WASHINGTON – CMS has instructed its contractors not to retrospectively audit providers for compliance with the face-to-face requirement.

The news comes via an Aug. 20 letter sent by CMS Administrator Marilyn Tavenner to Rep. David Roe, R-Tenn., who inquired about audit activities related to the requirement after meeting with members of ATHOMES.

“The delay in enforcement on the face-to-face encounter requirements applies to reviews conducted by the DME MACs, Recovery Auditors, the Zone Integrity Contractors and Program Safeguard Contracts,” CMS states in the letter. “Once an enforcement date is announced for the delayed requirements, CMS and its contractors will begin enforcement after the announced date. When CMS begins enforcing the face-to-face encounter requirements, audits will be conducted prospectively.”

CMS implemented the face-to-face requirement July 1, 2013, but it hasn’t begun enforcing the requirement.

The delay does not apply, however, to reviews completed by the Comprehensive Error Rate Testing Program (CERT), CMS states in the letter.

“CERT must review claims in accordance with all Medicare policies to product an unbiased improper payment rate,” it stated.

Members of ATHOMES have made the face-to-face requirement a priority when meeting with their congressional members. They received support from not only Roe, but also Republican Reps. Marsha Blackburn, Diane Black, John Duncan, Chuck Fleischmann, Scott DesJarlais and Stephen Fincher.

WASHINGTON – CMS should scrap its plans to expand competitive bidding nationwide and to implement bundled payments, AAHomecare stated in comments submitted to the agency on Sept. 2.

CMS is proposing applying competitive bidding prices in non-bid areas by using regional prices limited by a national ceiling (110% of the average of regional prices) and a floor (90% of the average of regional prices).

“The top line recommendation to CMS reiterated AAHomecare’s position that single payment amounts (SPAs) are the product of a profoundly flawed competitive bidding program, do not reflect the true cost of doing business, and should not be used,” the association stated in a release. “AAHomecare strongly advises that CMS withdraw the proposed rule until it has balanced bidding data to implement payment adjustment in areas outside the CBAs.”

AAHomecare made the comments in response to a proposed rule that CMS published in the Federal Register on July 11. CMS is also proposing amending the competitive bidding regulations to allow it to conduct auctions using bundled payments.

In its comments, AAHomecare questioned whether CMS can legally replace payment categories under the fee schedules with bundled payments, and whether the agency can implement bundled payments without harming beneficiaries.

“This type of bundling would be so complex that it is unrealistic for CMS to expect it can implement this new methodology in the near future without placing the welfare of beneficiaries at risk,” the association stated in the release.

WASHINGTON – Industry stakeholders say a large number of providers answered the call to submit comments by Sept. 2 on a proposed rule to, among other things, expand the competitive bidding program nationwide.

More than 4,000 comments were submitted on the overall rule, and stakeholders believe a good number of them pertained to the bid expansion and another HME provision to create bundled monthly payments.

“The feedback we’ve gotten from providers spoke to rural healthcare access,” said John Gallagher, vice president of government relations for The VGM Group. “The comments were diverse—from the guy who can no longer go out to islands off of Cape Cod to the guy in Montana who covers a 400-mile radius and can no longer cover Indian reservations.”

CMS published the rule in the July 11 Federal Register.

Stakeholders planned to sift through the comments as a strategic exercise, looking to see where they agree and don’t agree with other commenters.

“We like to analyze comments, to see if there’s a theme and to maybe reach out to other associations whose comments didn’t align with ours to get feedback,” said Kim Brummett, senior director of government affairs for AAHomecare.

Of course, it’s one thing to comment en masse, it’s another thing for CMS to take notice. Brummett pointed to the *advance notice of proposed rule, published in February, as an example.

“Not one comment on that ANPR said that bundling enterals was a good idea and they listed the reasons why,” she said. “CMS went ahead and included it anyway.”

WASHINGTON – Could CMS’s offer to hospitals to resolve certain appeals in exchange for timely partial payment be something the agency also extends to HME providers?

Possibly, says Kim Brummett, senior director of regulatory affairs for AAHomecare, who has reached out to CMS to say, “Hey, what about us?”

“We asked if this is a sign that we could do a settlement on the DME side, and they said, ‘Absolutely,’” she said. “They need to see how this works. This is the easiest thing for them to settle right now. We’re going to watch what happens.”

CMS on Aug. 29 offered a settlement to acute care hospitals and critical access hospitals to resolve pending appeals of patient status denials in exchange for timely partial payment of 68% of the net payable amount.

Even if CMS were to extend a similar offer to HME providers, would they take it? Sylvia Toscano, president of Professional Medical Administrators, says many would, especially those with a significant amount of money tied up in appeals.

“I know providers who would welcome an offer like that,” she said. “It would relieve a lot of the administrative and financial burden of having to go through the appeals process. That’s something that’s not factored into that 68%.”

This is the second concession made to alleviate a massive backlog of appeals at the administrative law judge (ALJ) level. The first: A pilot project by the Office of Medicare Hearings and Appeals (OMHA) that brings together a provider and CMS with a facilitator to try and work out a settlement. But early reports from the project don’t sound too promising.

“I was just talking to a law firm that I work with that filed a settlement conference for a DME provider,” said Stephanie Greene, chief consulting officer at ACU-Serve. “They say CMS is not being responsive about moving through the process. There’s some frustration at OMHA.”

Regardless, CMS’s offer and the OMHA pilot are two clear signals that something has to give with the audit program, stakeholders say.

“I think CMS is starting to see the repercussions,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “They need to do something.”

WASHINGTON – CMS has instructed its contractors not to retrospectively audit providers for compliance with the face-to-face requirement. The news comes via an Aug. 20 letter sent by CMS Administrator Marilyn Tavenner to Rep. David Roe, R-Tenn., who inquired about audit activities related to the requirement after meeting with members of ATHOMES. “The delay in enforcement on the face-to-face encounter requirements applies to reviews conducted by the DME MACs, Recovery Auditors, the Zone Integrity Contractors and Program Safeguard Contracts,” CMS states in the letter. “Once an enforcement date is announced for the delayed requirements, CMS and its contractors will begin enforcement after the announced date. When CMS begins enforcing the face-to-face encounter requirements, audits will be conducted prospectively.” CMS implemented the face-to-face requirement July 1, 2013, but it hasn’t begun enforcing the requirement. The delay does not apply, however, to reviews completed by the Comprehensive Error Rate Testing Program (CERT), CMS states in the letter. “CERT must review claims in accordance with all Medicare policies to product an unbiased improper payment rate,” it stated. Members of ATHOMES have made the face-to-face requirement a priority when meeting with their congressional members. They received support from not only Roe, but also Republican Reps. Marsha Blackburn, Diane Black, John Duncan, Chuck Fleischmann, Scott DesJarlais and Stephen Fincher.

