• CRE Requests CMS Extension of DMEPOS Supplier Accreditation Deadline

    CRE has requested an extension of the DMEPOS supplier accreditation deadline because of the backlog at accrediting organizations. Failure to grant the extension will result in a serious curtailment of services to beneficiaries, particularly in rural areas. The CRE request lays out in painstaking detail the legal authority of CMS to grant the extension.

    Please post your views on the Discussion Forum at http://www.thecre.com/Forum/


    44 responses to “CRE Requests CMS Extension of DMEPOS Supplier Accreditation Deadline” RSS icon

    • Thanks for your action on this looming deadline. It makes no sense that CMS did not stagger the deadline in the first place.

      Why on earth would you make every single HME/DME in the country have the same deadline date? There were suggestions made to CMS by several credible groups and individuals that having a single deadline would result in huge congestion and disruption that was totally unnecessary. States do not have all Drivers Licenses expire on the same date do they? Only CMS would wonder why….or maybe they hoped that the crush would eliminate lots of pesky small businesses?

      It doesn’t take a rocket scientist to discover that this problem could be easily avoided at no cost and without endangering the end goal of getting all suppliers accredited by a certain date. They just wouldn’t listen and here we are exactly where it was predicted we would be……

    • There seem to be several considerations that have been over looked – in addition to limited suppliers in rural areas – these suppliers are generally smaller and do not have the support staff to jump through the hoops so to speak as the larger corporations do making it more difficult to meet the unrealistic deadlines. If there is not an extension granted several of these suppliers will be forced out of business and then the larger suppliers will have to pick up the slack which may sound great at first, but the cost of increasing their coverage territory will be great and the delay in meeting the needs of the beneficiaries will be even greater!!!!! Now once these larger groups are the only ones left providing services to the beneficiaries who will police the quality until reaccreditation time rolls around? Wow!!!!!

    • I find it hard to understand why companies are now claiming that they aren’t ready – especially since the accreditation deadline has been well-published. As usual, the companies that paid attention and obtained the necessary accreditation will watch as others whine their way to special treatment.

    • The requirements and deadlines were established and publicized well in advance. Everyone in the industry knew they were coming. It doesn’t make a difference whether or not the company is large or small. The playing field was level.

      So far as I’m concerned those companies that failed to comply should be penalized with a loss of the right to bill Medicare. It’s all about enforcing the standards that CMS has established. What’s the point of setting the standards if they aren’t going to be enforced; if dubious accreditation bodies that allow companies to meet lower standards can be formed ad hoc; if deadlines are simply going to be put off until it suits each and every DME company to comply?

    • In response to Anonymous I do agree in part. Companies that have waited untill the 11 hour to even start should face the consequences;however, there are hundreds of companies who busted their tails like the above mentioned and have been waiting for 4-5 months for a site survey. My company is one of those still waiting. We signed up August of 2008 and were very diligent in the guidelines that were required of us (75% we already had in place). Now with 3 weeks left we have no choice but to wait on the backlog of the AO’s. Has anyone ever thought for one moment that the majority of fraud might extend from MD’s and Hospitals.My company has been in business for 7 years, I have been in industry for over 20. We have always held ourselves to the highest standards and it sickens me when those in our industry abuse the system. I have been reassured that we will be seen before the deadline, but as each day ticks by I have to figure out my next plan of action at the expense of my employees and most importantly our patients.

    • Here we go again….because of the few that don’t take their job responsibility seriously and do not abide by the rules, policies and guidelines set forth by the agency that governs our line of business, you punish those that act promptly to avoid any unexpected delays, congestion etc. I own a small DME in an area with over 300 competitors and I’m sure that the real players have been accredited for over a year now. Why can’t others? No more extensions, we all had plenty of time to prepare for accreditation or seek another line of business.

    • There is a serious problem with back log from the accreditation agencies. Our company has been survey ready since April of 09, but we are still waiting for survey. We have been told we will be surveyed by October 1. This is a concern in that if their are recommendations that require additional attention we will have no time to complete them prior to the October 1 dead line. We have had 3 acceditation surveys in past years but have never experienced this type of delay in getting surveyed. CMS needs to address this problem. As a provider we have applied prior to the CMS deadline but we could suffer financial loss if the accreditation agency can not meet it’s requirements. We have a Medicare patient population that we may not be able to service on October 1, 2009.

    • My business is also awaiting for the accreditation company to come give us our site survey. We registered for the accreditation in October of 2008 and they tell me that they may not be able to get to our store in time. We have been servicing patients for 40 years and it will be devastating to our business if we do not receive our survey in time from the accreditation agency. I don’t believe this was the intention of the law to financially destroy our business or put us in this situation where we can not service our patients.
      If the government can allow a last minute extension to convert from analog to digital television than I know that they must consider the health of our patients much more critical.
      For those of you who think that those of us who have not gotten the survey complete I wonder if you are just being selfish and want to be able to cash in as other businesses are destroyed at the expense of patient care.

