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- 03/07/14--11:33: _CMS: ‘There’s no sp...
- 03/07/14--11:19: _In brief: Lawmakers...
- 03/07/14--07:31: _President’s budget ...
- 03/11/14--08:20: _Medicaid fraud unit...
- 03/13/14--13:09: _AAHomecare tells Se...
- 03/14/14--11:47: _Bundling would wors...
- 03/14/14--11:43: _Full plate: AAH tac...
- 03/14/14--11:35: _In brief: Brightree...
- 03/17/14--13:27: _AAH to consumers: H...
- 03/20/14--10:53: _Contractors warn do...
- 03/21/14--12:08: _Confusion permeates...
- 03/21/14--12:06: _AAHomecare courts c...
- 03/21/14--12:05: _ICD-10 lurks in sha...
- 03/21/14--12:02: _In brief: Lawmakers...
- 03/27/14--08:19: _House passes ‘doc f...
- 03/28/14--11:56: _Consultant petition...
- 03/28/14--11:54: _Stakeholders warn s...
- 03/28/14--11:34: _Industry pushes for...
- 03/28/14--11:27: _Survey says: Provid...
- 03/28/14--11:22: _In brief: AAH surve...
- 03/07/14--11:33: CMS: ‘There’s no specific proposal at this point’
- 03/07/14--07:31: President’s budget reins in DME spending
- 03/11/14--08:20: Medicaid fraud units secure thousands of convictions
- 03/13/14--13:09: AAHomecare tells Senate: Stop audits until backlog clears
- 03/14/14--11:47: Bundling would worsen broken system, poll respondents say
- 03/14/14--11:43: Full plate: AAH tackles audits, bidding, consumer engagement
- 03/14/14--11:35: In brief: Brightree, ResMed rebrand and more
- 03/17/14--13:27: AAH to consumers: Help us stand up for home care
- 03/20/14--10:53: Contractors warn docs of DME scams
- 03/21/14--12:08: Confusion permeates RAC transition
- 03/21/14--12:06: AAHomecare courts consumers
- 03/21/14--12:05: ICD-10 lurks in shadows
- 03/27/14--08:19: House passes ‘doc fix’ bill with ICD-10 delay
- 03/28/14--11:56: Consultant petitions for civil complaints court
- 03/28/14--11:54: Stakeholders warn state lawmakers on bidding supplies
- 03/28/14--11:34: Industry pushes forward after disappointing vote
- 03/28/14--11:27: Survey says: Providers criticize bidding, bundling
- 03/28/14--11:22: In brief: AAH surveys providers, DHS taps Univita exec
BALTIMORE – CMS in February began taking public comment on how to expand competitive bidding nationwide, but not on the program itself, officials said during a March 5 Open Door Forum.
During the Q&A portion of the forum, Kim Brummett, senior director of regulatory affairs for AAHomecare, asked if CMS planned to wait until the Office of Inspector General (OIG) releases a pair of reports on Round 1 and Round 2 of competitive bidding before issuing a proposed rule on expanding the program.
Joel Kaiser, director of the Division of DMEPOS Policy, said CMS is taking comments on the methodology to adjust prices in non-bid areas, not on the bid program.
In addition to adjusting prices, CMS is looking at the payment rules for certain DME and for enteral nutrient supplies and equipment.
“What we’re doing in the same document is soliciting public comment on whether, under the competitive bidding program, we should simplify the payment rules,” Kaiser said.
Brummett followed up by asking, “On bundling for enteral therapy, is the intention of CMS, if it is bundled, to include the formula or are you guys thinking primarily of supplies and equipment?”
“This is just an advance notice of proposal,” Kaiser replied. “We’d like to get some thoughts and ideas. There’s no specific proposal at this point and there may never be one.”
WASHINGTON – A group of lawmakers has written to CMS Administrator Marilyn Tavenner to express grave concerns with CMS’s plans to transition certain complex rehab items to capped-rental status on April 1. In the March 6 letter, the two representatives and two senators ask CMS to delay the transition until at least July 1 “to allow for the development of appropriate classification policies that provide patients with medically necessary CRT equipment in a reasonable and cost-effective way.” Industry stakeholders contend, and these lawmakers agree, that CMS is basing its decision on Medicare claims data that is more than 27 years old and fundamentally flawed. CMS has said that congressional action would be needed to update the statute that requires use of the outdated data, according to the letter. Sens. Thad Cochran, R-Miss., and Charles Schumer, D-N.Y., and Reps. Jim Sensenbrenner, R-Wis., and Joseph Crowley, D-N.Y., ask for a prompt response to their request for delay.
Brightree Services cuts jobs
PADDOCK LAKE, Wis. – Brightree Services, a Brightree subsidiary, has laid off 50 employees from its Paddock Lake, Wis., office, the Kenosha News reports. The company will still provide services there, but it may eliminate more jobs between now and June 30, according to the story. “Competitive bidding, a process mandated by Medicare, is just one of those pressures that by itself drove down total reimbursable amounts across our billing service customer base by 45%,” said Judson Phillips, marketing and communications director, for Brightree. Brightree Services had 175 employees in the Paddock Lake office. The company moved there from Antioch, Ill., with 80 employees in 2010, the story reports.
New coalition seeks to protect urologicals
NEW YORK – The United Spinal Association and a group of manufacturers have banded together to ensure people with disabilities have access to needed supplies. The newly formed Urology Coalition is particularly concerned about the impact of competitive bidding, which it says limits patient access, and the future expansion of the program to include urologicals. The coalition will also work to ensure access under Medicaid and private insurances. In general, the Urology Coalition’s mission is to act on health policy matters that: maximize function and independent living for people with disabilities; provide people with disabilities with their choice of, and access to, prescribed and medically appropriate urological medical technology and supplies; and ensure appropriate coding, coverage and payment. In addition to manufacturers, the coalition will include consumers, disability advocates, clinicians and physician groups. Members are: ABC Home Medical, Adapta Medical, CR Bard, Coloplast, Convatec, Cure Medical, Hollister, McKesson, Teleflex Medical, UroMed, Wellspect Healthcare, Simon Foundation for Continence and the United Spinal Association.
VGM gathers bidding comments
WATERLOO, Iowa – The VGM Group has received 280 replies so far for its online competitive bidding survey, and it doesn’t want to stop there. The group created the survey to make it easier for providers to respond to CMS’s recent request for public comment on a proposal to expand the competitive bidding program nationwide in 2016. CMS on Feb. 24 published an advanced notice of proposed rulemaking seeking input on developing a methodology to adjust rates in non-bid areas based on bid rates; and on bundling payments for certain DME, including complex rehab and enteral nutrition. VGM says its survey clarifies the six questions asked by CMS. It will forward the results to the agency by the March 28 deadline. Take the survey here.
Medline to open $18M distribution center
MUNDELEIN, Ill. – Medline Industries will open a new, state-of-the-art distribution center in Lincoln County, N.C., in early 2015, the manufacturer/distributor of medical and surgical supplies announced March 3. Medline expects to begin construction on the $18 million, 400,000-square-foot center this spring. The center will be located in Lincoln County Industrial Park and will create about 40 new jobs. When the center opens, Medline will have more than 40 distribution centers throughout the United States, along with 19 manufacturing facilities. It has a team of 1,200 sales reps to support its line of 350,000 medical and surgical products. The center will be constructed using the latest energy efficient technology and undergo LEED (Leadership in Energy and Environmental Design) certification review. Features will include motion sensors to keep lights off in aisles when not in use, 200 skylights, and super-sized fans to reduce dependency on air conditioning and heating. Medline will use the center to service hospitals, nursing homes, surgery centers, home care agencies and other healthcare providers throughout North Carolina and surrounding states. The company serves as the primary distributor to more than 450 major hospitals and healthcare systems in the U.S. In 2013, Medline’s sales increased 13% to $5.8 billion.
