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- 11/14/14--12:21: _Appeals backlog soa...
- 11/14/14--12:20: _Stakeholders: ‘Our ...
- 11/14/14--11:29: _In brief: Industry ...
- 11/18/14--07:43: _Mixon to step down
- 11/19/14--08:57: _Medtrade Spring fea...
- 11/21/14--11:49: _NewsPoll: Beneficia...
- 11/21/14--11:45: _In brief: NCART get...
- 11/26/14--09:31: _Industry presses fo...
- 11/26/14--09:25: _Social media 'ultim...
- 11/26/14--09:22: _In brief: OIG repor...
- 12/01/14--08:25: _Expect more aggress...
- 12/01/14--08:24: _Maine: Providers to...
- 12/01/14--08:21: _Corporations steppi...
- 12/03/14--12:55: _Medicare outlines n...
- 12/04/14--10:10: _Senate companion bi...
- 12/05/14--11:43: _Stakeholders run wi...
- 12/05/14--11:36: _In brief: New enrol...
- 12/12/14--11:05: _In brief: Rumored s...
- 12/12/14--07:52: _CMS announces DMEPO...
- 12/19/14--11:36: _Bid bills likely to...
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WASHINGTON – Less than a year after a massive appeals backlog at the Administrative Law Judge (ALJ) level first came to light, that backlog has nearly tripled.
“They confirmed that there’s more than 900,000 appeals in the backlog and they are getting 14,000 a week,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “Do the simple math: with 72 ALJs, even with no new appeals, they will catch up in 12.5 years.”
Brummett, along with Jay Witter, senior vice president of public policy for AAHomecare, met with staff of Chief ALJ Nancy Griswold on Nov. 12 to discuss the appeals backlog and possible solutions to relieve the burden on HME providers.
“I think they are willing to work with us, but the scope of what they can do is limited,” said Brummett. “We’re all screaming, ‘stop the audits until you catch up,’ but that’s not within their purview.”
The industry first learned of the appeals backlog when Griswold said in a Dec. 31, 2013, memo that the Office of Medicare Hearings and Appeals (OMHA) had seen its workload increase 184% since 2010, resulting in a then-backlog of 357,000 appeals. As a result, OMHA has suspended the assignment of hearings for appeals.
At an Oct. 29 forum, OMHA officials suggested, to the dismay of HME stakeholders, that providers need more education on documentation. With approximately 56% of ALJ appeals overturned, that simply doesn’t make sense, said Seth Johnson.
“It’s extremely frustrating and outrageous,” said Johnson, vice president of government relations for Pride Mobility, who attended the hearing. “The ALJ’s return rate indicates that the audit system is broken.”
For now, providers have only two options, neither of them promising for HME providers: the first is a pilot aimed at brokering settlements between the provider and CMS; the second is a statistical sampling initiative in which a payment decision is based on a random sampling of claims. Both options are limited in scope and could place burdens on providers, says Brummett.
OMHA has also issued a request for information, published in the Nov. 5 Federal Register, seeking input on current initiatives being undertaken by the ALJs, as well as suggestions for additional initiatives.
“That’s a good start and we are appreciative of the opportunity,” said attorney Steve Azia, counsel at Baker Donelson. “But the bottom line is that the process needs to be fixed. We are seeing a massive amount of denials for claims that should not be denied.”
YARMOUTH, Maine – When the balance of power shifts in the 114th Congress, HME leaders say the industry will be OK.
Democrats lost at least a dozen seats in the House and eight in the Senate, giving Republicans control of both after November’s midterm elections.
Though the industry lost several of its most vocal champions, like Bruce Braley, D-Iowa, and John Barrow, D-Ga., as well as Howard Coble, R-N.C., who retired, Jay Witter, senior vice president of public policy at AAHomecare, says a shake-up in Washington isn’t necessarily a bad thing.
New members in the House and the Senate often understand or are more willing to listen to the issues than some of the more senior members, he said.
“With each election you lose some of your friends, but it’s an opportunity to get new ones,” said Witter.
The VGM Group has already invited Senator-Elect Joni Ernst, R-Iowa, who beat out Braley, and Representative-Elect Rod Blum, R-Iowa, to VGM headquarters.
“We’ve had (Blum) out to VGM during the campaign, so he knows what we’re all about, but he doesn’t know all of our issues,” said John Gallagher, VGM’s vice president of government relations.
Gallagher plans on discussing audits and competitive bidding with Blum during their December meeting.
He’s also optimistic about the Republicans’ recent power grab, particularly incoming Majority Leader Mitch McConnell’s, R-Ky., call for regular order, which would give committees more oversight over CMS and DHHS.
