There are two recent DHCS announcements that come at an incredibly bad time for DME / Supply providers.
The first is the announcement that at Electronic Payment Correction will be performed in January to recoup the 10% provider rate cut for the period of 2011 - 2013, here is a Link to the EPC and specific dates. This was the time period where an injunction was in place to prohibit the 10% cut and CAMPS was a plaintiff in obtaining that injunction. The 10% cut injunction was eventually lifted and the cut began in either late 2013 or early 2014.
DHCS has apparently just got around to recouping for that gap period. It fee for service Medi-Cal only and recoups will only come from FFS billings and payment. The recoup will take no more than 5% of the Medi-Cal check write.
The second notice regards the rental rate for oxygen concentrators E 1390 indicating that the rate set for rental was inaccurate at $144 per month, minus the 10%, and does not reflect 80% of the Medicare rural rate for rental. That notice (Here is the Link) indicates that an EPC will be done but does not state when. It will be retroactive to 1/1/19.
These cuts are devastating to DME providers at a time when we are on the front lines of caring for COVID patients and others. We are reviewing all our options in fighting against the recently announced retroactive cuts and will keep all informed. DHCS has taken these actions against other types of providers based upon their requirement to reimburse for Medi-Cal services according to the methodology indicated in their State Plan filed with CMS.
CAMPS has been working with DHCS for months on inappropriate denials for ventilator rentals. DHCS announced a change in August to require that claims for monthly rental had to include a “from-to date” where no such requirement previously existed. They did revise their policy to delete the requirements but rental claims continued to be denied for months if those dates weren’t included. That changed as of 11/23/2020 and vent claims are now being paid. An EPC will be implemented to pay those incorrectly denied claims in the past but that will not occur until March of 2021. This policy only impact FFS Medi-Cal claims.