Pharmacy partners with HME, becomes ‘healthcare destination’
MEDINA, Ohio – Discount Drug Mart has partnered with Hastings Professional Medical Equipment to make health care more convenient for its customers. The new affiliation will allow patients to work with their local Discount Drug Mart Pharmacy to get home medical equipment, such as oxygen, nebulizers, hospital beds, power wheelchairs and more, according to a release. “Discount Drug Mart will now be a place people can find answers who are struggling with questions about home health care needs, as well as the ability to pick up their prescriptions at the same time, truly making Discount Drug Mart a healthcare destination,” the release states. Discount Drug Mart has 71 stores in more than 20 counties across Ohio. Its slogan is “Discount Drug Mart Saves You the Runaround…We Have Everything You Need.”
Colonial takes interest in Baar
ORLANDO, Fla. – Colonial Medical Supplies has become a minority shareholder in Channahon, Ill.-based Baar Home Medical. As part of the agreement, Colonial will renegotiate Baar’s pricing with manufacturers, and help it expand into new product categories and apply best billing practices. Colonial is also adding Baar’s location to its private insurance and competitive bidding contracts. Colonial won more than 600 contracts to supply walkers, oxygen, CPAP, manual and power wheelchairs, hospital beds and support surfaces in nearly all bid areas. In 2013, it began seeking strategic partners, instead of subcontractors, to more directly serve patients.
3B offers automatic sleep data collection
LAKE WALES, Fla. – 3B Medical’s iCodeConnect cloud-based patient management portal now integrates voice recognition and patient auto-dialing to better help providers collect sleep compliance data. Here’s how it works: During patient set-up, the provider can select the auto-dial option for the patient. At scheduled times, iCodeConnec will automatically call the patient and walk them through retrieving his or her iCode. The iCode string can be entered by the patient using the number pad on the phone or by voice recognition. Then iCodeConnect routinely calls and collects patient data directly from the patient and the iCodeConnect patient portal will auto-populate with necessary compliance data.
Permobil previews new technology
LEBANON, Tenn. – Permobil is previewing the Virtual Seating Coach this week at the International Seating Symposium in Vancouver. The technology coaches wheelchair users through their seating regimen for improved compliance and health outcomes. By installing an application on the wheelchair user’s smartphone, clinicians are able to program specific seating instructions, including the amount of tilt and recline, the hold time for the position and the number of times a day the functions should be used. The Virtual Seating Coach, which was developed by the University of Pittsburgh and VA Pittsburgh Healthcare System’s Engineering Research Laboratories, will be available on certain Permobil chairs later this year.
101 Mobility ramp spans Mississippi
ST. LOUIS – 101 Mobility installed a temporary 1,100-square-foot aluminum wheelchair ramp on the new Stan Musial Veterans Bridge to ensure an opening ceremony was fully accessible. The ramp installation was done in windy, subzero conditions, according to a press release. “At one point, the wind was blowing so hard that it threw a 24-foot ramp straight up into the air,” said 101 Mobility St. Louis owner Brad Kohlbracher. The opening ceremony included a ribbon cutting and a 5K run and cycling road race.
Provider transitions to employee ownership
GARDEN CITY, N.Y. – Home Medical Equipment, a provider of custom mobility products, equipment and services, is now 100% owned by its Employee Stock Ownership Plan (ESOP). “Our new ownership structure promises great things for the future of our company,” said Bill Tobia, president of Home Medical Equipment, in a release. “It’s a meaningful change for all of our hardworking, dedicated employees who now share ownership in the company they helped to build.” CSG Partners served as the exclusive financial advisor to Home Medical Equipment on the transition. “Not only is the ESOP a highly strategic liquidity structure for shareholders, it also provides exceptional benefits to employees and positions the company for long-term success,” said Stephen Berman, a managing director at CSG, in the release.
Sigvaris celebrates 150 years in business
PEACHTREE CITY, Ga. – Sigvaris is celebrating 150 years in business by giving customers the chance to win a weekend trip to Atlanta and an invitation to its anniversary party in July. To determine the winner, Sigvaris is asking customers to share their stories of how using the company’s compression garments has helped them. “The theme for the party is ‘Every Day a Step Further’ and giving people an opportunity to share their story is the perfect opportunity to celebrate both our commitment to leg health and the longevity of our company,” said Clay Walker, North America marketing manager, in a release. In addition to the trip, Sigvaris will be giving away 10 pairs of Sigvaris Well Being or Sigvaris Sports products in the 10 weeks leading up to the announcement of the winner on June 2. For official rules, go to http://www.sigvarisusa.com/en/ContestsandSweepstakes.
Jurisdiction C DME MAC releases results of prepay reviews
A claim review of the initial month of therapy for CPAP devices (E0601) for Oct. 1, 2013, to Dec. 31, 2013, showed a denial rate of 48%. In the previous quarter, the rate was 56%. The most common reason for denial: The documentation did not include a copy of a board certified document, screen print from a national certification agency, etc., that verifies that the physician who interpreted the sleep test met policy requirements (30%)…A claim review for oxygen concentrators (E1390) for Oct. 1, 2013, to Dec. 31, 2013, showed a denial rate of 68%. In the previous quarter, it was 58%. The most common reason for denial: The medical records that were received did not document that the beneficiary was seen and evaluated by the treating physician within 30 days prior to the date of initial certification (24%)…A claim review for Group 2 standard power wheelchairs with Captains chair (K0823) for Oct. 1, 2013, to Dec. 31, 2013, showed a denial rate of 45%. In the previous quarter, it was 54%. The most common reason for denial: The face-to-face requirement did not provide a measurable assessment of upper extremity strength and function, so the reviewer could not rule out that the beneficiary was unable to use an optimally configured manual wheelchair (21%)…A claim review for inhalation drugs (J7605, J7606, J7613, J7620 and J7626) for Oct. 1, 2013, to Dec. 31, 2013, showed a denial rate of 56%. In the previous quarter, it was 53%. The most common reason for denial: No medical records were provided for review (46%).
Mobile, Ala.-based Supreme Medical is a provider to the stars, supplying medical supplies and equipment to the show Grey’s Anatomy, the company said March 2. The national wholesale distributor is working with the prop department at ABC Studios to deliver surgical supplies and hospital equipment for the show, now in its 10th season…The Board of Certification/Accreditation (BOC) has won a Stevie Award for sales and customer service in the “Best Use of Technology in Customer Services” category. It’s the second consecutive year that BOC has won the award.
Beth Ludwickhas joined AAHomecare and will be responsible for implementing communications strategies that position the association as the voice of the homecare industry. Ludwick comes to AAHomecare with six years of communications and marketing experience at the largest trade association representing the food industry, the Grocery Manufacturers Association…Dan Fedor has joined the reimbursement team at The VGM Group. He will work with Peggy Walker and Ronda Buhrmester. Fedor comes to VGM from The Mobility Consultants, where he was CEO and compliance consultant, and before that, Pride Mobility Products…Jenn Wolfe, a disability advocate, lobbyist and Ms. Wheelchair Iowa 2011, has been selected to spearhead the United Spinal Association’s UsersFirst program. Wolfe replaces Ann Eubank, who left the association to be the executive director of the Center for Independent Living in Nashville…Stu Novitz has joined B&B Medical Technologies as vice president of sales and marketing. He will work to expand the company’s growing international presence and strengthen its current distribution network. Previously, he spearheaded Clement Clarke’s efforts to extend its reach into North American medical markets.