“Now you will have committees saying, ‘Before you roll out competitive bidding, you will complete an OIG study,’ or they can hold the hearings to review the OIG study once it’s done to see what the impact has been on small business, but also to the beneficiaries,” said Gallagher. “Right now, there’s no oversight.”
Though stakeholders are hopeful its key legislation—bills to reform the competitive bidding and audit programs—will be passed during the current lame duck session, they say they will get it reintroduced in the next session, if it doesn’t.
“With regard to the competitive bidding legislation, that’s largely been a bipartisan issue,” said Seth Johnson, vice president of government relations for Pride Mobility. “The audit legislation is largely bipartisan as well, so I don’t think it will be any more challenging in the new Congress than it is in this Congress.”
WASHINGTON – People for Quality Care (PFQC) and Save My Medical Supplies (SMMS) have partnered to spread the word about the positive impact of home medical equipment. In honor of Homecare Month, the two groups have created a centralized base, www.homecaremonth.org, for positive stories featuring patient testimonials and HME providers who go out of their way to help others. “The patients we speak with have remarkable things to stay about their home medical equipment providers,” said Kelly Turner, director of advocacy PFQC. “Unfortunately, these positive testimonies can get drowned out by stories of fraud and abuse. We want to shine the spotlight on the heart of HME providers and honor all the important work that they do.”
CMS revisits coverage of SGDs
BALTIMORE – CMS is instructing its contractors to rescind the “coverage reminder” that mandates speech generating devices (SGD be covered for speech only. Since 2001, when the current national coverage determination (NCD) took effect, technology for SGDs and the ways in which the devices are used for patients’ medical needs has changed significantly, says CMS. The agency has indicated that it will internally reconsider Medicare coverage of augmentative and alternative communication devices.
Brightree, Inogen make ‘500’ list
ATLANTA and GOLETA, Calif. – Brightree and Inogen were ranked on Deloitte’s Technology Fast 500 list as two of the 500 fastest growing tech companies in North America. Between 2009 through 2013, Brightree and Inogen grew 331% and 605%, respectively.“The companies ranked on the 2014 Deloitte Technology Fast 500 continue to set the bar for their industry higher each year,” said Eric Openshaw, Deloitte vice chairman. To be eligible for the list, companies must own proprietary intellectual property, have base-year operating revenues of at least $50,000 USD or CD, have current-year operating revenues of at least $5 million and be headquartered in North America.
RAC contracts: CMS still working on it
BALTIMORE – CMS expects to award the national RAC contract by the end of this year, according to AAHomecare, as well as a contract for region 3 (Part A and Part B). Contracts for regions 1, 2 and 4 remain under a pre-award protest, filed earlier this year by CGI Federal and HMS Holdings. CMS wound down RAC operations for the most recent RACs over a period of several months, from February to June.
3B Medical devices offers advance reporting
LAKE WALES, Fla. – 3B Medical’s devices are now capable of enhanced reporting for central sleep apnea (CSA) detection. "Patients diagnosed by home sleep testing are often not screened or accurately diagnosed for the presence of CSA,” said Angela Giudice, 3B Medical clinical manager. “For that reason, the open airway apnea reporting in our units can act as a surrogate marker for CSA and allow for more comprehensive patient care." The devices can detect when a patient is experiencing an open or clear airway apnea in real time and alert clinicians and physicians should a patient require care.
BBB carries ‘torch’ for DeVilbiss
SOMERSET, Pa. – DeVilbiss Healthcare won a 2014 Better Business Bureau (BBB) Torch Award for Marketplace Ethics for mid-size companies in Western Pennsylvania, it announced today. Nominees were required to submit answers to questions regarding decision making, marketing and solicitations, recognition and awards, history and reputation, and return to the community. “Knowing every effort in our day directly affects the lives of others, we strive to be a company of individuals who try harder, work smarter and embrace the true value of innovation,” said Ed Murphy, president and CEO, of DeVilbiss, in a release.
Jurisdiction D to conduct neb-med review
FARGO, N.D. – The Jurisdiction D DME MAC is conducting a documentation compliance review for nebulizer inhalation drugs (J7605 and J7626). The purpose is to verify whether submitted documentation meets payment requirements according to local coverage determinations. To avoid denial, providers should ensure requested documentation is sent to the contractor within the allotted timeframe, medical records supporting the management of obstructive pulmonary disease are submitted and refill requirements are met.
International Biophysics, VGM ink deal
AUSTIN, Texas – International Biophysics Corporation has partnered with The VGM Group to become a preferred vendor for its AffloVest, it was announced yesterday. The AffloVestprovides daily portable oscillation treatment for respiratory diseases, such as Cystic Fibrosis, Bronchiectasis, ALS, MS, MD and COPD. “We’re thrilled to connect our members to this innovative technology that will improve their patients’ quality of life,” said Van Miller, CEO and founder of VGM, in a release.