ResMed, Apex Medical resolve patent disputes

SAN DIEGO and TAIPEI, Taiwan – ResMed and Apex Medical have agreed to a confidential settlement that resolves their outstanding patent disputes. Per the agreement, announced Sept. 5, Apex has the right to sell and import globally its Wizard masks, and its XT and iCH glow generators. In turn, it has agreed to dismiss all validity challenges to ResMed patents pending in the United States, Europe, Germany, Japan and China. ResMed has agreed to dismiss pending litigation against Apex’s products. The two companies didn’t provide any additional details. The settlement brings to a close a legal conflict that began in March 2013, when ResMed filed a patent infringement lawsuit against Apex with the U.S. International Trade Commission and in federal court in Los Angeles. Apex Medical’s U.S. distributor, Medical Depot, does business as Drive Medical.

Invacare sponsors summer sports clinic for vets

ELYRIA, Ohio – Invacare is sponsoring the National Veterans Summer Sports Clinic Sept. 7-12 in San Diego. The clinic features adventure sports and recreation, including sailing, surfing, track and field, kayaking and cycling to recently-injured veterans. “The clinic helps participants to develop sports skills that improve their quality of life and to realize that a disability doesn’t meant they can’t live life to the fullest,” said Brian LaDuke, Invacare vice president, homecare and long-term care, in a press release. “This is something Invacare fully believes and it is crucial to the work we do every day.” The clinic aims to provide early intervention to veterans recovering from injuries to strengthen their bodies and improve their overall being and self-worth.

EZ-Access launches new website

ALGONA, Wash. – EZ-Access has unveiled a new website featuring four new tools: the ramp selector, the incline calculator, the dealer locator and the buy online tool. The tools were added to help customers select ramps and inclines, find nearby dealers and, if there’s no dealer in their area, buy online. The website also includes product information and large images, and a support section. The company plans further updates to the website.

Power Soccer association to play exhibition games at Medtrade

ATLANTA – The United States Power Soccer Association will play two exhibition games during Medtrade. The games will take place on the show floor on Oct. 22 at 11 a.m. and at 2 p.m., according to a press release. Two teams of four will play with a 13-inch soccer ball in games typically held on regulation basketball courts in gymnasiums. The 11 a.m. game will be followed by a press conference and Q&A session.

NSM makes buy in Oklahoma

OKLAHOMA CITY – National Seating & Mobility (NSM) has acquired Advantage Mobility & Medical Equipment, a provider doing business here since March 2005. Advantage Mobility’s eight staff members will continue to work for NSM and former owner Tom Hoover will remain onboard as NSM Oklahoma City branch manager. “As a team, we provide 45 years of experience in the complex rehab technology industry and we’re excited to add our passion to the NSM family,” said Hoover, who will serve as one of three ATPs and CRTSs at the location.

Hasco Medical’s Q2 revenues jump 28%

ADDISON, Texas – Hasco Medical’s net revenues for the second quarter of 2014 were $24 million, up 28% from the same quarter last year, the company has announced. Gross profit was $5.1 million vs. $4.3 million. Revenues in the first half of 2014 totaled $44.5 million, up 32% from the same period last year. Gross profit was $10.4 million vs. $7.8 million. The company credits increased private-pay business for accessible vans and contributions from Auto Mobility Sales, which it bought last September, for the gains.

Interactive Compliance acquires CMB Solutions

INDIANAPOLIS – Interactive Compliance has acquired a 95% interest in CMB Solutions, a provider of patient contact management and business solutions to the HME industry, and installed Asif Kidwai as CEO. “The acquisition allows for an optimized business plan of growth, as well as a broader scope of support for existing and new clients,” said Nyika Wright, now COO and executive director. Interactive Compliance is a provider of physician-backed patient management tools and home health alternatives to accountable care organizations, managed care organizations, major hospitals, medical research facilities, pharmacies, equipment providers and physicians, according to its LinkedIn page.

DMEevalumate offers new face-to-face tool

GAINESVILLE, Fla. – DMEevalumate.com has launched its General DME program, an online documentation tool to aid clinicians with face-to-face evaluations. The program offers standardized documentation for manual wheelchairs, canes, crutches, walkers, hospital beds, support surfaces, commodes, urological supplies and diabetic supplies. “Rather than guessing what is needed for each DME item, DMEevalumate.com ensures that all data points are addressed and answered,” stated Eric Gregory, director of operations, in a press release. DMEevalumate launched a PMD module in 2012 and a respiratory module in 2013.

NRRTS names board members

LUBBOCK, Texas – NRRTS has announced its 2014-205 board members. Mike Osborn is president, Mike Barner is president elect, Elaine Stewart is vice president, Leslie Rigg is secretary, Mike Nadeau is treasurer, Carey Britton is review chair DMAC A, Toby Bergantino is review chair DMAC B, Keith Jolicouer is review chair DMAC C and Katie Roberts is review chair DMAC D. At-large directors are Gerry Dickerson, Thana France, Jim Douglas, Andrea Madsen and Luke Moore.

More people in the news

Universal Software Solutions has hired Carmen Purcell-Vasquez as an account executive. Purcell-Vasquez has more than 20 years of experience in the HME industry, including seven years as a software trainer at Fastrack. She will be based in St. Louis…Ottobock has added two mobility sales representatives: Kelly Hasenei, a certified orthotic fitter with experience in medical sales, and Keith Friedman, owner/operator of a therapy clinic…Numotion has appointed Mark Vachon to its board of directors. Vachon spent 30 years with GE before retiring. He was most recently president and CEO of GE Healthcare Americas.

YARMOUTH, Maine – A defiant 60% of the respondents to last week’s HME NewsPoll say they wouldn’t take up CMS on an offer to settle pending appeals in exchange for partial payment.