WASHINGTON – President Obama’s fiscal year 2015 budget includes proposals to limit Medicaid spending on DME and to ramp up Medicare fraud efforts.
On Medicaid spending, the budget explains, “States have experienced challenges in preventing overpayments for DME. Starting in 2015, the budget would limit federal reimbursement for a state’s Medicaid spending on certain DME services to what Medicare would have paid in the same state for the same services.”
This is the third year that Obama has tried to limit Medicaid spending on DME, according to The VGM Group.
The Office of Inspector General (OIG) has released a string of reports saying that state Medicaid programs could see significant savings by aligning their pricing with Medicare’s, particularly its competitive bidding pricing. A report in January, for example, states that Medicaid programs could have saved 23%, or $62 million, if they paid the median competitive bidding rates for incontinence supplies in 2012.
The budget scores this proposal to save $3.135B over 10 years, from 2015-2024.
On fraud, the budget proposes requiring prior authorizations for power mobility devices and advanced imaging—a move that could be expanded to other items and services at high risk of fraud and abuse.
CMS in September 2012 launched a demonstration project in seven states requiring prior authorizations for power mobility devices. The agency reported in December that the demo reduced overall expenditures in those states from $12 million in September 2012 to $4 million in September 2013.
“We have almost a year and a half experience with the program,” AAHomecare stated. “We are working with CMS to make necessary changes and continue to advocate for improvements. However, the budget proposal is very vague, so it’s unclear how it would be implemented.”
Also on fraud, the budget proposes modifying the documentation requirement for face-to-face encounters for DME claims. CMS is expected to start enforcing a face-to-face requirement for DME some time this year. The requirement went into effect July 1, 2013.
“The budget is not law,” VGM stated in a bulletin. “The House and Senate will play a key role in determining which or any of the provisions discussed above will actually be implemented.”
WASHINGTON – Nationwide, Medicaid Fraud Control Units (MFCU) in 2013 secured 1,341 criminal convictions and 879 civil settlements and judgments in cases involving Medicaid fraud and patient abuse and neglect, according to a report from the Office of Inspector General (OIG).
Criminal recoveries reached nearly $1 billion, while civil recoveries topped $1.5 billion, the March 7 report says. Both types of cases involved a variety of providers, but the most notable were home health agencies in criminal court and pharmaceutical companies in civil court.
“This report represents a new effort by OIG to compile in one document information about MFCU activities and results, and we anticipate issuing annual reports for future years,” wrote OIG, which conducted 10 onsite reviews of MFCUs, publishing eight reports.
OIG relied on convictions from MCFU investigations to exclude more than 1,000 providers from federal healthcare programs in 2013, the report says.
In compiling the report, OIG says it found some Medicaid managed care organizations may lack incentive to refer providers suspected of fraud to MCFU and that new rules under the Affordable Care Act require more coordination between MCFUs and state Medicaid agencies.
The OIG issued regulations to allow data mining by MCFUs and proposed more authority for the units to investigate allegations of patient abuse and neglect.
WASHINGTON –AAHomecare has met with senators to discuss improvements the association wants to see to the audit process. First on the list: stop new audits until a massive appeals backlog is cleared.
Kim Brummett, vice president of regulatory affairs, and Jeff Mastej, chairman of the AAHomecare Regulatory Council, met with members of the powerful Senate Finance Committee today to discuss their list of recommendations, according to a bulletin.
“AAHomecare remains deeply concerned about the tremendous burden unfair, poorly managed audits have placed on home medical equipment providers,” said Brummett.
The battle to fight audits has gained strength ever since a Dec. 31 memo from Chief Administrative Law Judge (ALJ) Nancy Griswold cited a backlog of 357,000 pending appeals pending, and suspended assignment of hearings for appeals dating to July 15, 2013. It could be at least two years before those appeals get assigned to an ALJ.
Brummett and Jeff Mastej, chairman of AAHomecare’s Regulatory Council discussed the association’s recommendations with committee members.
The association is drafting legislation for audit reforms.
In addition to halting new audits, AAHomecare recommends CMS:
•Stop interest penalties until an audit clears all levels of appeals;
•Stop recoupment/repayment until an audit is through all levels of appeals;
•Issue guidance to DME MACs to allow for a timely filing override on continuous rental or supply claims;
•Issue guidance to DME Macs to require reopening after a redetermination on a technical denial;
•Evaluate the Qualified Independent Contractor to determine if the step is effective or a stop gap on the way to the Administrative Law Judge;
•Assign greater weight to clinical inference, letting the medical record reflect the patient’s needs and pay for services based on those facts.
YARMOUTH, Maine – Bundling payments for certain DME would create a bundle of problems for providers and beneficiaries alike, according to a recent HME NewsPoll.
“Bundling would vastly complicate all aspects (ordering, supplying, billing) because customers’ needs vary so much,” said Janet Poole, a billing supervisor with New Hampshire Pharmacy and Medical Equipment in Washington, D.C. “How could a fair price be determined?”
Nearly three quarters of the respondents to the April HME NewsPoll (71%) say that bundling would not simplify the payment process—at least not for providers.
“Bundled payments simply mean less admin for the payer,” said Jim Rogers, with Pinnacle O&P Services in Chattanooga, Tenn. “What happens to the patient is a different story and usually not the concern of those making the bundling decisions.”
If anything, bundling could worsen an already broken payment system, say providers.
“Without improvement of the claims processing and audit system, bundling will not help our business and probably only decrease quality for beneficiaries,” said Pam McElrath, director at Hendrick Medical Supply in Abilene, Texas.
In fact, decreased quality is a sure bet, say the vast majority of poll respondents (90%).
Some poll respondents acknowledged, however, that healthcare costs need to be controlled somehow.
“Bundling might be a better way to control the process and all costs associated with the services,” said Ronald Rukas, president of Blackburn’s Physicians Pharmacy in Tarentum, Pa. “The question is, what will we be paid and can we change the old habits of patients and staff?”
Poll respondents were split on whether bundling would reduce utilization rates, with 52% saying it would vs. 48% saying it wouldn’t.
“Bundling would reduce high utilization, but it would also force Medicare to pay for those not using equipment, as well,” said one respondent. “A very bad idea.”
LAS VEGAS – AAHomecare is on the verge of making announcements in three key areas, association officials told Medtrade Spring attendees on March 11.
Audits: Time to force things to happen
After trying to work with the administration and CMS on reforming the audit program for several years, Jay Witter, vice president of government affairs, said, “There are things that need to be forced to happen” through legislation.
“(A bill) is close to being finalized,” he said. “We’ll make an announcement very shortly on this huge audit effort. We’re working with lawmakers and we’re working with other (healthcare) groups. We’ll need your help.”
While association officials didn’t detail the legislation, they said it pulls from a list of recommendations to the administration and CMS. Those recommendations include conducting independent reviews of contractors, implementing interest penalties when claims are overturned, limiting the number of audits a provider can receive during a given period, and reinstating “clinical inference.”
“Some of those are inside the legislative language, some are just goals in working with the MACs individually,” said Kim Brummett, senior director of regulatory affairs.
AAHomecare officials also said they’ve met with a developer to create an Internet-secure tool for tracking audit data similar to the American Hospital Association’s RACTrack. They estimate it will cost $250,000.
“(We) need to raise funding,” Brummett said.
Competitive bidding:We have leverage
CMS’s recent request for comments on how to take competitive bidding nationwide in 2016 has raised the stakes on the industry’s fight to derail the program, AAHomecare officials said.