    • My business is also awaiting for the accreditation company to come give us our site survey. We registered for the accreditation in June of 2008 and they tell me that they may not be able to get to our store in time. We have been servicing patients for 12 years and it will be devastating to our business if we do not receive our survey in time from the accreditation agency. I don’t believe this was the intention of the law to financially destroy our business or put us in this situation where we can not service our patients. Our Accredidation company is unable to provide surveyors to accomodate all the surveys that need to be done. Those of us that followed the rules and were timely should be granted an extension due to issues beyond our control. We are concerned for our patients and have always provided quality healthcare and provided high standards of care for all our patients without being told to do so by any government agency.
      If the government can allow a last minute extension to convert from analog to digital television than I why are they not considering the health of our patients much more critical.
      For those of you who think that those of us who have not gotten the survey complete I wonder if you are just being selfish and want to be able to cash in as other businesses are destroyed at the expense of patient care. The patient is who suffers in the end. We are requesting that proper review of providing an extension be examined by CMS.

    • What the extension critics don’t understand is that those who wish to defraud medicare dont really care about accredidation or deadlines anyway. They have already moved on or found some way around the requirement. It’s those of us who have done all of the work but are just waiting for the accrediting agencies to catch up who will be hurt by the backlog and deadline.

    • I am a small DME business and we have worked hard to get things ready for the accrediation survey. We now have been waiting several months and was informed last month that we now have a window between Sept – Nov 09 for a surveyor to come. It’s really sad, to think that I will not be able to continue sevicing my Medicare patients as of October 1st, 2009 because of a wait. I have already sent in my forms to Medicare to temporarly suspend my medicare number so that I wold not have it revoked permantely. There should be an extension for those that have applied and are sitting and waiting for their surveyor to come. Why should we DME compainies be penalized because we are waiting and most important why should our Medicare patients have to suffer.

    • We too are in the middle of the accrediting agency backlogged web of destruction. We are a small DME focusing on complex rehab – a large majority of our business is Medicare recipients. The impact this deadline has on our business is beyond critical! We have been ready for survey for several months, we even continue to get billed for workroom fees monthly until our survey is complete…not sure why?! – seems a bit blackmailish if you ask me! We are in jeopardy of closing our doors if an extension doesn’t pull through, we are contemplating how we can survive at this point without Medicare. Besides, there is no way we can send our clients to another provider in the area, although we are not in a rural area, there is only 1 other provider in the area that accepts Medicare…let alone serves the complex rehab community.

      Our accreditation company had set up a deadline of March 31st to ensure survey – yet NEVER expressed the importance or consequences of what happens after that date – it was NEVER mentioned that after March 31st we would be swinging in the wind in the end. When I called and posed a question to the company…”what if we get surveyed by Sept. 16th, and lets say we pass with flying colors…will we be accredited in time?” the answer….”I can’t promise you.” SERIOUSLY?!!

      Please tell me how this becomes a provider problem…a provider error…and please explain why we as the provider get penalized when the ball is in the accreditation company’s court?!

      All the nay-sayers speaking about how its our fault – we waited, we had 2 years…blah blah blah…BOGUS! The accreditation bodies were “RAMPING UP” their efforts and staff to ensure accreditation by October 1…..WHERE IS THE PROVIDERS FAULT IN THAT?!

    • We too are just finishing up our paper work.We will not be accredited on time.Our company has relationships with a large base of medicare recipients.Our specialties do not exsist in our rural area. Our business exist with very limited resources and man power.The big companies with thier selfish intercept have no concern about the well being medicare recepients like our beloved customers.Money is there bottom line.Thier motto should be “We will take all we can at anybody’s cost” We have run our business with caution and respect for many years.We have also hired entities that promised a timely process for accreditation that was not fulfilled.There is an ambush of excuses and ideas.Fact is we are in the 11th hour and people that are not even able to move from one seat to another,Medicare beneficiaries, will be severly affected. Think about this, If you care at all, Don’t rush to impose harsh judgement. after all it’s all about people, Which include medicare beneficiaries.If we support our families and make good citizens in the process ,I think we did a good thing. Time and an extention I truly beleive should be granted

    • I am very appreciative of the request for an extension. We also serve a very rural area and definitely put out more manpower than we are reimbursed for, so we are doing what we do because we have a sincere concern for our patients and their families. We are also in the backlog waiting for surveying and if the playing field was really fair and even, then we would have had multiple accrediting agencies per state and not mainly on the East Coast. We’ve paid our dues, done our homework and are now sitting gooses with big companies waiting like vultures for the small business go fold so they can treat people like nothing more than a dollar sign. The big companies cannot handle after the initial sale services like the small locals can and when it’s all said and done and a bunch of us are put on hold, it will hit the media like a tornado and leave the main persons (the patient) in limbo. THANK YOU AGAIN FOR YOUR REQUEST FOR AN EXTENSION! GOD BLESS!