“I would rather go out of business than give CMS another 32% discount with all the hoops they make us go through,” said Jody Wright of Rocky Mountain Medical Equipment in Lakewood, Colo. “It’s insulting and I’m going to fight them to the end for every dollar they own my company.”

CMS on Aug. 29 offered a settlement to acute care hospitals and critical care access hospitals to resolve pending appeals of patient status denials in exchange for timely partial payment of 68% of the net payable amount.

A good number of respondents asked why they should help CMS get out of a sticky wicket that the agency itself has created, one where about half a million appeals are tied up at the administrative law judge (ALJ) level.

“Medicare has set the allowables; they should pay their portion of the allowable plus interest if the claim is not paid within 30 days,” said Kevin Jones of All American Medical Equipment & Supplies in Oklahoma City. “They are dragging this out. They should be charged late fees and interest.”

Another reason not to take CMS up on its offer, respondents say: The agency might get the wrong idea that providers can make due with 68% of reimbursement.

“Beware of giving them another tool to use against us,” said Ed Huyke of Anything Medical in Bullhead City, Ariz. “It may be used to show that we are currently being overpaid and are willing to accept and can survive with 68%. The offer is not good.”

Some providers said they would accept CMS’s offer—but not without strings attached.

“As long as this settlement wouldn’t affect the timely payment of future claims, I would accept 68% of my audited claim files at this time,” said Ronnie Sleeper of Med Supply Plus in Corinth, Miss. “Also, any settlement would have to stipulate that the claims in question are legitimately filed claims in the first place.”

For the 40% of respondents who say they would accept CMS’s offer, it would be largely a financial decision.

“The administrative cost alone of winning 100% of my over $100,000 of appeals would cost me at least $30,000,” said Mike Coughlin of CVI Medical in Dallas.

MINNEAPOLIS – With the explosion of interest in post-acute care, it’s time for HME providers to get off the sidelines, said the speakers at last week’s HME News Business Summit.

“I can’t think of a more meaningful time for the HME industry to stand up and shine than right now,” said speaker Tom Sayre, vice president of strategy and business development for CHI Health at Home, the national home health services division of Catholic Health Initiatives. “It’s time for the industry to reach out in meaningful ways—that’s what population health management is.”

The Summit, held Sept. 7-9 in Minneapolis, featured sessions that ran the gamut from healthcare reform to investment in HME.

But a common thread throughout: data’s role in helping HME providers secure their rightful position in the post-acute care lineup.

“You have to be a data freak,” said panelist and provider Gregory LoPresti, senior vice president and CEO of Upstate HomeCare. “It’s out there—you just have to collect it.”

Be accountable—to the right patients

It’s time to stop fixating on the 5% of Medicare beneficiaries who consume 60% of Medicare dollars, mostly in the last 18 months of their lives, speaker and consultant Andy Edeburn told attendees.

“Our inability to manage our own behavior will be our demise,” said Edeburn, vice president of continuum strategies for the Health Dimensions Group. “If we manage behavior more efficiently, we can reduce the number of people who get to that 5%.”

Prove your value

In the past, hospitals didn’t care about penalties, but now, hospital admissions and margins are going down, and penalties are going up. That’s an opportunity for HME providers to capitalize on what they have to offer—as long as they have the data to back it up.

“Show them what their readmission rate is, show them what your readmission rate is, and over time,” said speaker Alan Morris, director of business development for HealthCall. “Then tell them, ‘Here’s the evidence to prove it and let’s talk about what this means for your bottom line.’”

Here to stay

As if to underscore the value of home care, a panel of private equity investors told attendees that, despite it’s challenges, HME is an exciting market to be in.

“This is a market that is not going away,” said panelist Jeff Lipsitz, managing partner with Cortec Group, which has investments in Harmar and 101 Mobility. “No matter what the government tries to do, there is a wave of older folks that want your products and to stay in their homes.”

YARMOUTH, Maine – Suppose you were an HME provider supplying a Medicare beneficiary with oxygen therapy through a competitive bidding contract. Suppose the beneficiary also needs non-prescription items like a hospital bed, mattress and other HME for which you don’t have contracts.

Suppose the beneficiary and his or her children want to continue doing business with you, even though you don’t have the contracts. What are your options?

“You can’t sell the equipment to the patient, so we sell the equipment to the daughter or son,” said Tom Inman, president of Virginia Home Medical in Newport News, Va. “They can put a bow on the foot of the bed and call it a present. They’re as happy as can be.”

While industry consultants concede this is a gray area—there are “a ton of different cash arrangements out there,” said one—they recommend providers always get an advance beneficiary notice (ABN).

“When you have knowledge that a piece of equipment is subject to insurance, you’re required to get an ABN,” said Andrea Stark, a reimbursement consultant with MiraVisa. “That protocol is in place to protect the beneficiary and the family, and to make sure everyone knows how the transaction will be treated.”

Here’s one reason why that’s necessary: It’s not uncommon, for example, for the children of a beneficiary not to be on the same page, turning a simple transaction into a complicated one, says Sylvia Toscano, owner of Professional Medical Administrators.

“What we see a lot is that one of the kids will make an arrangement and then another will get involved later on and say, ‘That’s a Medicare-covered item; I don’t know why you took our money,’” she said. “If they go to Medicare, it becomes our word against theirs and refund requirements could come into play.”

This is almost a nice problem to have, says Rob Baumhover, director of retail programs for The VGM Group.

“The nice thing is that it means you’ve built that relationship with the children, and they’re the ones that want mom and dad to be taken care of by you,” he said. “Then, when the time comes for them to need your services, they’ll stick with you, too.”

Inman says he’s comfortable selling non-prescription equipment to the children of his patients without an ABN.

“If you have an ABN, you’re admitting that the Medicare patient is your customer,” he said. “They’re not my customer; I’m not getting anything from them. I’m selling for cash to the public.”

Inman says Medicare is making it so hard to get equipment that many families with loved ones in need are saying, “Screw it.”

“You have to be creative,” he said.