ACHC offers new consultant program
CARY, N.C – ACHC has released a Certified Consultant program for industry professionals wanting to demonstrate proficiency in ACHC accreditation standards and processes. Participants will receive ACHC Certified Consultant recognition, a company listing on the organization’s website, access to ACHC accreditation and standards and an ACHC workbook. Certified consultants are required to attend a consult training workshop Dec. 2-3 at ACHC headquarters in Cary, N.C.
VMI celebrates Veterans Day with giveaway
PHOENIX – Toyota and Vantage Mobility International (VMI) awarded a disabled US Air Force veteran with a new car on Veterans Day. The 2015 Toyota Sienna with VMI’s Northstar Access360 wheelchair conversion was award to Susan Kirsch, who entered VMI’s Star Spangled Salute contest. Developed by VMI and Toyota, the Star Spangled Salute program educates disabled veterans about mobility. The wheelchair accessible van features a full-cut floor and removable driver and passenger seats.
ELYRIA, Ohio – Mal Mixon is retiring.
The founder of Invacare will step down as executive chairman of the Board of Directors Dec. 21.
''Over the past 35 years, I have had the privilege of leading and guiding Invacare’s evolution into a global manufacturer and distributor of medical devices that promote recovery and active lifestyles,” said Mixon in a release. “At this important transition point in the company’s history, I feel that now is the appropriate time for me to retire and let the next generation of leadership guide the company into the future.”
During Mixon’s tenure, Invacare has grown from a domestic company with $19 million in annual sales to a global powerhouse with sales of $1.4 billion.
Invacare has struggled in recent quarters thanks to a consent decree with the U.S. Food and Drug Administration. In October, the company reported a 4.8% decrease in third quarter sales.
Mixon, 74, will continue as a non-employee member of the board until the 2015 annual meeting when the company will nominate him for one additional year. The board’s mandatory retirement age is 75.
LAS VEGAS – Medtrade Spring is mixing it up this year.
The three-day conference, slated for March 30–April 1 at the Mandalay Bay Convention Center in Las Vegas, has a new format aimed at reducing overlap between conference sessions and expo floor time. A majority of educational sessions have been moved to Monday, allowing attendees to browse the expo floor on Tuesday and Wednesday.
“Finding the right balance of education, networking and time on the expo floor can sometimes be tricky for attendees,” said Kevin Gaffney, Medtrade group show director, in a press release. “Feedback from surveys, and directly from providers, indicated a strong desire for that balance.”
This year’s format also features hour-and-a-half sessions led by teams of experts, rather than a single speaker, said Medtrade Marketing Director Sarah Varner.
Registration for Medtrade Spring is officially open. Attendees who sign up now will be able to take advantage of early bird rates and are encouraged to call (877) 914-4677 or (240) 439-2984 (international residents) with any questions. To register click here.
YARMOUTH, Maine – Nearly two years after the implementation of Round 2 of competitive bidding, and with the Round 1 recompete well under way, a whopping 95% of HME providers report they are still seeing beneficiary access issues.
“Calls stream in every day from beneficiaries who can’t find necessary medical equipment or diabetic supplies,” said one provider. “They are elderly people who have not been informed. Shame on our government.”
And it seems like things are getting worse, not better, say 95% of poll respondents, who report problems have increased in the past year. The two biggest issues are lack of access to equipment (43%), and delays in obtaining equipment (42%).
“Contract suppliers are taking forever to deliver equipment,” said one provider. “Discharge planners/referral sources are frustrated because they no longer have one-stop shopping for DME and coordinate of equipment delivery is difficult with multiple providers.”
Although only 8% of providers report hearing of poor quality equipment or service, for the beneficiaries, that has a huge impact, they say.
“I had a long-time patient that recently needed a customized K4 and called almost every winning bidder in her area to no avail,” said Lori Sear, owner of Active Home Medical in Lapeer, Mich. “The only way for her to get a professional evaluation was to drive three hours. How is that acceptable?”
It’s not just the bidding program itself impeding access, counters a contract supplier. Getting the proper documentation from physicians continues to be a struggle.
“We receive, at times, over 100 new orders each day,” said Susan Kelly CEO of MetroCare home Medical. “Very few of those orders come across with proper documentation, despite our extensive efforts to educate the physicians and the referral sources.”
Unsurprisingly, beneficiaries accounted for 66% of the complaints providers are hearing. Non-contract suppliers express frustration at being unable to help them.
“We are hearing from beneficiaries and discharge planners who ask, ‘When will you be able to take care of us again?’” said Sam Clay, president of Clay Home Medical in Petersburg, Va. “The bid winners provide such terrible and slow service or don’t respond to phone calls at all. They are very disgusted with the whole process.”