    • we are a small DME company and pharmacy that has been in business for 30 years. we are also currently waiting for our survey. i think it a sever injustice that we have not been surveyed. we have done so much work and spent so much time and money that we cant afford to miss the deadline. yes people have known about this for sometime but at the same time small retail pharmacies in rural areas dont have the man power or the financial resources to devote the time to this. alot of our accreditation was done in house. one of the largest pains i feel was the requirement to hire therapists for just about every peice of equipment. on top of the training of the patients doctor on forms and procedures that we must now fill out. but along with these items we are now facing not meeting the deadline because there are too many people that have not been surveyed. i think if medicare can not extend the deadline then grant a paper accreditation to those individuals that are survey ready and allow them to be surveyed when their accrediting organization comes to them.


    • Thank you for writing this letter to CMS. An extension of the accreditation deadline would not only help my company and patients, but hundreds across the country. Here are excerpts from a recent letter I sent to my senator, John Kerry:

      For the past year, we have been undergoing accreditation with a CMS-approved accreditation agency. Through this long process, I’ve had to take medical leave because of my illness. I am disable and also a veteran.

      We were scheduled to have an on-sight survey in Oct. 2009, past the deadline. I need an extension from CMS of at least six months. If not, CMS will terminate my Medicare provider number and thus terminate all payments to me.

      All my patients would be immediately transferred to another company, probably not of their choosing. We have patients with no insurance or who do not meet the criteria for reimbursement – they would be transferred, but being unable to pay for these services themselves, would not be kept. They would have not place to go – no recourse.

      A transfer of all our patients would effectively and immediately put us out of business. Our employees would be terminated. With no patients and no prospect of any new business, my company would be worthless. After many years in the military and with thirty-three years of exemplary and compassionate care to all of my patients,; after paying thousands of dollars for accreditation required by CMS, I would be faced with bankruptcy. This would be a sad ending for a company where a patient was always a fellow human being, not just a monthly payment.

    • Anxiously awaiting survey in Alabama!

      Like so many other companies, we are a small DME company in Northern Alabama that is awaiting an on site survey. We started preparing for accreditation in July 08 and have been survey ready since March 09. It blew me away last week when I heard that a pharmacy 1 mile down the road from us was surveyed last week (by the same AO that we are waiting on) and the surveyor left there going to Georgia for her next survey instead of surveying us. Our AO is still telling us as of 2 days ago that we will be surveyed in time but I am beginning to lose hope. We have been in business for 20 years and though it will hurt us if we are not surveyed, our patients are going to be the ones most devastated. Let’s hope there is some extension granted very, very soon!!!

    • We also are a small supplier waiting for inspection. Less than 1 week to this deadline and without an extension many across the nation are going to be hit hard. These critics of a deadline extension must work for the government. They seem to have no problem with government having so much power in the operations of small companies. As far as accreditation some how ending Medicare fraud, how did they come up with that. I wouldnt know how to commit fraud if I wanted to. Its hard enough getting paid for legit claims. And they have no clue how often we dont get paid for those. The people who do commit fraud are so obvious to everyone. Medicare could easily stop fraud without creating new billion dollar programs. Consider all the hoops we have to go through just to file a claim. How do you commit fraud without being obvious about it? You cant. This extension needs to be implemented very soon.

      Although there are a Lot of very good Companies that have been accredited the truth is that the suppliers that are stealing from the Government and Medicare are the ones that have the best chances to get the best acreditation. OF COURSE, THEY CAN PAY IT WITH THE SAME MONEY THAT THEY ARE STEALING.
      THEY HAVE BEEN STEALING FROM MEDICARE AND FROM US FOR YEARS and now we small suppliers have to pay for their sins!
      But for us that Honestly try to earn our daily bread they only put more and more obstacles every day to take us out of the way of the big companies that can afford accreditation easily.

      They just have to say “How much is cost? and here is the check.

      That ain’t working..That’s the way you do it….

    • I am not afraid to leave my name.
      The bottom line to the anonymous writer who does not think it is fair to extend the September 30th date because of “fairness”,
      You should sell your business because what is best for the patient should be the first concern of anybody in the healthcare field. It seems you would rather have the patients pay the price to prove your point.Please identify your name to continue this debate.
      People that use urinary catheters could be in danger of having to reuse them.
      I fought hard for three years to get CMS’s horrible policy of patients only getting 4 catheters a month changed to where the patient gets a new catheter each time.
      Congressmen Patrick Kennedy, Jim Ramstad and myself worked to make the change and now if some dealers are not accredited their patients will have to reuse catheters in October which is against FDA Regulations.