“Who’s not in a bid area?” Tom Ryan, president and CEO, asked attendees. “Guess what—you’re now in the soup.”
That fight got a boost recently when members of the Senate Finance Committee included a competitive bidding-related provision on licensure in their draft doc fix bill.
“(It’s the) first time the committee has voiced concern with bidding,” Witter said. “That gives us leverage.”
Association officials are in continued talks with lawmakers to expand that provision to include more substantive relief, including elements of H.R. 1717, a bill to replace competitive bidding with a market-pricing program (MPP).
“We’re working to get something done in a very short time,” Witter said.
Consumer engagement:'I need my HME'
AAHomecare officials said they have a renewed focus on engaging consumers on issues like audits and competitive bidding, after hearing, in meeting after meeting with lawmakers: “Why aren’t they complaining?”
“Because you’re doing such a good great job, the patient has never known what’s going on,” Witter said. “We’re at a point now where it just can’t be done anymore. Patients are getting frustrated, and that’s going to be the driving force. We need a campaign, ‘I need my HME; don’t take it away.’”
LAS VEGAS – Brightree unveiled a new brand at Medtrade Spring to reflect its growing investments in technology and services in post-acute care, including home health, home infusion and hospice. The provider of cloud-based billing and management software says its expansion will help HME businesses expand, diversify revenue streams and attract new customers. Brightree estimates spending on the post-acute side of HME, home infusion, home health, hospice and long-term care will double in 10 years to more than $500 billion. “Our goal is to help Brightree customers capture the greatest share of that growth by equipping them with the broadest array of software, services and professional expertise targeted to their specific needs,” said CEO Dave Cormack. In other news, the ICD-10 test claims that Brightree has submitted to CMS were all accepted.
ResMed rebrands to reinforce committment
SAN DIEGO – ResMed has a new tagline, “changing lives with every breath,” and an updated logo. It’s the first re-branding in the company’s 25-year history, according to a March 10 release. “Worldwide shifts in healthcare dynamics have opened up important opportunities to further impact the well being of millions of undiagnosed patients,” said CEO Mick Farrell. ResMed says the updated brand reinforces its commitment to patients, providers and partners. The company’s new brand, including a new website, rolls out with its U.S. operations and globally through the rest of the year.
AAH briefs Finance Committee on audits
WASHINGTON –AAHomecare met with the Senate Finance Committee March 13 to discuss improvements to the audit process, according to a bulletin. Now drafting legislation to overhaul the process (see related story), the association recommends CMS stop new audits until a massive backlog is cleared; stop interest penalties and recoupment/repayment until an audit clears all levels of appeals; issue guidance to DME MACs to allow for a timely filing override on continuous rental or supply claims; and assign greater weight to clinical inference, among other suggestions. The industry’s battle against audits has strengthened ever since a Dec. 31 memo from Chief ALJ Nancy Griswold citing a huge backlog of pending appeals and the suspension of the assignment of new hearings for appeals dating back to July 15, 2013.
ActiveCare program cuts healthcare costs, says study
OREM, Utah – Patients participating in ActiveCare’s diabetes management program saw first-year cost savings of nearly $3,400 each, according to a study published in US Endocrinology. “These findings suggest that even partial improvement of diabetes testing adherence within an employed population may result in substantial attenuation of employee medical expense,” study authors wrote. “The reduction in healthcare costs, even when considering those who did not comply, outweighed the program costs by several-fold.” Study authors looked at allowed claims between 2011 and 2012. They found participating members’ costs fell, while care costs for nonparticipants increased $282. ActiveCare uses real-time data from participants’ cellular glucometers to call those with dangerously high or low levels of glucose. Registered nurses follow up regularly with participants and advise them on eating and exercise habits.
ASP: Brand-name drugs see increase
BALTIMORE – Two nebulizer medications will see payment increases for the second quarter of 2014. In the latest average sales price (ASP) figures, released March 4, brand-name drugs Brovana (J7605) and Perforomist (J7606) increased 37 cents and 55 cents, to $6.14 and $6.91, respectively. That’s in contrast to budesonide (J7626), which decreased nearly 51 cents to $5.61 per dose. Other neb meds saw little change: albuterol (J7613) was up just over a penny to 13 cents per dose, while ipratropium (J7644) stayed at just under 12 cents per dose.
Stand Up for Homecare brings in $50K
LAS VEGAS – AAHomecare’s Stand Up For Homecare reception on March 11 raised an estimated $50,000, the association reported in its weekly bulletin. Held during Medtrade Spring at the Mandalay Bay Conference Center in Las Vegas, the fundraiser supports industry efforts to get positive, accurate DME news in national and local media, and the Mobility Matters and DME Matters newsletters. At the October Stand Up for Homecare event, AAHomecare raised $75,000.
Medtrade names award winners
LAS VEGAS – Five manufacturers took home awards for products and booths at Medtrade Spring. Medela, of McHenry, Ill., earned Best Booth Award and Algona, Wash.-based EZ-Access took home the Creative Concept Award. The iWalk2.0 Hands Free Crutch won the Providers Choice Gold Award; Jordi Airflow’s Jordi-Stick took home silver; and Utah-based Stander’s Endevr StrengthTape took bronze. Nearly 2,000 providers attended the March 10-12 show at the Mandalay Bay Conference Center in Las Vegas, according to a release. Medtrade is scheduled for Oct. 20-23 in Atlanta.
Medicaid fraud units secure thousands of convictions
WASHINGTON –Medicaid Fraud Control Units (MFCU) in 2013 secured 1,341 criminal convictions and 879 civil settlements and judgments nationwide, according to an Office of Inspector General (OIG) report. Criminal recoveries reached nearly $1 billion, while civil recoveries topped $1.5 billion, the March 7 report says. Both types of cases involved a variety of providers, but the most notable were home health agencies in criminal court and pharmaceutical companies in civil court. “This report represents a new effort by OIG to compile in one document information about MFCU activities and results, and we anticipate issuing annual reports for future years,” wrote the OIG, which conducted 10 onsite reviews of MFCUs and published eight reports. The OIG relied on convictions from MCFU investigations to exclude more than 1,000 providers from federal healthcare programs in 2013, the report says.
The Audit Team, ACU-Serve formalize partnership
CUYAHOGA FALLS, Ohio – The Audit Team has partnered with ACU-Serve to provide billing audits and appeals consulting services, and government compliance help. “It is impossible for dedicated HME/DME companies to both serve patients and adapt procedures every time a law or insurance policy is changed,” said Stephanie Green, general counsel and chief consulting officer for The Audit Team, in a release. In February, ACU-Serve co-founder Jim Knight stepped into the role of CEO and announced plans to have Green head up an auditing and consulting division.
Registration opens for RESNA conference
WASHINGTON – Registration is now open for RESNA’s annual conference, slated for June 11-15 in Indianapolis. “Racing Towards Excellence in AT” will feature the introductory “Fundamental in Assistive Technology” course and nine other full- and half-day instructional courses; more than 40 workshops and research-oriented platform; and poster sessions. The conference will screen the award-winning documentary, “Fixed: The Science/Fiction of Human Enhancement,” and host presentations on pediatric mobility research, AT and safety in agricultural-related workplaces, and improving wheeled mobility for older adults.
WASHINGTON – AAHomecare plans to kick off a digital marketing campaign in April to drive consumer awareness of Medicare policies that are restricting access to home medical equipment, services and supplies.
“This campaign will help consumers better understand why flawed policies affect their health and how they can make their voices heard,” said Tom Ryan, president and CEO, in a press release. “Consumers will be able to stand up and defend their access to the equipment, services and supplies they need to receive healthcare at home.”