WASHINGTON – NCART has asked CRT stakeholders to take to Twitter in an effort to reach key Congressional offices to push—and pass—its two bills to carve out a separate benefit for complex rehab, by the end of the year. The message NCART wants tweeted: “Help people with disabilities get needed specialized equipment. Pass #HR942 & #S948 this year!” NCART has created a list of Congressional twitter handles to include in tweets. “In about fifteen minutes, you can generate attention from close to 50 key Congressional offices,” said Executive Director Don Clayback. “If we all work together to tweet these offices over the next few days, we can create a real impact.” H.R. 942 has lingered at 160 co-sponsors since September; S. 948 in November picked up its 21st co-sponsor, Sen. Christopher Coons, D-Del.
NSM makes second November buy
NASHVILLE, Tenn. – National Seating & Mobility (NSM) announced Friday that it plans to acquire the custom seating and mobility division of Indianapolis-based Home Health Depot (HHD). “HHD is a respected presence in our industry with an excellent staff and reputation,” said NSM CEO Mike Ballard, in a release. The deal adds 16 ATPs and 50 support professionals to NSM’s staff. HHD branches begin operations as NSM immediately in Atlanta, Coralville and Urbandale, Iowa, Indianapolis and Broadview, Ill. Earlier this month, NSM acquired Newington, Conn.-based Hudson Seating & Mobility.
Philips launches COPD Survey
Andover, Mass. – In recognition of World COPD Day Nov. 19, Royal Philips launched a patient survey to uncover the physical, emotional and psychological challenges COPD patients face on a daily basis.
“COPD is highly prevalent, but few people know how serious the condition is or have information at their fingertips to make decisions about when they should talk to their doctor,” said Eli Diacopoulos, general manager of respiratory care. Currently open to diagnosed patients in the U.S., U.K., and Germany, the goal of the study is to help Philips design better technology solutions to meet the needs of COPD sufferers. Philips expects the study’s findings to be available in early 2015.
Medtrade Spring features new format
LAS VEGAS – Medtrade Spring is mixing it up this year. The three-day conference, slated for March 30–April 1 at the Mandalay Bay Convention Center in Las Vegas, has a new format aimed at reducing overlap between conference sessions and expo floor time. A majority of educational sessions have been moved to Monday, allowing attendees to browse the expo floor on Tuesday and Wednesday. “Finding the right balance of education, networking and time on the expo floor can sometimes be tricky for attendees,” said Kevin Gaffney, Medtrade group show director, in a press release. “Feedback from surveys, and directly from providers, indicated a strong desire for that balance.”This year’s format also features hour-and-a-half sessions led by teams of experts, rather than a single speaker.Registration for Medtrade Spring is officially open. Attendees who sign up now will be able to take advantage of early bird rates and are encouraged to call (877) 914-4677 or (240) 439-2984 (international residents) with any questions. To register click here.
At Home Medical launches new site
CUMMING, Ga. – At Home Medical unveiled its new customer–friendly website for those who use wheelchairs, continence care, urology, ostomy, skin and wound care products. The new design features separate sections for specific product categories and name brands, as well as a sales portal, offering daily deals, customer loyalty programs and weekly specials for newsletter subscribers. The site, www.athomemedical.com, also links to the company’s iPush program, which offers free resources, social networking and news for wheelchair users.
Hasco performs well in third quarter
ADDISON, Texas – Hasco Medical’s revenues were $23.8 million for the third quarter of 2013, a 22% increase over third quarter 2013. The handicap-accessible vans, parts and service provider’s gross profit increased 34% to $6.3 million over the same quarter a year ago, while net income increased 93% to a record $0.8 million vs. 2013. The overall growth is attributed to an increase in private-pay business for van sales, and the addition of Auto Mobility Sales, acquired last September, stated a press release. "To support continued growth, we are expanding our footprint on the East Coast,” said Hasco CEO Hal Compton. “This includes the opening of a new wheelchair accessible van dealership to service customers in the Baltimore metropolitan area, which marks our 20th location.”
DeVilbiss rolls out online ordering system
SOMERSET, Penn. – DeVilbiss Healthcare is offering U.S. customers another option to place orders for respiratory products. “DeVilbiss Provider Online Ordering makes looking up product information and placing orders very convenient for our providers,” said Brian Shearer, director of customer service for DeVilbiss. “With this tool, users may log in and place orders at their convenience—24 hours a day, 7 days a week.” The secure, web-based portal allows users to place new orders, request quotes or returns and look up product pricing and availability.