      The patient is always left out of the mix and always suffers the consequences.
      Our group not only fights for the patient we also look for the fraudulant dealers who cause all of thes problems in the first place.
      As far as I know CMS never notified any patients that this deadline even existed. They should have so the patients could see if their dealer would make the deadline.
      For many patients October will be their first notice when they will not get their supplies.
      For humane reasons CMS must extend the deadline and they will still achieve their goal of the Congressional mandate of accreditation without patients being put at serious risk. Members of Congress feel the same way as well and will be calling CMS on Monday. Patients and the small dealers need a voice in Washington.The smaller companies are being legislated out of business

      Steve Winter
      We the People Patient Rights

    • Lots of great points. First of all- when you signed with an approved accredidation agency 19 months ago and have been waiting for a site survey, and being told it will be in time up until mid Sept and then be told that they have over 5000 suppliers to see and there is no way that will happen in two weeks… and nothing to indicate how that applies to you…. Several problems exist- one could be some of us simply chose the wrong accredidation agency- maybe some were more greedy- and took on all willing to pay- as they have the money they then can do what they want.

      Plus if anyone thinks that those in the DMEPOS industry that are the fraud problems will go away- they are naive-if they are smart enough to get around things before- they are smart enough to get accredited and change some of their practices to keep ahead of that curve.

      Did any of you out there get contacted recently by your slow moving accredidation agency and be told that there would be a greater chance of getting that survey (in many cases that FIRST survey) if an additional up front fee was paid that was maybe 100% of the fee you already paid? -and many times those are the first visits- because they can make much more off of you if they need to visit you again.

      While I am sure that there are smaller companies out there that got accredited just fine- due to many different reasons- if you dont think there is a huge plus here if you are a larger company- again naive- – it is the standard that was out there for the past eight years or so- where everything was geared to help big business and thwart small business.

      There hasnt been a major change to physicians regarding Medicare where the deadlines dont change or go away completely that I can think of. The AMA has strenth and respect- the DMEPOS providers dont have such a respected body to speak for us- many agencies out there that get our fees for their efforts- but those efforts normally dont change much that I have seen.

      It will be interesting to see how this plays out.

    • Are there other companies out there aware of the fact the ABC company had NASI send out letters to organizations that they were accrediting and let them know that they were paper accredited and to expect on on site visit within 2 1/2 years. I spoke to someone at CMS and they are aware of the error and have told them (ABC) that they have to do their site visits much sooner but the companies that received the letters have been “grandfathered” in and can continue to bill their medicare patients on OCT 1st. If that is not discriminating then I don’t know what is. The government has so many regulations for our business’ yet discrimination is okay for them. I don’t think it is FAIR when we are dependent on another organization controlling the time when they do their site visit. CMS could easily grant an extension and resolve this whole issue for their medicare recipients. Continue to contact your senators and representatives now.

    • I heard that there were some companies that were accredited without a visit.
      They were customers of ABC.
      The one question I cannot get answered by CMS is concerning the September 30th date.
      Is there a Congressional mandate that says it has to be September 30th?
      If not CMS has a legal duty to extend the deadline because they admitted there will be patients without supplies throughout the country.
      Our group will instruct any patient that calls that they should go to the ER room to get a sterile catheter.
      There is no way a patient can get a prescription the same day and then find a dealer who is accredited.
      The DME’s by law cannot dispence without a prescription or CMS will shut them down even if it is for humantiarian reasons.

    • Andrea Livingston

      I feel for all DME suppliers, as I am a supplier in Middle GA, however, the deadline has been established for over a year now and there are really no excuses. We are a small company with 7 employees and we did it by May and passed with flying colors..really because we were already doing a lot of the things that are required by CMS. We are a high end supplier, so it was difficult to put aside our work to complete this task, but without it, we would have to close our doors and this was not an option!! Good Luck to all..today is the day!!

    • We are in the same boat with those who have not gotten their accreditation. We are a mom and pop operation and have worked on this since March. We have spent over $8,000 and have been waiting on our site survey for 2 months. I agree with those who have finshed the work and have their accreditation that it would not be fair for someone who has done nothing. However, I believe there are many, many pharmacies like us that have not gotten their site survey’s but have done all of the work. It is not our fault that we have not been inspected. Ultimately, it will be the customer that will suffer. We live in a very rural area without a public transportation system.