The association will launch the campaign in concert with Lisa Wells, president of Get Social Consulting, and Anna McDevitt, president of Laboratory Marketing.
At the heart of the campaign: humanizing Medicare policies that are hurting patients, Wells says.
“We will be sharing individual, personal stories in a format that is visual, viral and digital,” she said.
AAHomecare will share resources and other specifics with providers in the upcoming weeks, according to the release.
WASHINGTON – The DME MAC medical directors say they are fielding frequent complaints from doctors who are the targets of DME marketing schemes.
The medical directors reminded physicians in a recent letter that they can report suspected abuse to the Office of Inspector General (OIG).
“Most of these scams are obvious in their wording or their attempts to get you to approve unnecessary medical equipment and supplies,” the letter states.
Common scams, according to the letter: unsolicited orders for medical equipment or supplies, often claiming a patient asked the supplier to contact the doctor; advertisements saying Medicare will pay physicians for patient referrals; and pre-completed medical necessity forms with instructions to sign and date.
The medical directors have asked doctors to pay careful attention to orders asking for their signatures. They recommend that doctors be skeptical of unsolicited orders for patients no longer in their practices and document medical justification for any DME item ordered for a patient.
YARMOUTH, Maine – The first few weeks of CMS’s wind-down of audits by the current group of recovery audit contractors (RACs) have brought confusion to some providers.
Provider Ron Evans says, although the volume has declined in March, he’s still receiving additional documentation requests (ADRs) from the RACs.
“We’ve gotten about 20 pre-pay reviews for oxygen and complex medical reviews for CPAP,” said Ron Evans, owner of Valley Respiratory Services in Phoenix, Ariz. “They are dated between March 4 and March 12.”
Feb. 21 was supposed to be the last day the RACs could send a post-payment additional documentation request (ADR) and Feb. 28 was supposed to be the last day a MAC could send pre-payment ADRs for RACs to review. June 1 is supposed to be the last day RACs can send improper payment files to the MACs for adjustment.
One thing for providers to be aware of, stakeholders say: Other audits, besides RAC audits, are still a go.
“Providers are still getting requests for documentation from other sources and have them confused with RACs,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “The Medicare administrative contractors (MACs) still have the authority to review claims for reasonableness and medical necessity at any time. It is very confusing.”
Industry consultant Andrea Stark says she hasn’t heard of any new requests from the RACs.
“Based on mailing protocols, there may have been some delays in the mail getting to the supplier, but those letters should not be dated after Feb. 28,” said Stark, a reimbursement consultant with MiraVista.
Another possible reason for the confusion: Maybe not all contractors have gotten the word, stakeholders say.
“Sometimes the RACs or MACs don’t always get the clear message,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “I would call them up.”
That’s just what Huntington Beach, Calif.-based Diversified Medical Equipment and Supplies did after receiving new ADRs in March.
“They said, ‘We know there’s a transition but nobody’s told us to stop,’” said Adrian Ioja, general manager, who heard the same from another local provider. “We have no choice but to continue to respond to the requests.”
WASHINGTON – AAHomecare hopes its all-hands-on-deck approach to fighting competitive bidding and other “bad” Medicare policies will soon include consumers.
The association on April 1 plans to kick off a new digital consumer advocacy campaign, called “Save My Medical Supplies,” to allow it to tap into a new outlet of support.
“Many, many patients have been affected by these bad policies,” said Tom Ryan, CEO of AAHomecare. “Building awareness in the general Medicare population that their access and choices are being eliminated by these egregious policies is something we’re building into our communication efforts. They are our best advocates.”
AAHomecare will use email, social media and a new consumer website to direct consumers to a web-based tool that allows them to show their support through emails or snail mail to lawmakers.
The tool will also allow the association to measure how many consumers participate in the effort and their impact on the Hill.
“That’s a message the member of Congress needs to hear, wants to hear and will, in fact, respond to,” said Ryan. “It’s raising the noise on our issues.”
To engage consumers, AAHomecare will use digital media and advertising. It will also ask providers to share contact information for their marketing reps for use in an email and phone chain to spread the word.
“We need to be using every single channel and making sure we’re on the cutting edge and taking advantage of every resource available to us,” said Beth Ludwick, senior manager, digital media and communications, at AAHomecare.
Consumers and digital media are two pieces that have been largely missing from the industry’s efforts so far, said Lisa Wells, president of Get Social Consulting, who is managing the campaign along with Anna McDevitt, president of Laboratory Marketing.
“While competitive bidding is a familiar phrase inside the industry, very few consumers have heard of it and even fewer know what it means to them individually,” she said.
WASHINGTON – It may not be the documentation change grabbing headlines, but the transition to ICD-10, scheduled for Oct. 1, will still muck up the process for HME, industry consultants say.
The biggest misconception that providers have about ICD-10, they say: that there will always be an easy, one-to-one transition from ICD-9 to ICD-10.
“If we think we can just pick a code in the crosswalk, we can’t,” said Sarah Hanna, president of ECS Billing & Consulting North. “It will be important to get the appropriate code from the physician, because down the road, in an audit, they’re going to request medical records to back up that ICD-10 code.”
There won’t always be a direct crosswalk, stakeholders say, because in ICD-9 there are many unspecified codes, while in ICD-10 the codes are more specific and diagnosis-driven.
The transition could prove particularly tricky for capped-rental and resupply items, stakeholders say.
“You’re definitely going to want to work out the codes for rentals prior to Oct. 1, so those claims can keep going out without a holding pattern,” Hanna said.
Like with many documentation changes, providers will be at the mercy of their physician referral sources in many ways, stakeholders say. Are their systems updated for ICD-10? Do they know the right new code?
“We have to prepare for it, but we’re not in control,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “If they’re not trained on it, it’s another thing on top of the list of things that we have to train them on.”
Unfortunately, the early buzz is that physicians won’t be ready for the transition.
“Remember PECOS?” asked Mary Ellen Conway, president of Capital Healthcare Group. “Physicians didn’t know anything about that, to the point where it kept getting delayed.”
There are things that providers can do to make the transition smoother, stakeholders say. First, they should make sure their software vendors are prepared. Brightree, for example, announced this month that it submitted multiple test claims across all its product lines to CMS and 100% of those claims were acknowledged by the agency.
Second, providers should come up with a plan to determine how the transition will affect their operations, including the referral process, revenue cycle management, and CMNs and claim forms, Conway says.
Third, by summer, providers should ask their referral sources if they can dual code, or include both the ICD-9 and ICD-10 codes on claims. At the very least, providers should ask them verbally what the ICD-10 code will be, Conway says.
“Your claims aren’t going to start going out the door ICD-10 by themselves,” she said. “What’s your process?”
The next step in the transition: In July, CMS plans to offer end-to-end testing to a small group of providers.
WASHINGTON – Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, are spearheading a congressional sign-on letter urging CMS Administrator Marilyn Tavenner not to expand competitive bidding until the Office of Inspector General (OIG) has completed its investigation into the program, according to AAHomecare. “It’s no secret that policymakers on both sides of the aisle see the controversial national bidding program as an unacceptable burden on the elderly and disabled,” stated Tom Ryan, president and CEO of the association, in a release. “AAHomecare thanks Reps. Thompson and Braley for urging CMS to work with Congress in a way that will best serve Medicare beneficiaries.” The VGM Group also applauded Thompson and Braley. It says it has heard from more than 3,000 Medicare beneficiaries and more than 400 providers about delays, increased costs and the difficulty receiving/providing supplies under the program. “The evidence is there that this program doesn’t work, and we’re grateful to the congressmen for their action,” stated John Gallagher, vice president of government relations for VGM.