WASHINGTON – Contractors conducting pre-pay audits and prior authorizations are required to load that information into the RAC Data Warehouse, CMS has said in response to an AAHomecare inquiry. “Contractors conducting pre-pay audits are required to load that information into the RAC Data warehouse,” CMS said. “Claims that are paid through one of the prior authorization programs have a unique tracking number that follows the claim and is included in all data shared with the Recovery Auditors. Claims with a unique tracking number are excluded from Recovery Auditor review.” AAHomecare said in a bulletin that it was pleased with CMS’s statement and plans to work with DME MACs provider outreach and education groups to ensure such processes are in place.

Twelve lawmakers sign on to separate benefit bill

WASHINGTON – Twelve more lawmakers have lent their support to H.R. 942 and S. 948, bills that would create a separate benefit for complex rehab. With the 11 representatives who signed on in August, there are now 159 co-sponsors in the House, NCART Executive Director Don Clayback wrote in a bulletin. There are 21 co-sponsors in the Senate. “It shows that the ongoing communication between CRT stakeholders and their members of Congress is paying off,” Clayback wrote. “The additions maintain solid bipartisan support and include members of the key congressional committees that have jurisdiction over the Medicare program.”

Dick’s Homecare buys assets from Walnut Medical Services

ALTOONA, Pa. – Dick’s Homecare has purchased certain assets of the Lewistown, Pa., facility of Walnut Medical Services. The deal provides operational efficiencies to both companies in the central Pennsylvania market, according to a press release from Duckridge Advisors, which served as the M&A adviser for Walnut Medical Services. Dick’s Homecare is one of the largest providers of HME and related products and services in the rural Pennsylvania market with eight locations. It will consolidate Walnut Medical’s facility into its own facility there. Terms of the deal were not disclosed.

Active Controls, Quantum Rehab expand strategic alliance

SEWELL, N.J. – Active Controls alternate drive controls are now available pre-assembled on Quantum Rehab power wheelchairs as part of an expanded strategic alliance between the two companies. The line of midline specialty controls includes head arrays, chin controls and mini-proportional joysticks. “All of them are fully compatible with our Q-Logic line of electronics, so the expansion of our alliance makes applications even more seamless for our providers,” stated Jay Brislin, vice president of Quantum Rehab, in a press release. Active Controls and Quantum Rehab first formed an alliance earlier this year. To order, providers must request a quote for the desired control using the quote generator on the Active Controls website. Once approved, the company will convert the quote to an order. Providers must then place an order for the power wheelchair with Quantum Rehab and request shipment to Active Controls. The turnaround, once there, is 48 hours.

Lawmakers: Medicare should cover infusion at home

WASHINGTON – Reps. Eliot Engel, D-N.Y., and Pat Tiberi, R-Ohio, have introduced a bill that would allow patients fighting severe infections, cancer or chronic diseases to receive infusion treatments in their homes instead of in a site of care. The Medicare Home Infusion Site of Care Act, H.R. 5435, would pave the way for Medicare Part B to cover infusion-related care and services, including equipment and supplies, provided in a patient’s home. The lawmakers, citing research by Avalere, a non-partisan healthcare policy firm, say the move would save an estimated $80 million over a 10-year period.

AAH comments highlight NWPT code confusion    

WASHINGTON – Commenting on code changes in CMS’s proposed CY 2015 Hospital Outpatient Prospective Payment System, AAHomecare says there is significant confusion among providers about the use of G0456 and G0457 with mechanical and electrical disposable NWPT devices. Confusion also surrounds the variance in components billed with distinct products, according to the association. Three manufacturers, through the Alliance of Wound Care Stakeholders, are working to provide CMS with detailed information on the costs of devices so the agency can establish non-facility practice expense relative value units for the new CPT codes for disposable NPWT, the association says. “AAHomecare recommended that CMS review those paid invoices and consider the costs of these devices when setting APC assignment of disposable NPWT and that any APC reassignment would be premature at this time and CMS should continue to place disposable NPWT APC 0016,” the association stated in a bulletin to members.

Disposable Medical Express adds auto ship

SPRING LAKE PARK, Minn. – Online retailer Disposable Medical Express, which specializes in incontinence products, now offers automatic shipment. Customers can sign up for the program during checkout. “This program will make it easier than ever for our customers to get the supplies they need to manage their incontinence,” the company stated in a release. “Now, instead of having to remember to place their order, we’ll do the work for them and their shipment will show up at the front door every month.” Customers receive a $2 discount on every case in their first order, and can alter or cancel at any time. Autoship is available for almost every product in the online store.

Shield HealthCare announces caregiver contest

VALENCIA, Calif. – Shield HealthCare has announced its 14th annual caregiver story contest. The contest recognizes the role of both family and professional caregivers, and the rewards and challenges they face, the company announced in a press release. The top three story winners and the five runners-up of the “What Makes Caregiving Rewarding?” story contest will each receive a monetary prize and a one-year subscription to Today’s Caregiver Magazine. All entries must be one page and submitted or postmarked by Nov. 30. Full contest details and official rules are available on Shield HealthCare's website at www.shieldhealthcare.com/caring.

Inogen cleared for reimbursement in France

GOLETA, Calif. – The Inogen One G3 portable oxygen concentrator has received coverage for reimbursement in France, the company announced Sept. 9. The Department of Social Affairs and Health has added the concentrator to its list of reimbursable oxygen therapy products and services as published in the Official Journal of the French Republic. The Inogen One G2 received similar coverage in 2013. France is estimated to be the third largest market in Europe, according to Global Industry Analysts.

Breathe device approved for European sales

IRVINE, Calif. – Breathe Technologies has received CE Certification for its Non-Invasive Open Ventilation System (NIOV), paving the way for the company to sell the device in the European Union. "We are now exploring potential commercialization partners for the EU and developing a European advisory board," said Larry Mastrovich, president and CEO, Breathe Technologies, in a press release. NIOV has also been recognized by the European Respiratory Society with a Product of Outstanding Interest (POINT) Award for 2014.

ResMed exec sells stock

SAN DIEGO – ResMed CFO Brett Sandercock on Sept. 3 sold 10,000 shares of stock at an average price of $53.23 for a total value of $532,3000. Sandercock now owns 70,913 shares valued at about $3.7 million. ResMed on July 31 reported revenues of $1.56 billion for fiscal year 2014, an increase of 3% over fiscal 2013.