    • The bottom line is- CMS set a deadline of January 31 for submitting an application to an AO and the pharmacy had to have been survey ready by that date. It sounds to me like you weren’t survey-ready on time. If your Medicare patients were this important to you in January, maybe you would have been ready at that time and wouldn’t be panicking about today’s deadline.

    • 2009 Press Releases

      NCPA Applauds House of Representatives for Passing Bill Maintaining Seniors’ Access to Durable Medical Equipment
      Alexandria, Va. – September 30, 2009

      The U.S. House of Representatives today passed H.R. 3663, a bill introduced yesterday by Reps. Zack Space (D-OH) and Lee Terry (R-NE) extending the accreditation deadline for pharmacies providing Medicare Part B Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) from Sept. 30 to Dec. 31, 2009. The extension enables seniors to continue getting valuable health care supplies like diabetes testing strips from community pharmacies without disruption as Congress weighs separate legislative action to exempt pharmacists from the regulation. In response, Bruce T. Roberts, RPh, National Community Pharmacists Association (NCPA) executive vice president and CEO issued the following statement:

      “Seniors are the real winners from this vote. This bill would allow seniors to continue relying on their pharmacists to help manage diseases like diabetes.

      “For community pharmacies today represents a clear line of demarcation. Some have become accredited suppliers of durable medical equipment. But for most independent community pharmacies, the accreditation requirements were far too expensive and time-consuming. It’s all the more frustrating since nearly two dozen other state-licensed health care providers have already been exempted from the rule.

      “Unless this law is enacted, tomorrow morning thousands of community pharmacies will no longer be able to offer these supplies and patients will experience an unwelcome disruption in their health care regimen. The Senate must now act as quickly as possible so the President can sign it into law.”

      The accreditation requirements are time-consuming, costly and redundant for community pharmacists, who are already subject to regulation at the state level. NCPA has helped its members navigate the process. Those suggested actions can be found here. The regulations target perpetrators of DMEPOS fraud, which is not something associated with pharmacists. However, they are the only health care providers not yet exempted from the requirements. As a result, an exemption community pharmacy has been a primary focus of NCPA’s efforts with Congress and with the Centers for Medicare and Medicaid Services (CMS).

      The National Community Pharmacists Association, founded in 1898, represents the nation’s community pharmacists, including the owners of more than 23,000 pharmacies. The nation’s independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation’s retail prescription medicines. To learn more go to the NCPA Web site.

    • Wow! Some of the companies are really not getting it. Some of these companies are saying, ‘Tough luck’ for those who have applied for accreditation over a year and a half ago and never received an answer back from the surveying company. Despite the fact that the suppliers make numerous calls to the surveying company, the accrediting company has full control of who they will visit or respond to.
      The bottom line is that CMS has created a mess. They have put massive amounts of control in the accrediting companies’ hands with no supervision.
      How can an accrediting company surveyor be in a company for 20 mins to 1 hours and pass or fail a company? It seems to be about how many companies they can make or take money from and have total disregard for the operating company. Whether a company passes or fails is based on if the surveyor likes you and maybe what you will do for him/her. I have seen the drastic flaws. (I am speaking of one company, not all)
      You have 10 accrediting companies with one particular company having only one (1) surveyor servicing several states. (This is a problem) How can they expect the companies to be accredited in the time frame they stated? Yet they continue and have no problem accepting new applications [and the fees that go with those applications].
      You have suppliers’ calls not being returned from the accrediting company and different measurement standards varying from supplier to supplier. Oh, there are major problems and they are not due to the fault of the suppliers! CMS hired the companies and they really need to look at the hardship they have caused. What about the surveyor and accrediting company that has their own scram going on? It seems that everyone has overlooked that. The only ones who can’t are the ones who have been affected by these scams. It seems impossible for a company to pass with this organization. How is a company supposed to fix any deficiencies if they don’t receive any? What if instead of receiving deficiencies they receive a failing notice with things that should have been fixable? They talk about suppliers and here it is CMS has opened the door for the suppliers’ failure. Can anyone guess which accreditation company I am talking about?

    • Why did the Bill say Pharmacies only? We are calling our senators to vote against this selfish bill for only pharmacies.If they cared about the patient they would include all DME providers.

    • I keep seeing the number 28,000 suppliers are not accredited? Then I see 200 hme companies?
      How many HME companies are having to revoke their numbers?

    • What happened to equal oppurtunity? How can they choose one group gets the extension and another group does not get the extension? The Senate needs to correct this before they bring a vote. All men are to have EQUAL oppurtunity, thats what our founding fathers established.

