What is going on? Why is accessing quality medical equipment and services so difficult for people on Medicare today?
#1/2 : UNNECESSARY AUDITS
An ‘audit’ in the home medical equipment context is the inspection of a provider’s activity by Medicare. The audit system is in place to eliminate fraudulent activity, such as over-payment of equipment/services, which is a good thing. However, we are finding that home medical equipment providers are getting audited by Medicare on simple clerical errors, such as missing date stamps and illegible doctors’ signatures. These simple errors are impacting providers, seniors and people with disabilities BIG TIME!
- PEOPLE LEFT WAITING – For providers, the threat of an audit is pushing them to spend a lot of time carefully completing paperwork before they send a claim to Medicare. While they do this, patients wait for the paperwork to go through so they can get their equipment. They wait in their homes. They wait in hospitals. They wait in nursing homes, and sometimes the wait can be weeks.
- A LONG FIGHT – Providers are able to appeal audits, but the process is long and slow. Thousands of audits are at LEVEL 3, the highest appeal level where the Administrative Law Judge looks at the case and can overturn it. Due to severe backlog the court is not looking at new appeals.
- DOORS ARE CLOSING – Smaller home medical providers who are unnecessarily audited struggle to find money and time to fight the audit. Many end up drowning under debt to pay for the audit and are losing access to financial assistance because financial institutions will no longer lend them money. No money = no provider. Fewer providers = less choices for Medicare beneficiaries.
See how patients and providers are being impacted by audits in our Faces Behind the Red Tap series
#2/2 : COMPETITIVE BIDDING (CB)
This law requires providers to bid on Medicare contracts, The provider who puts in the lowest bid wins the contract. Competitive bidding was implemented to lower Medicare costs and decrease fraudulent activity while providing beneficiaries with quality medical equipment and services; however the opposite is happening.
- LONGER WAIT TIMES: Less providers + growing number of Medicare beneficiaries = longer wait times for equipment and services. Not only does this cause frustration for the patient, but can be dangerous and expensive. If a patient is in need of equipment right away, such as an oxygen tank, they do not have time to wait. Once their situation is dire enough, the patient will go to the hospital, which costs more money in the long run.
- LOWER QUALITY EQUIPMENT: Remember, Medicare awards contracts to the lowest bidders. If Store A says they will provide wheelchairs for $150 and Store B wins the bid, because they can provide wheelchairs for $50, beneficiaries will be left with basic and lower quality equipment.
- GOODBYE PROVIDERS: Many providers who have been in business for decades and built strong relationships with beneficiaries are being forced to shut their doors, because they did not win a Medicare contract. If they do not win a contract, they are only able to provide equipment to beneficiaries who are willing to pay out-of-pocket or pay through private insurance.