Contractors warn docs of DME scams
WASHINGTON – The DME MAC medical directors say they are fielding frequent complaints from doctors who are the targets of DME marketing schemes. The medical directors reminded physicians in a recent letter that they can report suspected abuse to the Office of Inspector General (OIG). “Most of these scams are obvious in their wording or their attempts to get you to approve unnecessary medical equipment and supplies,” the letter states. Common scams, according to the letter: unsolicited orders for medical equipment or supplies, often claiming a patient asked the supplier to contact the doctor; advertisements saying Medicare will pay physicians for patient referrals; and pre-completed medical necessity forms with instructions to sign and date. The medical directors have asked doctors to pay careful attention to orders asking for their signatures. They recommend that doctors be skeptical of unsolicited orders for patients no longer in their practices and document medical justification for any DME item ordered for a patient.
OIG spotlights diabetes test strips
WASHINGTON – The Office of Inspector General (OIG) says in a March 18 report that state Medicaid programs could save millions on diabetes test strips. The OIG conducted audits in five states—Illinois, Indiana, New Jersey, New York and Ohio—to see whether competitive bidding or manufacturer rebates could lower costs for the test strips. The OIG found that two of the five states had saved $17.9 million through the use of rebates; and four of the five states could have saved an additional $29.7 million through rebates or competitive bidding. The OIG also identified $8.3 million in additional savings in four of the five states if pricing from Medicare’s national mail-order program had been used. The OIG recommends, and CMS concurs, that the agency should work with state Medicaid agencies to determine whether manufacturer rebates and lower reimbursement rates could achieve savings. In a separate report, the OIG reviewed claims for diabetes testing supplies without the KL modifier from three suppliers for calendar years 2010 and 2011. All three suppliers used company-owned vehicles to deliver supplies to beneficiaries, which the OIG says did not meet CMS’s then-definition of a mail-order supplier. The OIG says Medicare would have paid approximately $4.7 million vs. $8.2 million for the supplies if the definition for mail order included deliveries with company-owned vehicles.
Ottobock relocates distribution operations
MINNEAPOLIS – Ottobock announced March 17 that it is relocating its North America logistics and distribution operations from Minneapolis and Toronto to Louisville, Ky. “The move to Louisville is part of an expanded investment by Ottobock in the U.S. and North America that includes the goal to triple business,” the company states in a release. Ottobock notes that Louisville is a strategic shipping hub. The move is already underway, “with limited receiving, stocking and shipping of mobility products and the warehouse being readied for additional inventory,” according to the release. Additionally, Ottobock has started to hire in the area and plans to fill an estimated 20 new jobs by October. The company expects to spend $3.375 million as part of its relocation and growth efforts. Ottobock previously announced that it’s also relocating its North America headquarters from Minneapolis to Austin, Texas.
Therapy Support grows regional footprint
SPRINGFIELD, Mo. – Therapy Support has picked up all of the equipment and facilities of Town & Country Medical, an Overland Park, Kan.-based DME provider, according to the Kansas City Business Journal. “We’re excited to be in the Kansas City area,” Phaedra Craig, Therapy Support marketing director, told the newspaper. “We’ve actually been in the area since May of 2011, but we saw a great opportunity to grow with the acquisition of Town & Country.” Therapy Support provides specialty medical products for acute care, extended care, home care and hospice. The company’s products range from wound care to bariatric to patient safety equipment. It serves more than 10,000 patients in seven states, according to the newspaper.
Drive Medical taps new logistics provider
PORT WASHINGTON, N.Y. – Drive Medical has contracted with Pittsburgh-based Genco to provide transportation-related services, including routing, load optimization and planning, carrier contracting and management, and parcel audit and mediation, it was announced March 18. “Genco’s transportation and logistics capabilities will provide Drive Medical with the enhanced transportation and logistics infrastructure to help manage the company’s rapid growth,” said Allen Clem, executive vice president of global operations and logistics at Drive Medical, in a release.
Sleep association sets new course
WASHINGTON – Ed Grandi has stepped down as executive director at the American Sleep Apnea Association (ASAA). The association has named Tracy Nasca as his replacement, according to a March 17 press release. Nasca, who has sleep apnea, has worked in the sleep field since 1999, and has served on the board for the past two years. ASAA also appointed Adam Amdur COO. Amdur is the former chairman of the association. Grandi, who served 10 years at ASAA, said in a blog post he plans to continue promoting sleep health.
Medline signs on another healthcare provider
MUNDELEIN, Ill. – Medline Industries has been selected by ProHealth Care, a provider of community health services in Waukesha County, Wis., as its exclusive distribution partner for medical and surgical supplies. The five-year deal is expected to be worth about $50 million. Medline says it will deliver an array of efficiencies and cost savings to help ProHealth Care better monitor and control costs. Earlier this year, Medline was tapped by Centegra Health System as its preferred distributor for medical and surgical supplies. That three-year deal is expected to be worth $30 million.
Market for sleep disorder diagnostic devices to get hotter
SAN ANTONIO – The market for sleep disorder diagnostic devices generated revenues of $95.6 million in 2013 and could generate $125.8 million in 2017, according to a report from Frost & Sullivan. Driving that growth: a large pool of undiagnosed patients and a growing population of elderly people. Also driving growth is a trend toward home care sleep tests that are more convenient and lack side effects. “Vendors that offer self-help devices have the potential to erode the share of sleep centers that offer sleep tests, as self-help technology can decrease the number of visits to physicians and overnight stays in clinics,” stated Akanksha Joshi, a healthcare research analyst, in the report. “Overall, a manufacturer that offers accurate data through real-time device connectivity involving the insurer and physicians, as well as a precise predictive model for better patient outcomes, will elicit greater interest in its product line.”
U-Sleep, Universal Software integrate
HALIFAX, Nova Scotia – HME providers can now access Umbian’s U-Sleep compliance monitoring solution directly from Universal Software Solutions’ Healthcare Data Management System (HDMS) billing management platform. The end result: a more efficient mechanism for merging practice management and billing-related activities with patient usage compliance, according to a release. Key features of the integration include the ability to: add a patient simultaneously in HDMS, U-Sleep and ResMed’s EasyCare Online compliance platform; receive U-Sleep patient compliance notifications and automatically merge that data into HDMS; generate and store U-Sleep compliance and CPAP usage reports; and trigger the creation of operator tests within HDMS based on U-Sleep compliance rules.
SCA adds sailor to team
PHILADELPHIA – SCA, maker of Tena incontinence products, has added American sailor Sara Hastreiter to Team SCA, the only all-female crew to compete in the 2014-15 Volvo Ocean Race. Hastreiter has sailed more than 40,000 nautical miles and competed in numerous races. Team SCA has been trialing candidates and, with only seven months left until the start of the race in October, has honed the final crew to 12. The team is based in Puerto Calero, Lanzarote, and is due to complete two practice transatlantic sails in May, which will include a stop in Newport, R.I. “We couldn’t be more thrilled to have Sara join the team and represent SCA and our brands in the U.S., Tena and Tork,” stated Don Lewis, president of SCA, in a release.
WASHINGTON – The House of Representatives today voted to approve a “doc-fix” bill that includes a provision to delay ICD-10 implementation for a year.
The Senate is also expected to take up the measure today.
The House Ways and Means Committee on March 26 released a version of its “doc-fix” bill that includes the following sentence: “The Secretary of Health and Human Services may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets,” according to news reports.
The switch to ICD-10 codes is scheduled to take effect Oct. 1, 2014, but HME industry advocates have said physicians aren’t ready for the change.