    • Waiting on an INSPECTION

      Corruption, Corrution, Corruption… Who’s best interest is this mandate going to help… Follow the money…We are waiting for our inspection and started in August of 08, Where is the Justice for All? Call your Senators and have your patients call them! If we dont raise a stink no one will…
      No power in our lobby… Where was AA Homecare, VGM, MAMES,etc… Where are they now? SILENCE

    • DME’s are the main providers for part B Medicare beneficiaries, not the pharmacies. DME’s have taken the full blunt of the accreditation processes from the very begining, and are now NOT meeting the October 1st deadline due to the fact that there are NOT enough inspectors
      (even though Medicare says there are) to perform the required surveys. Medicare has required that the surveyors inspect the businesses that will be bidding in the next round of competitive bidding shall be accreditied first. Those are the 70 metropoltian areas that were selected, not the small Mom and Pop companies that have been providing beneficiaries with services for years. Many DMEs have taken out loans to pay the high price of the required accreditation cost, and now will not be able to bill Medicare for their services. Many small DME businesses will more than likely be closing their doors for business today. I wish them well.

    • What about a class action law suit? Will it stop the madness?

    • I went to dc a week before the deadline. I walked to the offices of many reps including my own. They all promised they would help extend the deadline. In the end they told me the only deadline that would be extended was for pharmacies. They said because of fraud and abuse adding dme’s would add a cost to the bill and it had to be budget neutral. Where is our lobby. We have no voice in Washington. The reps I went to didn’t even know what organization represents our industry. By extending the deadline for pharmacies only they are saying all fraud and abuse is our fault. We only make up 8% of the entire Medicare budget but every single time fraud is talked about we get stepped on because know one stands up for us. How much pro Bono equipment do we give out to indigent patients? How many hours do we spend making sure we get all the forms back from the doctors. I can go on and on. Every dme owner goes above and beyond to make sure the patient is taken care of. These guys in Washington do not have a clue what we do. Is it their fault or our lack of representation? I had to voluntarily surrender my Medicare number while I continue to wait for my AO. What happens to my rentals? Am I supposed to pick all our equipment up and tell our patients tough luck. This is so ridiculous.