Do-gooders: DeVilbiss, Med-Care, Ottobock, Convaid

Somerset, Pa.-based DeVilbiss Healthcare has announced a partnership with Team Fisher House, a program benefitting the Fisher House Foundation. The foundation is best known for its network of comfort homes where military and veteran families can stay at no cost while a loved one is receive medical treatment. As part of the partnership, DeVilbiss will champion the finish line tent for the Army Ten-Miler Oct. 12 in Washington, D.C…Boca Raton, Fla.-based Med-Care Diabetic & Medical Supplies has donated $100,000 to support Best Buddies, a nonprofit organization dedicated to creating opportunities for friendship, employment and leadership training for people with intellectual and developmental disabilities. Med-Care has also signed on to raise additional funds through vendors and partners, and to participate in the Best Buddies jobs program in Palm Beach...Ottobock Healthcare will provide technical service for the Rio 2016 Paralympic Games, it announced Sept. 8. The manufacturer has played this role for 13 games. As the Official Prosthetic, Orthotic and Wheelchair Technical Services Provider, Ottobock, which has offices in Brazil, will provide a team of prosthetists, orthotists, wheelchair technicians and welders from across the region and from its network worldwide…Torrance, Calif.-based Convaid recently donated a Cruiser wheelchair to Environmental Travelling Companions (ETC), a national pioneer in the field of accessible outdoor adventures for people with disabilities. The ETC will use the Cruiser at its camp location at the South Fork of the American River to assist people with disabilities to and from the river’s edge for an adaptive whitewater rafting program.

People in the news

Ottobock has hired Chris Wintenburg to fill the newly created position of director of e-commerce and inside sales for North America. Wintenburg will be responsible for managing the company’s e-business relationship; driving the overall success of North America online sales; increasing throughput and online sales for all business units and product categories; and managing inside sales efforts. He comes to Ottobock after a 13-year career at Dell.

WASHINGTON – A legislative fly-in on Sept. 10 spearheaded by The MED Group and supported by AAHomecare resulted in 100 meetings with lawmakers.

The topics of discussion at the meetings: bills to reform the competitive bidding and audit programs, H.R. 4920 and H.R. 5083, respectively.

“These bills are gaining momentum and our presence on the Hill should make a difference,” said Jeff Woodham, senior vice president and general manager of The MED Group, in a press release.

Currently, the bid bill has 40 co-sponsors; the audit bill, 24. At least 9 and 10 co-sponsors, respectively, were added to the bills just this week.

AAHomecare officials helped to manage the appointment process, provided briefing materials and joined in on the meetings.

“Working together on our HME legislative priorities—through back-home meetings, letters to Capitol Hill, and face-to-face meetings in D.C.—will ultimately be what makes the difference in getting these bills passed and enacted into law,” said Tom Ryan, CEO of AAHomecare, in the release.

Provider Jackie Semrad, who attended the event, said even though stakeholders have been touting bidding and audit reform for some time now, the industry’s message needs constant reinforcement.

“They understand that the bidding program is flawed and that this bill will address one of the biggest issues—the fact that current bids are not binding,” said Semrad, the compliance officer for Reliable Medical Supply, in the release. “Most were not aware of this part of the bid program until we educated them. This is one reason why we need to continue to talk to our members of Congress.”

WASHINGTON – Recent clarifications from CMS and its contractors have loosened the noose that is the face-to-face rule, industry stakeholders say.

Stakeholders have learned that 1.) CMS and its contractors won’t audit providers for compliance with the rule until they start enforcing it; and 2.) CMS won’t require providers to obtain a new face-to-face evaluation every time a new order is required, such as when a state requires a new order on a periodic basis.

“They have been slow to come, but every clarification is a bit more breathing room,” said Andrea Stark, a reimbursement consultant with MiraVista.

CMS implemented the face-to-face rule July 1, 2013. The agency planned to start enforcing the rule this year, but it has since pushed back its plans indefinitely, stakeholders say.

There is a minor glitch in CMS’s plan to prohibit the DME MACs, RACs, ZPICs and PSCs from auditing providers for compliance with the face-to-face rule: It doesn’t apply to the CERT. But stakeholders don’t see that as a “giant risk.”

“The CERT audits a small number of claims on a post-payment basis,” Stark said. “I don’t envision them doing a mass audit to catch providers.”

The clarification that CMS and its contractors will require providers to obtain new face-to-face evaluations only for orders for Medicare payment is a big relief, stakeholders say.

“A lot of states have annual prescription requirements for oxygen,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “If you had to get a new face-to-face for every patient, every year, that would be crazy.”

Of course, there are still numerous gray areas that stakeholders would like to see CMS clarify. Among them: Do providers really need to obtain a new face-to-face evaluation when a beneficiary changes providers (due to personal preference, an acquisition, or competitive bidding), or when a beneficiary switches insurance plans?

“We’re not trying to be unreasonable,” Brummett said. “We continue to try to work with CMS to find a solution. Every little thing counts.”

YARMOUTH, Maine – In an industry that has become accustomed to incremental changes through the years, external forces are now combining to greatly accelerate the shift away from the old fee-for-service (FFS) Medicare system to a value-based payment model that places more accountability on providers.

Though there are many external forces directing this metamorphosis, there are three major catalysts: consolidation, change in scope and information technology.

Consolidation is resulting in strategies for increased leverage and scalability; changing scope, in new business opportunities in post-acute care; and information technology, in improved operational  efficiencies.

‘Tech will make it all possible’

Alan Morris, director of business development for Crown Point, Ind.-based HealthCall, which provides communications solutions for chronic care, says these three catalysts are intertwined, but each is stamping its own imprint on the industry.  

“Reduced reimbursement and growing demand are driving change in HME,” he said. “The dynamic shift from volume-based to value-based purchasing models, paired with the rapidly growing elderly population, is beginning to drive a massive spike in demand for post-acute services. Data and technology are empowering HME to do more with less. The market is growing and the HME provider community is consolidating, but technology will make it all possible.”

New players, new money

In terms of influence, Mike Mallaro, CFO of Waterloo, Iowa-based The VGM Group, believes consolidation—throughout health care—is having the deepest impact on the changing industry.