The delay would “give practices the opportunity to upgrade their software and do internal testing so they’ll know exactly what the impact of ICD-10 will mean,” Robert Tennant, senior policy advisor for the Medical Group Management Association, said in a news report.
However, the American Health Information Management Association and the American Medical Association do not support the delay. The former believes another delay will cost the industry time and money, and the latter seeks a more permanent fix to physician reimbursement, according to news reports.
No matter how much money you spend or how many lawyers you hire, you cannot sue Medicare. Consultant Roni Pidcock wants that to change.
In February, she launched a petition on change.org to designate a court of jurisdiction for civil complaints.
“What we are trying to ask is that they give providers the right to pursue their appeal,” said Pidcock, vice president of Quality Healthcare Systems.
There are four levels of audits in the appeals process: re-determination, reconsideration, ALJ, and the Medicare Appeals Council. If you get to the fourth level of appeal and lose, no matter how wrong the audit contractor might have been, federal law says audit contractors have official immunity as government agencies, Pidcock says.
With the HME industry under siege from auditors, and a waiting period of more than two years to get assigned a hearing before an administrative law judge, the audit system is causing great harm to providers.
“We are asking the government to step in and give us a voice,” said Pidcock. “We need to be able to go after the people that are hurting us.”
WASHINGTON – A recent Office of Inspector General (OIG) report calls on CMS to urge states to cut costs on incontinence supplies, and the agency agreed. Industry stakeholders warn that could lead to an expansion of competitive bidding.
Released in January, the report found Medicaid fee-for-service programs spent $266 million on disposable incontinence supplies in 2012, but they could have saved $62 million, or 23%, by using median competitive bidding prices, a move that five states have already made.
Competitive bidding isn’t the answer, contends Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services (MAMES).
“Our recommendation would be to work with the respective state associations and come up with a plan if they need to achieve certain savings,” she said.
Incontinence supplies are in the crosshairs because they involve less service and are more subject to commoditization than other DME, said Ryan Ball, director of state policy for VGM & Associates.
“A lot of payers see that business as a drop-ship business and that there’s no need for a provider in some cases,” he said. “And, they’re just wrong in that.”
Ball said state-level competitive bidding would result in less service, lower quality products, and significantly fewer suppliers, especially local ones. Even worse, the introduction of competitive bidding for incontinence supplies could open the door to bidding for other products, he cautioned.
“Right now, they’re only looking at incontinence supplies,” Ball said. “Once they get their nose under that tent and see some savings that may be available there, you’re going to see a rather quick transition to other products to do the same thing.”
To stop it, the industry must educate and lobby state government about the potential drawbacks, Ball said.
“CMS has been espousing the benefits of bidding without talking about any of the challenges or problems,” said Ball.
WASHINGTON – In a setback for the HME industry, the House of Representatives on March 27 passed a “doc-fix” bill that contains no amendments to fix the competitive bidding program.
“Am I frustrated? Absolutely,” said Tom Ryan, AAHomecare president and CEO. “But I remain confident that the support we’ve ginned up over the past several months (will continue).”
The temporary fix prevents a 24% cut in Medicare payments to physicians for one year. The Senate is scheduled to vote on a similar bill on Monday, March 31, and that too, is expected to be a slimmed-down bill with no HME-related amendments, says Ryan.
The House bill did have one positive element: a provision to delay the transition to ICD-10for one year.
“That’s a reprieve for providers,” Ryan said.
If it’s any consolation, plenty of lawmakers and other groups are unhappy with the “doc fix” bill because it’s not a permanent fix, say stakeholders. That could mean the industry has another opportunity to get language included in another bill, they say.
“There are discussions about having another Medicare vehicle this year to address the remaining issues,” said Jay Witter, vice president of government affairs for AAHomecare. “We are coordinating with committee members to talk strategy for moving forward.”
One thing the industry would like to push forward in any future vehicle: an expansion of the power mobility device prior authorization demonstration project. At the behest of the Senate Finance committee, the industry has drafted language that would expand the demo from seven states to all 50 and would expand it to include all power mobility devices, including Group 3 wheelchairs.
“It’s believed it would save Medicare about $100 million and it’s something the industry supports,” said Seth Johnson, vice president of government affairs for Pride Mobility.
In the meantime, a congressional sign-on letter spearheaded by Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, that urges CMS Administrator Marilyn Tavenner not to expand competitive bidding until the Office of Inspector General has completed an investigation has garnered 63 signatures.
Also high on AAHomecare’s priority list: getting audit legislation introduced. Language has been drafted and is in the approval process, and the association has lined up possible sponsors, Ryan said.
WATERLOO, Iowa – The VGM Group didn’t just submit its own comments to CMS last week on expanding the competitive bidding program nationwide. It also submitted the results of a survey completed by more than 850 members.
“We didn’t just want our perspective,” said Ryan Ball, director of state policy and government relations for VGM & Associates. “We wanted to incorporate the thoughts of our members.”
CMS published an advance notice of proposed rulemaking on Feb. 28 seeking comments on: 1.) developing a methodology to apply bid rates to non-bid areas; and 2.) bundling payments for certain DME, such as enteral nutrition. Stakeholders had until March 28 to respond.
Survey respondents cautioned CMS from applying bid rates to non-bid areas without considerations for geography and population. Ninety-seven percent of respondents said the costs of furnishing items and services varies based on the geographic area in which they are furnished; 97% of respondents also said the costs vary based on the size of the market served in terms of population and/or distance covered or other logistical reasons.
“The bid program was started in metropolitan areas for a reason,” Ball said. “There are some pretty severe impediments to providing care and service to beneficiaries in outlying areas. CMS needs to reexamine the makeup of the program and how they came up with these single payment amounts. It’s apples to oranges.”
Ninety-two percent of respondents also said CMS should use a different methodology to adjust payment amounts for items that have not yet been included in the program, such as TENS devices.
As for bundling, 91% of respondents said there would be negative impacts associated with continuous monthly payments for enteral nutrition and other DME, though they acknowledged the impacts depended on the type and price of the equipment involved. The main reason: For enteral nutrition, for example, the cost and amount of formula varies greatly, making it difficult to determine the appropriate reimbursement.
“It’s outside the provider’s control,” said Mark Higley, a vice president at The VGM Group. “When a patient needs formula and it costs more than the reimbursement or they need more per month than is covered by the reimbursement, it’s referred to as stinting, which is a hospital term. It incentivizes the provider to reduce clinical care to patients.”
In addition to CMS, VGM is also sharing the survey results with members of Congress and it’s asking providers to do the same.
“We’re pushing hard,” Ball said.
WASHINGTON – AAHomecare is conducting a short survey on the level of awareness among patients on Medicare issues and reform. The association will use the results of the survey as a benchmark to track the progress of its new patient awareness campaign,“Save My Medical Supplies.” Campaign resources and specifics will be shared in the upcoming weeks, AAHomecare says.
DHS taps Univita exec as new leader
HARRISBURG, Pa. – Dynamic Health Services (DHS) has named Michael Grabko as its new CEO, the company announced today. "During this unique and transformative period in health care, there is no better person to lead DHS than Mike Grabko," stated Michael Holloway, president of GMH Ventures, a private equity firm that backs DHS, in a release. Grabko, who most recently served as senior vice president of Univita Health, has more than 30 years of experience in health care. During his tenure at Univita, Grabko led the company’s expansion into nine states and helped double revenues to more than $200 million. The company entered the HME market in 2010 when it acquired Atenda Healthcare Solutions. Granko’s resume also includes stints as vice president of operations at Apria Healthcare, and area vice president and corporate vice president at Air Products Healthcare. "We at DHS will look to position the company as a leader in the current geography we occupy, but with a vision for the expansion into new and profitable markets, products, acquisitions, and contracts," he stated in the release. DHS has made several regional acquisitions in the past two years, most recently Reliable Medical in Hackensack, N.J. Other buys include HomeTown Oxygen, Evanko Respiratory, APO2 and Progressive Home Medical—all based in Pennsylvania. “GMH Ventures is actively seeking to acquire other companies in the home and durable medical equipment marketplace within the Mid-Atlantic and Northeast regions,” the release states.