    • John, they do not know who the Homecare voices are. When I started my journey to get Medicare to change the policy that Medicare had with the catheters, all the groups that claim they represent homecare would not even give me an appointment.
      CMS had a policy where they gave only 4 catheters a month and made the patients reuse their catheters until they had two major infections and only then did they get a new catheter. The FDA clearly states these are single use only.
      I went straight to Patrick Kennedy’s office and told him this horrific policy and He and Jim Ramstad personally took this on and the change was made.
      Our patient group could single handidly have stopped this deadline had we knew about it before a week ago and could single handidly get all of competetive bidding thrown out.The only problem is all of the money to fight this seems to be controled by Invacare and VGM. They may be doing a good job but someone needs to be a voice for the smaller dealers and the patients and we could do that if we had even one fifth of the financial resources that these two groups had.Could you imagine competitive bidding gone for ever and all the new policies from now on would be “patient first” policies.
      For the rehab patients (SCI,Spina Bifada and MS) that we represent this bidding is a nightmare.
      When you take away competitin the patient suffers because the dealer has all of the business tied up and there is no incentive to treat the patient any better.
      Our group has won every battle we have taken on but get no support. Let me add this point we only call it a victory if reimbursement is IMPROVED . It is not a victory like some groups now define it as a lower cut that what would have happened. A cut is a cut and a loss is a loss.
      In the NFL if a team is favored by ten and and the other team only loses by 7 it is still a loss.
      Another axample is the groups that lobby for DME always say we are working hard which I have no doubt they are but they fought hard at the Alamo as well and they lost.
      I can get face to face meeting with any member of Congress and the Senate and the White House if needed(Have to admit the White House does have other priorities and this does not need their attention)yet I cannot get a meeting with Cara Bachenheimer.(I tried for three years)
      I do not know who can change all of this but the bottom line is if you look back the last 15 years DME other that urinary catheter(they went from 4 a month to 200!!!) has gone down hill dramatically and at this pace the DME dealers will be paying CMS fee per service for any thing they ship out.
      The fact that CMS will not purchase a quality wheelchair for a SCI,MS etc. patient is unbeleivable.
      Our group that represent the patient could achive the following goals that the other groups have been fighting for years.
      1)We could end the rediculous rule that when a home health nurse visits an SCI patient(Any patient it is good to use a specific to get the point through to the legislator)for a wound and then the patient cannot get their catheters from their DME during this time.
      We can end this within six months.
      2)We could end all competetive bidding not only with CMS but with all the Medicaids as well. In Arizona only two dealers handle all the Medicaid patients and the wait for a tire repair or catheter can be weeks or months.
      If this was fee per service they would get a home visit the same day.
      For the rehab patient competitive bidding is their worst nightmare and needs to be stopped.
      3)Private insurance networking. This needs to be legilatively outlawed. There should be a set price for any service but the patient must not be restricted.Sometimes it is like “Where’s Waldo” when it comes to finding a provider.
      4) A4353 billing for sterile kits still requires two infections beforethe patient gets the proper system. Burdensome documentation by the doctor and DME is required which wastes valuable time and money.
      No one should have to get sick before they get the treatment they deserve in the first place. One fact that is overlooked in discussions is that the patients do pay for their Medicare.
      Our group could turn DME reimbursement completely around if we had the support but historically all the groups are divided and they all crave to say they made the changes rather than saying we do not care who gets the credit and we know that whats best for the patient will naturally be better for business.
      I remember talking once with a doctor who is in charge of one of the four regions and I let him go on and on about how bad the dealers and manufacturers are. I then said you are right wouldn’t be great if all of them just went out of businees and he gleefully agreed. I then asked a sobering question and for the first time he was speechless(You all know him but I will not mention his name). I asked him that would be great but where would I get my catheters?
      This is a sobering question anybody who has a disability has to ponder.This is why we are more affective because we have a more sense of urgency but have no financial resources. I would love to jump back into the arena to Guarantee the changes(I could give a full presentationand you would all know why it would work) But I am not going to spend my time chasing money .
      The two groups which are run by Invacare and VGM will not give me the time of day let alone even expense money to DC.
      If we could combine the great organizing skills of Cara Bachenheimer and John Gallagher with our plan we could dominate and get anything we want for the homecare patient otherwise everybody will be frustrated wondering how the Pharmacies did it and HME was left out in the cold once again.
      I remember going to the Medtrade show two years ago and how depressed everybody as and the speeches said it will get better but since they kept on with the same old plan it is not better.
      One of my businees associates from Australia asked me to meet him in Vegas last summer for the Medtrade show. He had a hotel for three days but called me to say that he finished with all the booths in half a day and was shocked.
      If something dramatic is not put into place the smaller dealers are going to be extinct and this may be the overall plan of the HME lobby because the bigger companies would want this. If this is their goal I take it back and they are affective.
      My plea is that if the industry would let us be the “True voice”(Not a a patient rights group sponsired by) of the patient and smaller provider. We can turn DME around and it will be better than ever.
      Do not mistake our plan for some passion only push. We know the industry inside and out.
      They say history does not repeat itself but it sure rhymes.
      If HME lobbying stays the same the business and the patients will suffer.
      If the HME will even listen to our plan we can guarantee results.
      It is up to the dealers to demand better results.
      In closing the analogy that makes us different from the other groups is there a lot of people who do not mind knocking down a spider web but only a few will go after the spider.
      There are a lot of groups that lobby who are experts at telling you what the problem but only a few can fix it.
      The bottom line for me is there is no doubt there will be patients who will not get their catheters because of this disaster and CMS unwillingness to extend the deadline.
      They will be statistics to CMS but one could be a girl who has spina bifada who has been planning her wedding for this month and because of some policy she knows nothing of her supplies will not come and she will get infected. Some college student who may be tryin to pass a test. Who knows how many this will affect.
      I would suggest if they have not already done this is that all CMS decision maker must visit a series of home patients every year so they can get back in touch that these horrible policies do harm people.
      I would also suggest this to the leaders of the HME lobby groups as well.
      If you would do this you would change how things are done.
      I have written too much already. I have a major surgery Monday so I am supposed to stay home and take it easy but it is hard when you see this September 30th fiasco.
      If I wrote something that offends anybody I am sorry(I am on pain medicine for the first time so I will get my doctor to say this affects my thoughts)but all of this is true and the results are devastating and will get worse if HME groups continue the same stategy. Too tired to spell check so excuse please.

      For the Patient,

      Steve Winter

    • Was it a mandate from CMS that requires an unannounced site visit before a DME could be accreditted before Sept 30th?
      Did the accreditation companies have the option to accredit their customers before the site visit so they would meet the deadline and then visit them later?
      I was under the impression if a DME did not have an unannounced site visit they should voluntarily terminate their Medicare number.
      I just found out from CMS that an unannounced site visit was not mandated by them before a DME could be accredited.
      If this is the case why cannot all of the DME’s that are waiting for their unannounced site visit be accredited and then if they do not pass, then it can be taken away?
      Monday could be a recored day for accreditation.

    • I Never tought that this could happen in America!