The Med Group enters agreement with OmniSYS
LUBBOCK, Texas – The MED Group is teaming up with OmniSYS to offer comprehensive revenue cycle management and compliance services. “The increase in audits for HME providers has created significant resource demand and financial risk,” said Jeff Woodham, the Med Group’s senior vice president and general manager. “Having a solution that can bring expertise, efficiencies and results, will help our members continue to grow their business.” OmniSYS, which specializes in Medicare Part B claims reimbursement and compliance services, manages the full lifecycle of the medical claim, including eligibility checks at the point of sale, billing, accounts receivable management with denial tracking, electronic and manual remittance and patient invoicing.
Mediware releases new scheduling software
LENEXA, Kan. – Mediware released its newest rehab scheduling software, MediLinks AE. “With this scheduling component,” said Stuart Foster, general manager for rehabilitation and respiratory solutions, “the MediLinks software is an optimal rehabilitation therapy solution for any IRF or outpatient rehab hospital setting.” Designed for inpatient and outpatient use, MediLinks AE offers real-time scheduling and patient reminders via text, email or phone to reduce the rate of no-shows and cancellations, as well as wait and recall lists to ensure a full schedule. MediLinks AE also tracks and monitors 3 Hour Rule compliance for inpatient facilities.
People news
Joseph B. Richey, II,Invacare technologies division president and senior vice president of electronic and design engineering, is retiring Nov. 30. During his 35 years with the company, Richey helped develop the Invacare HomeFill Oxygen System, gearless brush motors and digital controls for power wheelchairs…Jim Schreiber is the new vice president of marketing at Pride Mobility Products. Schreiber previously worked for Sanofi Pasteur, a global vaccine manufacturer, where he developed integrated marketing strategies…Ralph Emmett has been hired as Golden Technologies’ VP of operations. “In the few short weeks he has been with the Golden team, Ralph has already made significant improvements to our manufacturing processes to increase production, while maintaining our highest quality standards,” said CEO Richard Golden in a release…Emerge Sales has tapped Ken Waters as its new global strategic adviser. Waters has extensive senior level domestic and global sales experience. In his new role, he will help Emerge expand its international presence.
WASHINGTON – Industry stakeholders are seeking answers to a laundry list of questions regarding CMS’s “incredibly vague” plan to bundle payments for standard power wheelchairs and CPAP.
“We’ve posed several questions already and will submit about a dozen more,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “CMS has indicated they are compiling the questions and will respond to the industry. CMS knows the bundling thing is incredibly vague.”
Among the unanswered questions: how will CMS calculate the bid ceiling, what codes are included in the bundles, how will CMS deal with documentation issues, and what is the timeframe for implementing bundled payments.
“My bet is on 2017,” said Brummett. “We’ve got the Round 2 recompete, the expansion into non-bid areas. To pile bundling on top of that—there’s no way they’ll be able to get it all done.”
Also unknown: the 12 CBAs included in the demonstration and whether the CBAs will be the same for both product categories.
Although the industry is used to CMS seeking to rein in costs by lowering payments, lumping multiple codes—there are a couple of hundred codes for accessories for standard power wheelchairs—into a single payment is a concern. Wheelchairs and CPAP were likely targeted because CMS considers them overutilized, not because they make the most sense to bundle.
“They think those are overused and overpaid and think doing this will drive down the costs,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Boiling down the bid system to bidding and billing for far fewer codes then they use today is scary.”
WASHINGTON – NCART recently asked CRT stakeholders to tweet to key Congressional offices in an effort to pass its two bills.
“I think it’s going well,” said Executive Director Don Clayback. “Our objective really is to make sure that were reaching out to the offices of Congress and whatever avenues they monitor.”
To maximize exposure, NCART has created a list of Congressional twitter handles and hashtags to use in tweets. Its key message: “Help people with disabilities get needed specialized equipment. Pass #HR942 & #S948 this year!”
“We’ve used Twitter before in limited situations, to let people know what’s going on relative to NCART, and also to highlight some other industry issues, but we’re looking at using it more frequently to get people engaged in outreach activities,” said Clayback.
It’s just one example of how HME stakeholders are ramping up their use of social media as a way to engage users and enact change.
Social media is the ultimate grassroots campaign tool, said Lisa Wells, president of Get Social Consulting, who manages Save My Medical Supplies (SMMS), an AAHomecare consumer education website.
“Today, more than ever, people are more easily educated and able to tell their friends and family about issues and political matters that impact them on a personal level,” said Wells.
Although providers and manufacturers may secretly hope for instant results, building relationships with patients through social media can take time, says Lalaina Rabary, a communications and marketing specialist for People for Quality Care (PFQC), the advocacy division of The VGM Group. In a perfect world individuals would take it upon themselves to mobilize and take action.
“Obviously our goal is to fire everybody up about what’s happening (with Medicare) and we do want them to say, ‘Hey what can we do?’ but that often times takes a lot of conversation to get to that point,” said Rabary.
Even so, Clayback says it would behoove providers and manufacturers to follow NCART’s lead.