“Consolidation is occurring on multiple fronts—dramatic payer consolidation has been occurring over the past several years and will continue,” he said. “With fewer, larger payers, the balance of power between payer and supplier is skewed and puts the supplier in a vulnerable position. Payers are able to drive lower reimbursement, narrow panels and demand supporting services that they, otherwise, could not compel providers to supply.”

Consolidation will also create a new economic environment, Mallaro says, as large providers seek to leverage their scale to create points of differentiation over smaller competitors.

“This leveraging of scale creates advantages in insurance contracting, cost efficiency and ability to invest in expansion and technology,” he said.

Consolidation is also bringing new players into the market, Mallaro says, pointing to “a tremendous amount” of European money and private equity investment in the HME market over the past several years.

“This new money has different perspectives on our market and new ways of looking at our business—that will drive changes and will affect the entire industry,” he said.

Risk is the only option

Jettisoning previously successful methods in favor of new, unproven and unfamiliar practices takes nerve, dedication, aptitude and faith—yet this risky approach may be the only option for survival, says Gregory LoPresti, CEO of Upstate Home Care in Syracuse, N.Y.

“It has been a long gradual change from FFS to what is now being contemplated with accountable care organizations and patient-centered medical homes,” he said. “But if you don’t move away from FFS, you will never cut your way to profitability. You have to add new lines of business.”

Part 2 next week: Voices of change: Industry insiders weigh in on the state of the industry

WASHINGTON – A legislative fly-in on Sept. 10 spearheaded by The MED Group and supported by AAHomecare resulted in 100 meetings with lawmakers. The topics of discussion at the meetings: bills to reform the competitive bidding and audit programs, H.R. 4920 and H.R. 5083, respectively. “These bills are gaining momentum and our presence on the Hill should make a difference,” said Jeff Woodham, senior vice president and general manager of The MED Group, in a press release. Currently, the bid bill has 49 co-sponsors; the audit bill, 33. At least 9 and 10 co-sponsors, respectively, were added to the bills last week. AAHomecare officials helped to manage the appointment process, provided briefing materials and joined in on the meetings. “Working together on our HME legislative priorities—through back-home meetings, letters to Capitol Hill, and face-to-face meetings in D.C.—will ultimately be what makes the difference in getting these bills passed and enacted into law,” said Tom Ryan, CEO of AAHomecare, in the release. Congress was expected to recess Friday until after the elections.

CMS touts popularity, value of MA plans

WASHINGTON – Enrollment in Medicare Advantage (MA) plans in 2015 is projected to increase to a new all-time high, CMS announced Sept. 18. Premiums are expected to remain affordable, as well, the agency says. “Seniors and people with disabilities are benefiting from a transparent and competitive marketplace for Medicare health and drug plans,” stated CMS Administrator Marilyn Tavenner in a press release. The annual open enrollment period for Medicare and drug plans begins Oct. 15. Between 2010, when the Affordable Care Act was enacted, and 2015, enrollment in MA plans is expected to increase 42% and premiums are expected to decrease 6%. For 2015, MA plans submitted average premiums that were $2.94 higher, but CMS estimates premiums will be only $1.30 higher because more beneficiaries are expected to enroll in lower cost plans.

CMS releases performance results for ACOs

WASHINGTON – Accountable care organizations (ACOs) in the Pioneer ACO Model and Medicare Shared Savings Program generated more than $372 million in savings in their second and first years, respectively, CMS reported Sept. 16. The Pioneer ACOs generated estimated total savings of more than $96 million and qualified for shared savings payments of $68 million. They saved the Medicare Trust Fund about $41 million. Broken down, 11 Pioneer ACOs earned shared savings, three generated shared losses and three elected to defer reconciliation until after the third year. Fifty-three Shared Savings Program ACOs held spending to $652 million below their targets and earned performance payments of more than $300 million. One ACO overspent its target by $10 million and owed shared losses of $4 million. They will save the Trust Fund about $345 million.

NSM makes buy in Pennsylvania

FRANKLIN, Tenn. – National Seating & Mobility (NSM), has acquired Oakdale, Pa.-based Able Mobility Center and renamed it NSM Pittsburgh. The provider will serve the entire Three Rivers region. “We were known as the ‘friendly mobility store’ and always considered the client the most important part of our job,” said Marci Kennedy, branch manager, in a release. “We look forward to continuing our mission with NSM.” NSM Pittsburgh will have seven complex rehab technology professionals on staff, all from Able Mobility. Two are also certified rehab technology suppliers (CRTSs).

Drive Medical becomes AAH corporate partner

WASHINGTON - Drive Medical is now one of AAHomecare's corporate partners. "Drive and its CEO Harvey Diamond have been actively involved in AAHomecare for much of the company's 14-year history," the association stated in a bulletin. Support from corporate partners allows AAHomecare to increase its work advocating on behalf of the HME industry. Partners increase their financial commitment to the association and many of their senior executives take part in its councils, committees and work groups.

Inogen execs, shareholder sell shares

NEW YORK – Two Inogen executives sold off some of their company stock this week. Vice President Byron Myers sold 22,333 shares Sept. 15 at an average price of $21.33 for a total transaction of $476,362. Director Timothy Peterson sold 39,135 shares Sept. 17 at an average price of $21.72 for a total value of $850,012.  In addition, Versant Ventures, a major shareholder of Inogen, has sold 7,388 shares of the company’s stock at an average price of $23.25 for a total of $171,771

New e-commerce website ranks products

PORTLAND, Maine – A new e-commerce website makes it easier for users to select the best home medical equipment for their needs by creating top 10 lists of the best/most useful equipment as ranked by physicians and consumers. Users can search the site, 10bestmedical.com, by product category or by condition. The products featured on the website are available for purchase for cash. “Based on our extensive experience in the field, we know that many baby boomers and those with chronic conditions are not willing to accept decreased product quality due to insurance cutbacks and often decide to purchase a second or higher quality product on their own,” said Tyrrell Hunter, co-founder and vice president, in a release. 

ResMed integrates with health system

SAN DIEGO – ResMed’s AirView compliance management platform (formerly EasyCare Online) is now securely connected to the Epic EHR system of Fairview Health Services. The integration means Fairview’s medical staff can view up-to-date outcomes data on sleep apnea patients without logging in to multiple patient management systems. “The healthcare system is under significant pressure to drive down the cost of care while still delivering exceptional patient outcomes," said Raj Sodhi, vice president, healthcare informatics at ResMed, in a press release. "Sleep apnea represents one area where technology integration can play a key role in making that happen.” Fairview is a Minneapolis-based nonprofit academic health system with 21,000 employees and 2,300 aligned physicians.

