TRICARE is issuing its first official acknowledgements that they will reprocess claims from July 1 through December 31, 2016 to reflect adjustments to the fee schedule mandated by last December’s CURES bill. In letters responding to HME providers who have inquired about potential CURES-based reimbursement adjustments, TRICARE states:
You are correct TRICARE uses Medicare’s DMEPOS fee schedule, Medicare reduced their rates in the second half of 2016, and a subsequent resolution (the 21st Century Cures Act) delayed that reduction, and retained the original, higher rates for claims with dates of service between July 1 and December 31, 2016. TRICARE followed suit and we suggest you resubmit any claims adjudicated under the reduced rates to the Managed Care Support Contractor (MCSC) in your region for reprocessing.
Laura Williard, AAHomecare’s vice president for payer relations, suggests that providers who have not already done so should submit the letter titled "Sample Provider Letter to DoD on CURES-Mandated TRICARE Reimbursements (MS Word Doc)" found among our payer relations resources here. By doing this, you should receive a similar response letter to the example noted above in case any questions arise from your TRICARE contractors.
Willard also advises providers to consider first resubmitting a small batch of claims to ensure they are reprocessed correctly prior to sending all claims. This approach would eliminate the need to resubmit all your claims multiple times if the contractor happens to deny or process the initial claims incorrectly.
AAHomecare and HME Stakeholders Nationwide Work Together to Secure a Big Win for Providers Who Serve TRICARE Beneficiaries
This development is the culmination of a sustained 6-month effort led by AAHomecare that included researching and securing legal opinions that confirmed that TRICARE was obligated to follow the CURES provisions, direct outreach and education to TRICARE and its contractors, and marshaling the community to raise the issue with TRICARE themselves. We thank the many providers and other stakeholders who took part in these efforts and helped spur TRICARE to formally adopt the CURES provisions.
One provider who reached out to TRICARE on the issue and just received the good news is Tyler Riddle, vice president of MRS Homecare and also the current president of the Georgia Association of Medical Equipment Suppliers.
“I am ecstatic to see that TRICARE is aware of the CURES-mandated adjustments and is ready to implement them,” remarked Riddle. “Now the HME community needs to keep making the case to TRICARE and other third-party payers that the current bidding-derived rates are unsustainable going forward and need to be adjusted on a long-term basis.”
“This is a great example of what we can accomplish through persistent advocacy and outreach efforts,” Riddle continued. “I hope this win encourages HME providers everywhere to redouble their efforts to advocate to CMS and Congress for much needed relief on Medicare reimbursement rates. Reaching out to your Senators to support the current sign-on letter on rural rate relief would be a great place to start.”