“Social media plays an important role in people’s daily lives, to both inform them, and sometimes spur them to action,” he said. “It’s important to make part of the process, in terms of maximizing your success. I think that needs to be a part of your strategy.”
WASHINGTON – Three types of diabetes test strips account for 58% of the Medicare mail-order market share, according to a study released Nov. 25 by the Office of Inspector General (OIG). The OIG examined 1,210 claims from the three-month period of October 2013 through December 2013. This is the third of three reports released in 2014 that the OIG has released to ensure that winning bidders are meeting the 50% market share requirement required by the Medicare Improvements for Patients and Providers Act. The study found that two types of strips accounted for 44% of the market and 10 types accounted for 91%. The Prodigy Autocode, from Prodigy Diabetes Care, has 26.9% of the market share. That’s an increase over a previous report, released in June, that found the Prodigy Autocode accounted for 23.9% of the market. By contrast, the same product comprised only 2.4% of the market for the three months ended December 2009.
Van Halem adds Medicare talent
ATLANTA – The van Halem Group has expanded, adding six full-time employees, it announced today. Among those joining the group are Lucretia LaFavor, a former operations manager with CGS Administrators, who will serve as a project manager; two former RAC clinical auditors, Karen Greco and Cheryl Wilkerson, as well as Donna Youngblood, a former reconsideration specialist, have also joined the team as clinical consultants. “There is no team in the industry that has more Medicare experience than ours,” says Wayne van Halem, president of The van Halem Group. “That knowledge and expertise is invaluable to our clients as we navigate complex issues related to audits, appeals, and compliance.” The van Halem Group merged with The VGM Group in June.
CPAP Planet debuts new site
FLOWOOD, Miss. – CPAP Planet’s new website, www.cpapplanet.com, features an online store for sleep apnea treatments and CPAP machines, and the company intends to add more in the future. Owner Rob Hines says the site has been well received. “It is the goal of CPAP Planet to become the leading resource for reliable information on issues impacting Sleep apnea sufferers,” he said. The company is asking visitors to give feedback for future improvements and updates.
Inventory Solutions updates price guide
NEW YORK – Inventory Solutions has released its Refurbished Equipment Price Guide for 2015. The guide includes pricing for many respiratory product categories, including vents, apnea monitors, pulse oximeters and concentrators. “Though the market has changed significantly since I started the company 14 years ago, our goal remains the same,” said President and Founder John Wittenberg. “We want to offer cost effective, reliable and affordable refurbished options to increase our customer’s bottom line.” For more information, www.invsol.com.
CMS adds accessory code
BALTIMORE – A new wheelchair accessory code, E2378 (power wheelchair component, actuator, replacement only) has been retroactively added to the group codes that were reclassified as the capped rental payment category, effective April 1, 2014. These codes can be billed as a purchase if used with a complex rehab wheelchair (K0835—K0864). If there is no indication that the E2378 is being used with a complex rehab wheelchair, it will be denied if billed as a purchase.
Invacare announces quarterly dividend
ELYRIA, Ohio – Invacare announced a quarterly dividend last week. A cash dividend of 0.0125 per share will be payable Jan. 14 to shareholders of record on Jan. 5. Invacare’s founder, Mal Mixon, has decided to step down as executive chairman of the Board of Directors, effective Dec. 21.
VMI teams up with USAA
PHOENIX – VMI and USAA are making it easier for USAA members to get a wheelchair accessible vehicle (WAV) by applying directly to USAA for financing. “For over a quarter century, VMI has led the charge to help disabled American veterans regain their mobility with the wheelchair accessible van they deserve,” said Doug Eaton, president of VMI. “We’re honored to work with USAA.” USAA members with approved credit can fast track delivery of their Toyota, Honda or Chrysler minivan with a VMI ramp conversion or use their loan to purchase a new or used wheelchair accessible van at VMI dealerships.
FreeRider offers new scooters
RANCHO CUCAMONGA, Calif. – FreeRider USA has added three new mobility scooters to its product line: the Luggie Classic, the FR168-4S, and the FR510-F. Powered by lead acid batteries, the Luggie Classic is a lightweight, compact and easy-folding mobility scooter. Designed for safety, FR168-4S holds up to 350 pounds and includes a dual electronic braking system and solid tires, while the FR510-F, carries up to 450 pounds and drives up to 18 miles.
ATLANTA – Medicare has gone from pay-and-chase to not letting the money out, says healthcare attorney Denise Leard.
The result is more—and meaner—audits, she said during a session at Medtrade in October.
Everything starts with the CERTs, she said. It’s their job to ensure Medicare is paying claims appropriately.
“If they see a trend, then all of a sudden the ZPICs are looking,” said Leard, who works for Brown & Fortunato. “It’s very important to do a good job of responding to those.”
