CGS for clarification on new documentation requirements. Today, we learned that DME MACs have not yet received instructions for relaxing telehealth requirements.

Time: 8:45 a.m. EDT
Source: Prochant (Internal)
Description: Our representatives working prior authorizations and accounts receivable are reporting extended hold times. They are also experiencing hang-ups and/or difficulty hearing for the following payors: Aetna, Aetna Medicare, Alphacare, Anthem Blue Cross Blue Shield of Virginia, Blue Cross Blue Shield of Colorado, Blue Cross Blue Shield of North Carolina, Blue Shield of California, CHAMPVA, Emblem Health, Healthnet, Humana, Local 1199, Molina, and more.

Below is a list of payors and their current hold times.

Payor Hold Time
Meritain Health 1.5 hrs
Humana 1 hr
Cigna Healthspring 1.5 hrs
Blue Cross Blue Shield of Texas 1 hr, 45 mins
McLaren Insurance 45 mins
Priority Insurance 30 mins
Blue Cross Blue Shield (All states) 1.5 hrs
Homelink*GEHA 35 mins
Louisiana Healthcare Connections 20 mins
Magellan Complete Care of VA 1.5 hrs
Anthem Blue Cross Blue Shield 1.5 hrs
NTC 45 mins
Wellcare Of NE 30 mins
Medica 20 mins
Tricare 45 mins

The following message has also been posted by a number of Blue Cross Blue Shield payors:

Our representatives were informed that due to short staffing and high call volumes, they will not be providing claim status/denial status, and will only be available to assist with appeals and reconsiderations. BCBS is requesting that all inquiries be submitted through the BCBS web portal, and committed to 30-day response time.

Time: 8:45 a.m. EDT
Source: Prochant (Internal)
Description: Our account managers are reporting an uptick in oxygen and PAP resupply orders for some providers. At the same time, they are seeing a downtick in orders for other providers with non-respiratory product lines such as mobility and orthotics.

Time: 7:00 a.m. EDT
Source: Prochant (Internal)
Description: Executive leadership has learned that multiple providers with outsourcing relationships in the Philippines are experiencing production shortages due to restrictions in Manila.


Prochant is the nation’s leading HME billing and process outsourcing company. Our highly-skilled team helps providers become more profitable by outsourcing or enhancing front- and back-office processes. We rapidly implement changes and proactively monitor metrics to ensure client success. Headquartered in Charlotte, North Carolina, we work with top medical equipment providers and health systems.