Governor commends DeVilbiss for manufacturing in US
SOMERSET, Pa. – Pennsylvania Gov. Tom Corbett recently visited DeVilbiss Healthcare’s corporate headquarters here, commending the company for its efforts to bring jobs back to the U.S. Corbett met with the DeVilbiss management team, toured the manufacturing facility and addressed the company’s more than 200 onsite employees. Bringing China-based product lines back to the Somerset facility has created more than 25 direct assembly, engineering and quality jobs, and several indirect vendor jobs, according to the company. “DeVilbiss Healthcare’s decision to move production back to Somerset is a testament to the company’s visionary leaders and the hardworking men and women that are producing innovative products for people throughout the world,” Corbett stated in a release. “We are building a stronger Pennsylvania where innovative companies like DeVilbiss can grow and compete in the global marketplace.”
Association takes on face-to-face rule
WASHINGTON – The National Association for Homecare (NAHC) is laying the groundwork for a possible lawsuit against CMS’s implementation of the face-to-face requirement for home health, according to AAHomecare. The association says providers are frustrated with denials related to the face-to-face requirement and believe CMS needs to provide more guidance and clarity. Arguments for the lawsuit include: Claims shouldn’t be denied for lack of documentation if it is present in the rest of the medical record; the requirement for the narrative is outside the authority granted to CMS by the Affordable Care Act; and CMS isn’t following Medicare due process requirements to publish clear, concise guidelines. The NAHC plans to talk with beneficiary advocates, disability groups and others about joining the lawsuit. AAHomecare plans to monitor its progress closely.
Roscoe distributes SLEEQ braces
STRONGSVILLE, Ohio – Roscoe Medical now distributes the SLEEQ spinal bracing system to HME providers as part of a deal with brace maker Quinn Medical announced March 26. The SLEEQ brace fits nearly all patients, and supports and stabilizes the lumbo-sacral spine with a lift effect that relieves disc pressure. “With recent cuts in reimbursement and the uncertainty of Round 2, we are extremely excited about offering the SLEEQ back brace to our HME and pain management dealers,” said Ryan Moore, vice president of Roscoe Medical’s pain management division. “The reimbursements are very healthy.” The PDAC-approved, physician-prescribed brace system is reimbursable throughout a patient’s treatment, according to the release.
Responsive Respiratory expands facilities
ST. LOUIS, Mo. – Responsive Respiratory, manufacturer of high-pressure oxygen products, has expanded its warehouse and manufacturing facilities for the third time in five years. With the expansion, the company can increase the volume of its Private Label Program, which brands provider logos on equipment like regulators, conservers and cylinder carry cases. “With the changing nature of medical reimbursements in the marketplace, our customers realize the value of branding equipment,” stated Tom Bannon, Responsive Respiratory president, in a release. “We are now better suited to service the increasing demands for this program and maintain our industry-leading service levels.” The company can now stock more finished goods, manufacture more custom items and maintain its same-day ship, complete Service Plus Guarantee, according to the release.
Convaid shipping goes green
TORRANCE, Calif. – Convaid has joined the “UPS carbon neutral” program, which allows shippers to offset the environmental impact of transporting freight with contributions based on each shipment’s CO2 emissions. Convaid ships about 80 packages each day. With an average “UPS carbon neutral” contribution of five cents per package, the company will be putting $1,040 each year toward projects that have included reforestation, landfill gas destruction, wastewater treatment and methane destruction, according to a release.
VGM earns honor
WATERLOO, Iowa – The VGM Group has been named the 2014 Iowa-Nebraska Employee Stock Ownership Plan (ESOP) Company of the Year by the ESOP Association. To be eligible for the award, a company must demonstrate, among other things, involvement with and commitment to, the ESOP Association; communication with employees; and financial solvency, according to a press release. VGM has been 100% employee-owned since 2008. The award will be presented May 7 at the ESOP Association Annual Conference in Washington, D.C.
VMI earns FSS contract
PHOENIX – The government National Acquisition Center has awarded Vantage Mobility International (VMI) a federal supply schedule (FSS) contract. The contract will expedite the process for disabled military veterans to acquire mobility transportation by supporting non-service connected veterans and giving qualified veterans access to VMI’s lowered-floor minivan conversions, according to a March 26 release. “The FSS contract supports VMI’s mission to help veterans secure the highest quality mobility conversions at the best value to our government,” said Jeff Weston, VMI vice president of sales and business development. VMI is the only manufacturer of wheelchair-accessible vehicles to earn an FSS contract, which supports healthcare requirements of the VA and other government agencies through access to more than 8,000 products, according to the release.
Stakeholders apply full-court press on bidding, audits
WATERLOO, Iowa – The VGM Group, HME providers and state association leaders held congressional meetings in four states last week to discuss their concerns with competitive bidding and audits. In Bismarck, N.D., Great Plains Rehabilitation hosted events with Sens. John Hoeven, R-N.D., and Heidi Heitkamp, D-N.D., and Rep. Kevin Cramer, R-N.D. In Meridian, Idaho, Norco and the Big Sky Association of Medical Equipment Suppliers organized events with Bob Ford, director of business, trade and rural development for Sen. Mike Crapo, R-Idaho. In Portland, Ore., Norco was the host again, this time with the Pacific Association for Medical Equipment Services, for a meeting with the director of business outreach for Sen. Ron Wyden, D-Ore. In Sioux Falls, S.D., VGM’s Tom Powers had meetings with staff representing Sens. Tim Johnson, D-S.D., and John Thune, R-S.D., and Rep. Kristi Noem, R-S.D.
Rotech cuts back oxygen deliveries
ORLANDO, Fla. – Rotech Healthcare has stopped oxygen deliveries, except for first-time set-ups and emergencies, in West Virginia, according to a local TV station. The company is now requiring patients to go to the Elkview location to refill their tanks, WSAZ reports. Rotech told the TV station that the cutbacks in service are the result of restructuring due to its bankruptcy. Another provider in the area, Boll Medical in Charleston, told WSAZ that it still delivers oxygen to more than 60 patients a week, with stops in more than 14 cities throughout the state each day. The reason: A lot of patients are older and don’t drive, and the company fears for their safety, according to the TV station. In comments to HME News, Rotech said the newscast contained numerous inaccuracies and that it had not commented to the TV station on the contents of the report. "This does not clearly represent the current situation at this location for our patients," stated Steven Burres, assistant general counsel for Rotech. "Rotech values its relationships with its patients and does not condone false reports being broadcast or published about the company."
Brightree’sHospice Solution is compliant with CMS’s change request (CR) 8358. Effective April 1, 2014, the change request requires hospice organizations to provide additional claims data to support payment reform. The solution now allows users to, among other things, automatically import patient medication fill detail from the top pharmacy benefit managers to support reporting requirements…SCA has been recognized as a 2014 World’s Most Ethical Company by the Ethisphere Institute, an independent center of research that promotes best practices in corporate ethics and governance. This is the seventh consecutive year that SCA has been named to the global list. It is one of only nine companies in the consumer products category this year.