The biggest problem? The physician medical records.
“It’s important to get them prior to dispensing the equipment,” she said. “Now, with the face-to-face rule, you have to have that documentation in hand.”
Also topping Leard’s list of concerns is the ZPICs.
“They are the contractors I worry about the most,” she said. “They are looking for fraud and abuse, they can make referrals to law enforcement. There are increased payment suspensions out there. They’ll let you keep billing but not pay you.”
They will eventually get more aggressive she warned.
“They are looking for ways to get people out of the Medicare system,” said Leard. “They will send the National Suppliers Clearinghouse. They’ve increased unannounced inspections. They can pop in if they happen to be in the neighborhood.”
Some of this scrutiny is due to provisions in the Affordable Care Act, which also gives payers more authority in matters of screening providers.
“Fingerprinting is coming,” she said.
And if you discover an overpayment, be prepared to pay it back fast. HME
PORTLAND, Maine – HME providers here are developing a medical documentation template for mobility equipment to help resolve issues with MaineCare, the state’s Medicaid program.
“It’s been a real box of chocolates with them,” said Jim Greatorex, president of Portland-based Black Bear Medical. “In many cases, they’re asking, for example, for people’s annual physical notes. It borders on the absurd at points.”
A work group has formed to produce an online documentation collection tool to help streamline the process.
Providers have looked to similar templates used in other states, specifically New York, said Kathy Adams, director of Maine CITE, a state agency promoting assistive technology for those in need.
“We’re not trying to reinvent the wheel from scratch,” said Adams, who has served as a liaison between the work group and the state’s Department of Health and Human Services. “We’re trying to use the resources we have.”
The work group anticipates having a template and recommendations to the state by year’s end.
Another issue the group hopes to tackle: the state’s poor payment rates.
“The state pays clinical people a pittance of what it actually takes to evaluate patients and document their needs,” said Greatorex. “They can’t ask for $500 worth of paperwork and pay $50.”
While there’s no way to predict how the state will react to provider recommendations for a template and adjusted payments, Greatorex and Adams agree it’s on providers to get the ball rolling.
“What we find is the best course of action is for us to do all the work and present it to them, instead of putting the ball in their court to come up with a solution,” said Greatorex. “That’s when nothing gets done.” HME
ALEXANDRIA, Va. – AAHomecare has increased efforts to bring more corporate partners on board and it’s paying off.
“We haven’t had too many new corporate members over the last several years,” said Tom Ryan, AAHomecare president and CEO. “These are members who want to put more of their dollars beyond the (revenue-based dues category) to show extra support for the association.”
In September, Drive Medical became the sixth company this year to join the ranks. Other corporate partners include Brightree, Invacare, ResMed, Pride, Philips Respironics and Medtrade, as well as providers like Apria, Byram and Shield. Sponsorships are available at bronze, silver, gold and platinum levels, and range from $40,000 to $95,000. In return, corporate partners receive full member benefits and added exposure for their brands.
“I hope that our providers, at the end of the day, will make buying decisions based on these people that support us,” said Ryan.
The support AAHomecare’s corporate partners provide goes beyond financial support. Many have lobbyists working in Washington and offer support in other ways, said Ryan.
“We are trying to engage the industry and energize them for their time and their talent,” he said. “We meet frequently and discuss our issues and see where they align with us on some of their key points. We also see a lot of these companies put a lot of time and talent into our committees.”
For Brightree, which became a corporate partner in July, joining forces with AAHomecare was also a way to support its provider customers, says COO Chris Watson.
“We felt, given a lot of the challenges that the industry faces today—from audits to reduced reimbursement to new payment models—that (it was important) to support initiatives that are focused on the overall health of our industry,” she said. hme
BALTIMORE – CMS has tightened its enrollment guidelines in a final rule issued today.
In February 2011, CMS revised its enrollment policy to increase the integrity of the Medicare program, as required by the Affordable Care Act.
New provider enrollment provisions include:
• Adding the ability to deny the enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt. This will help prevent individuals and entities from being able to incur substantial debt to Medicare, leave the Medicare program and then re-enroll as a new business to avoid repayment of the outstanding Medicare debt.
• Adding the ability to deny the enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses.
• Permitting CMS to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements.
In August, CMS announced that it would begin implementing fingerprint-based background checks for certain providers in the high-risk category.
WASHINGTON – Senators Rob Portman, R-Ohio, and Ben Cardin, D-Md., today introduced a bill that seeks to improve Medicare’s competitive bidding program.
The Competitive Bidding Improvement Act, a companion bill to H.R. 4920, has three key components: Providers need to prove they are licensed before they submit bids; bidders would be required to obtain bid bonds; and bonds will be forfeited if the bidder declines the contract and was at or below the bid price.