    • Have you noticed a strange relation between homecare magazine, vgm group, vgm bond insurance and hqaa? Some one is making a lot of money with accreditation and Surety Bonds.
      Have you noticed how the love to inflict fear on suppliers to make their bussiness.
      Why can CMS publish how many companies are going to be revoked and how many beneficiaries are going to be affected? How many employees will lose their jobs?
      Why does every AO has different standars?
      If the government was the one that set the quality standars, arent they the ones that are supposed to enforce it?
      Wouldnt it be better to close your dmepos bussiness and start an accreditation organization that is where the money is?
      Or start a counseling accreditation service. You can charge $6,000.00 for your service and give half to the surveyor. I have known of some of these “counselers” that they can guarranty that you pass the accreditation. If you ask them how they can be so sure, they say “Because we know the surveyors of course”.
      My opinion is that this whole accreditation thing is disguise like if it is for the benefits of the patients. Hipocrits, You are making a lot of money with it and you have not any real interest on the patients benefits. And what really hurts is that the Government is sponsoring these injustice. this only have a name. CORRUPTION.

    • I also, heard about the surveyor taken under the table payment and gaurenty passing of accreditation. I do know that CMS is a ware of this but, seems not to have no problem with it.

      I believe not only is the surveyor getting un ethical payments but so is one of the acrediting organization key person that approves the company. What the heck the surveyors is on the board of directors, they are on the appeal board and they do the surveys and have their family members and friends doing the surveys. It is sad but it seem they talk about fraud being commited in the DMEPOS and they open the door to the fraud with some of the surveyors. This is really sad.

    • Wow!
      We are Lost in Space. We have requested to “Voluntary Surrender our Supplier Nunber” With a gun in our heads…
      And up to this date we have not been informed by NSC of what is our status.
      We know a lot of Suppliers that are in the Same situation.
      Are we dead or alive?
      Do somebody know how many suppliers has been affected by de october deadlines?
      How many patients?

    • Have anyone thought of a class action law suit against CMS. Think about all they are doing to stop companies from staying in business or opening a business. Bidding, accreditation, bonds, extreme delays on surveyors visits, extreme delays on decisions for providers, paper review, cut in re-imbursement, bidding back. Forcing termination of provider number due to lack of surveyor visits in timely manner. It goes on and on. We have the power to stop them from making these harsh decisions. Most of the companies I know is out of over $50.000.00. As to the remarks of the gentlemen and the under table payment? I have heard about it. How can any company survive? It is more than a company can handle unless a stop can be done. You do realize out of the 10 accrediting companies not one of their method is alike. What one company accepts as a document or policy the other companies may reject. There is no Unisom even with the approve accreditation companies. How can the companies survive?

    • I have seen change after change in this business going back to the 1970’s when I lugged 244 cu. ft H oxygen tanks in and out of patients houses. As I read your various coments I am struck by how many of you believe that CMS cares about the patient. They never have and never will and guess what, you can’t make them. Let’s take a minuete to look at what they have done to us over the last few months.
      1. A 9.5% cut in HME Medicare allowables.
      2. Mandatory Accreditation and all of the
      survey expense including lobor cost that
      goes into preparing for this mandate.
      3. The cost of the Surety Bond.
      4. Capped Oxygen and all of the requirements
      that are placed on us without even cost
      being reimbursement.
      5. Competitive Bidding and all of the costs
      involved in preparation and seeing this
      to the end.
      6. A PECOS mandate that once again requires
      us to take the parent roll to physicians.
      7. Random Audits are in our very near future
      and these are designed for only one
      reason, “To delay payment to us for as long
      and to the extent that they desire”.
      I have complied with all of thier mandates to this point, however, it is way past time for us as DMEPOS providers to just say, “NO MORE”!
      There is only one way that we are going to survive this assult and that is by standing together and “saying no” in the only voice that they will here and that we have left.
      We have wasted the last three plus years by calling our Representives in DC and our
      respective states. We have wasted our money and time with consultants, lobbyst, Invacare, VGM, and every other factor and force that we have relied upon to stop this madness. Nothing will stop the will of CMS to drive us out of business except, possibly this.
      AS OF JANUARY 1, 2009 WE STOP ACCEPTING ASSIGNMENT ON EVERY MEDICARE PATIENT IN THIS COUNTRY WHO RECEIVES HME. You say what about the patient. We’ll boys and girls we are backed into a corner. If we are going to survive we have to let the patient, family, and physicians voices be heard, because to this point OURS HAVE NOT BEEN HEARD. Now I am not nieve enough to believe that the big boys will buy into this but I guarantee you that they will still be around to reap the rewards of our efforts down here in the trenches as they always have. My efforts will not stop this alone but it will increase my chances of surviving.I will not be in this business next year without doing this and neither will you. I promise you now that I will refuse assignment on every Medicare patient in 2010. IF MY BUSINESS IS GOING TO DIE I WILL CHOOSE THE METHOD, NOT CMS.
      PS: My secretary and spell check are off for Thanksgiving. Have a good day and spend it trying to find one thing that has woeked to this point. “ENOUGH from TENNESSEE”!!!

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