Cailor Fleming, AOPA renew partnership

YOUNGSTOWN, Ohio – Cailor Fleming Insurance has renewed its partnership with the American Orthotic & Prosthetic Association (AOPA). Per the partnership, Cailor Fleming will continue to provide the association’s members with a wide range of custom designed insurance products, including broad property, umbrella and workers compensation. The new partnership becomes effective Jan. 1 and will last five years. Cailor Fleming also has exclusive relationships with the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) and the Board of Certification (BOC), among others.

Mediquip pursues gov’t contracts

BETHPAGE, N.Y. – Mediquip has expanded its reach to service federal agencies by applying for a GSA Schedule and pursuing contracts. “The opportunity to service government accounts opens up significantly more markets throughout our region as our goal of expanding our services to various healthcare agencies becomes a reality,” stated William Hill, co-founder of Mediquip, in a press release. Mediquip is a full-line HME provider that specializes in clinical respiratory services, including ventilation.

Short takes: Brightree, SCA, Michael’s Pharmacy

Brightreehas released the latest version of Brightree HME, which features new capabilities for prior authorization requests (PARs), electronic purchasing, document management and electronic eligibility checking…SCA has refreshed its line of Tena Skincare cleansing, washing and protective cream products. The line, targeted to those suffering from incontinence, features milder formulations, easy-to-identify packaging and design updates…Michael’s Pharmacy, a compounding pharmacy and DME supplier, has achieved accreditation from the Healthcare Quality Association on Accreditation (HQAA).

Good works: Dr. Comfort, Hasco

Dr. Comfort will offer Tonya, a tall stylish pink slipper, for a limited time in October in honor of Breast Cancer Awareness Month. A portion of the sales from each slipper sold will be donated to the Susan G. Komen Foundation...Hasco subsidiary Mobility Freedom has delivered accessible vans to the Rentas family and to Aura Alfaro, both of Orlando, Fla., as part of its We Deliver Freedom Program. The program uses crowdfunding and social media to raise awareness of families in need. 

WASHINGTON – Enrollment in Medicare Advantage (MA) plans in 2015 is projected to increase to a new all-time high, CMS announced Sept. 18.

Premiums are expected to remain affordable, as well, the agency says.

“Seniors and people with disabilities are benefiting from a transparent and competitive marketplace for Medicare health and drug plans,” stated CMS Administrator Marilyn Tavenner in a press release.

The annual open enrollment period for Medicare and drug plans begins Oct. 15.

Between 2010, when the Affordable Care Act was enacted, and 2015, enrollment in MA plans is expected to increase 42% and premiums is expected to decrease 6%.

For 2015, MA plans submitted average premiums that were $2.94 higher, but CMS estimates premiums will be only $1.30 higher because more beneficiaries are expected to enroll in lower cost plans.

“The vast majority of MA enrollees will face little or no premium increase for next year, with 61% of beneficiaries not seeing any premium increase at all,” the agency states.

The quality of MA plans continues to improve, as well, CMS says. About 40% of plans will receive four or more stars for 2015, an increase of about 6% from 2014.

WASHINGTON – Accountable care organizations (ACOs) in the Pioneer ACO Model and Medicare Shared Savings Program generated more than $372 million in savings in their second and first years, respectively, CMS reported Sept. 16.

The Pioneer ACOs generated estimated total savings of more than $96 million and qualified for shared savings payments of $68 million. They saved the Medicare Trust Fund about $41 million.

Broken down, 11 Pioneer ACOs earned shared savings, three generated shared losses and three elected to defer reconciliation until after the third year.

Fifty-three Shared Savings Program ACOs held spending to $652 million below their targets and earned performance payments of more than $300 million. One ACO overspent its target by $10 million and owed shared losses of $4 million. They will save the Trust Fund about $345 million.

Additionally, 52 Shared Savings Program ACOs reduced costs compared to their benchmark, but they did not qualify for shared savings.

While CMS characterized the savings as “encouraging,” Kaiser Health News characterized them as “teensy sums in the context of a program that spends half a trillion dollars a year on care for the elderly and disabled.”

Suppose you were an HME provider supplying a Medicare beneficiary with oxygen therapy through a competitive bidding contract. Suppose the beneficiary also needs non-prescription items like a hospital bed, mattress and other HME for which you don’t have contracts.

Suppose the beneficiary and his or her children want to continue doing business with you, even though you don’t have the contracts. What are your options?

“You can’t sell the equipment to the patient, so we sell the equipment to the daughter or son,” said Tom Inman, president of Virginia Home Medical in Newport News, Va. “They can put a bow on the foot of the bed and call it a present. They’re as happy as can be.”

While industry consultants concede this is a gray area—there are “a ton of different cash arrangements out there,” said one—they recommend providers always get an advance beneficiary notice (ABN).

“When you have knowledge that a piece of equipment is subject to insurance, you’re required to get an ABN,” said Andrea Stark, a reimbursement consultant with MiraVisa. “That protocol is in place to protect the beneficiary and the family, and to make sure everyone knows how the transaction will be treated.”

Here’s one reason why that’s necessary: It’s not uncommon, for example, for the children of a beneficiary not to be on the same page, turning a simple transaction into a complicated one, says Sylvia Toscano, owner of Professional Medical Administrators.

“What we see a lot is that one of the kids will make an arrangement and then another will get involved later on and say, ‘That’s a Medicare-covered item; I don’t know why you took our money,’” she said. “If they go to Medicare, it becomes our word against theirs and refund requirements could come into play.”

This is almost a nice problem to have, says Rob Baumhover, director of retail programs for The VGM Group.

“The nice thing is that it means you’ve built that relationship with the children, and they’re the ones that want mom and dad to be taken care of by you,” he said. “Then, when the time comes for them to need your services, they’ll stick with you, too.”

Inman says he’s comfortable selling non-prescription equipment to the children of his patients without an ABN. 

“If you have an ABN, you’re admitting that the Medicare patient is your customer,” he said. “They’re not my customer; I’m not getting anything from them. I’m selling for cash to the public.”

Inman says Medicare is making it so hard to get equipment that many families with loved ones in need are saying, “Screw it.”

“You have to be creative,” he said.

For years, HME providers have been trying to teach physicians what they need to include in their chart notes, often to no avail, says Sarah Hanna, president of ECS Billing & Consulting North.

But the transition to ICD-10 may be the thing that finally gets through to them, she says.

“How a physician gets paid corresponds to a diagnosis procedure code,” she said. “Well guess what, to prove medical necessity for an ICD-10 code, which is more specific, you have to chart in a way that proves all these different characteristics of that ICD-10 code. Hello, we’ve been trying to do this for years.”

Where providers have often felt like the only ones out there educating physicians about proper documentation, now revenue cycle management companies and other groups tied into physician payments also have a vested interest, Hanna says.

“This should help us in the long run,” she said.

Discharge drama

Speaking of rude awakenings, discharge planners in hospitals are finding out real fast that they can no longer discharge patients with HME without a detailed written order signed by a physician, says Sylvia Toscano, owner of Professional Medical Administrators.

“They ask, ‘What’s changed,’” she said. “A lot of times we talk, talk, talk, but it only becomes an impact when they can’t dispense.”

Once discharge planners know the real impact of the change, which went into effect Jan. 1, there are still challenges to overcome. 

“We’re hearing a lot of, ‘The physician has already done the rounds and isn’t due to come back around for awhile,” she said. “The patient can’t get the DME; it’s creating some access issues.”

Bigger ticket, bigger pain

No one’s happy about the suspension of the assignment of new appeals to the administrative law judges (ALJs), but perhaps least happy of all are complex rehab providers, says Kelly Wolfe, CEO of Regency Billing and Consulting.

“The people looking at these claims at the earlier levels don’t always know what they’re looking for, because they don’t see many custom chairs, so most providers will try to turn it around at the ALJ,” she said.

But with the suspension, that’s no longer an option, Wolfe says.

“These are big-ticket items—we have one provider who has $127,000 wrapped up,” she said. “Now there are businesses that are being forced to close their doors.”

WASHINGTON – The Aug. 20 Open Door Forum was pretty much all hospice, all the time (OASIS, payment rates, cost report, cap survey), so you won’t be seeing a full story about it in HME News.

But there was an interesting question asked during the Q&A portion that’s worth mentioning.

Someone from a hospital called in to ask CMS officials why physicians are getting such detailed requests for documentation from DME providers.

He said: “We’re getting requests from DME providers for some level of documentation from the physician that there has been a face to face by the nurse practitioner. We’re wondering, in a situation where (patients have been hospitalized), wouldn’t the medical record itself serve that purpose? Can you clarify what’s really needed? There have been situations where discharges are delayed. Physicians, especially in the surgical world, are tied up. We’re not sure what’s required and they’re asking for some detailed information.”

Where do I begin: That the hospital sees the DME provider as a nuisance for trying to follow the rules? That CMS policies can sometimes defy common logic? That patients are getting delayed in their discharges due to that lack of common logic? That hospitals still don’t know what’s going on with the face to face?

CMS didn’t have anyone present at the forum to answer his question. Randy Throndset, director of the Division of Home Health, Hospice and HCPCS, advised him to send an email to the Open Door Forum email address.

I say, welcome to our world, hospitals.

RALEIGH, N.C. – More than a year after its implementation, HME providers here are still grappling with problems created by the state’s new Medicaid billing system.

“We’ve asked them to let us be involved in testing and fixing solutions,” said Laura Williard, senior director of reimbursement and contracting for High Point-based Advanced Home Care. “It’s not something they are open to. We have been told we will slow down the process, but we don’t want it fixed quickly; we want it fixed right.”

The system, NC Tracks, went live July 1, 2013.

The North Carolina Association of Medical Equipment Services (NCAMES) has identified five key issues, including the inability for providers to check for same or similar claims and the inability for the NC Tracks system to automatically process Medicare crossover claims.

“We’re having to void off of NC tracks what comes in from Medicare, which is very time consuming, and rekey everything manually,” said Kim Lynn, HME operations manager for Carolina Apothecary in Reidsville.

Although Medicaid has slowly ironed out problems affecting physicians, dentists and other healthcare providers, HME providers say they aren’t getting the same priority.

From the start, NCAMES has been working with Medicaid officials to try and resolve these issues. But a July 4 TV news report, in which a Department of Health and Human Services official said “a few” provider issues were addressed quickly, left providers frustrated.

“We’re not one or two providers—we’re an entire industry,” said Craig Rae, owner of Salisbury-based Penrod Medical Equipment. “It’s been a year. That’s not fixing things quickly.”

TALLAHASSEE, Fla. – Florida gas stations with two or more employees will soon be required to post their phone numbers on pumps so people with disabilities may call the station for assistance. 

Provider Bruce Bayes helped gather support for the bill.

“This is a real simple way to get help to people who need help,” said Bayes, CEO of Largo, Fla.-based Custom Mobility. “I couldn’t find anything wrong with it.”

The state legislature passed a bill in May making the phone numbers a requirement. Once signed by the governor and enacted into law, gas stations will have until July 2016 to comply.

The movement started with a point paper written by Ben Ritter, co-chair of the Tampa Mayor’s Alliance for Persons with Disabilities, which spurred a Hillsborough County, Fla., ordinance in 2011.

The phone numbers are an easy and inexpensive fix to a problem that’s a big hang up for disabled drivers who are unable to get out of their vehicles and pump gas, Ritter says.

“According to the federal Americans with Disabilities Act (ADA), if you have two or more employees working during normal business hours, then that gas station is required to pump gas for qualified people with disabilities,” he said. “It doesn’t affect the mom-and-pops.”

The problem is that the ADA doesn’t specify how people with disabilities are to get the attention of the station attendant. With this law, disabled drivers can travel throughout Florida, knowing they can easily get service when they need it, Ritter says. 

“You can honk your horn, flash your lights, wave your parking permit,” he said. “History shows that doesn’t work.”

Bayes hopes to see the idea spread.

“The only wish I would have is that we would get ahold of a national organization to jump on the bandwagon and get this passed nationally,” he said.