“Because of loopholes in the Medicare bidding process, speculative bidders were allowed to game the system,” said Tom Ryan, president and CEO of AAHomecare, in a release. “This bill will help restore accountability, alleviate artificially low prices and deter unlicensed providers.”
The bidding program has been plagued with issues such as unlicensed providers winning contracts, contracts being awarded to companies located hundreds, and in some cases, thousands of miles from the bid area, and bidders submitting low-ball bids and then not accepting contracts.
“Providing strong financial incentives for bidders to honor their bids, and having an outside third party financially vet bidders will significantly strengthen the Medicare bidding program,” said Cara Bachenheimer, senior vice president of government relations at Invacare.
H.R. 4920, introduced June 19 by Reps. Pat Tiberi, R-Ohio, and John Larson, D-Conn., currently has 64 co-sponsors, including Rep. Mark, Amodei, R-Nev., who signed on Dec. 2.
WASHINGTON – Drop everything, pick up the phone and ask your senator to sign onto a new Senate companion bill that seeks to improve the competitive bidding program.
That’s the message AAHomecare has for the HME industry.
“There’s no tomorrow,” said Tom Ryan, president and CEO of AAHomecare. “We have a very, very short window. We need to get senators lined up on the bill.”
The Competitive Bidding Improvement Act, S. 2975, introduced Dec. 4 by Sens. Rob Portman, R-Ohio, and Ben Cardin, D-Md., is similar to H.R. 4920. It has three key components: Providers need to prove they are licensed before they submit bids; bidders would be required to obtain bid bonds; and bonds will be forfeited if the bidder declines the contract and was at or below the bid price.
“The bid bond gets rid of the ability of speculative bidders to just throw in bids across the country when they may have no intention of fulfilling those contracts,” said Cara Bachenheimer, senior vice president of government relations at Invacare.
With just a few weeks left of the current legislative session—and the Round 2 recompete looming—there is no time to waste. There are three options for the bill: getting it passed as a standalone bill; getting it passed as part of a larger piece of legislation; or getting it placed on the suspension calendar.
“We’re pulling out all the stops,” said Jay Witter, senior vice president of government relations for AAHomecare.
Although the industry has seen several House bills over the years, this is the first time legislation has been introduced in the Senate. Both Portman and Cardin, members of the powerful Senate Finance Committee, represent states that have seen firsthand the problems associated with the bidding program. For example, *Maryland saw more than 100 contract suppliers in Round 2 without proper licensure.
“Once they saw the problems, there was a dramatic shift (in attitude toward the program),” said Witter.
http://www.hmenews.com/article/number-unlicensed-contract-suppliers-tops...
BALTIMORE – CMS has tightened its enrollment guidelines in a final rule issued Dec. 3. New provider enrollment provisions include: adding the ability to deny the enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt; adding the ability to deny the enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses; and permitting CMS to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements. In August, CMS announced that it would begin implementing fingerprint-based background checks for certain providers in the high-risk category.
Pharmaceutical firm partners with AAHomecare
WASHINGTON – Sunovion Pharmaceuticals is now a Silver Level Corporate Partner with AAHomecare, the association announced today. Sunovion specializes in treatments for central nervous system and respiratory disorders. “Sunovion brings a depth of experience in patient care, and we value the support that leading companies bring to the homecare community,” said Robert Steedley, chairman of the AAHomecare Board of Directors. AAHomecare has 11 corporate partners, including Invacare, Brightree, Drive Medical and Apria.
Respiratory provider settles allegations
WASHINGTON – North Atlantic Medical Services, DBA Regional Home Care, has agreed to pay $852,378 to settle allegations that it violated the False Claims Act, according to a release from the Department of Justice (DOJ). The company was accused of billing Medicare and Medicaid for respiratory services provided by unlicensed personnel from September 2010 to January 2013. Regional Home Care is based in Massachusetts, which requires respiratory therapists to be licensed. “To safeguard patient health and ensure that taxpayer money is spent well, Medicare and Medicaid require providers of respiratory care services to follow state licensure rules,” said Special Agent in Charge Phillip M. Coyne for the U.S. Department of Health and Human Services Office of Inspector General. “Companies seeking to boost profits by using unlicensed personnel will be held accountable for their actions.”
CPAP website gets facelift
ASHVILLE, N.C. – CheapCPAPSupplies.com is showing off its new and improved website. “The new site will further advocate the mission of CheapCPAPSupplies.com and Aeroflow Sleep Apnea,” said Josh Hill, director of business development. The new interface features an intuitive shopping layout, easier site navigation, a centralized blog, advanced shopping cart, and optimized search functions. In 2012, the site was updated with new images, content and inventory.
Jurisdiction B reviews for power wheelchairs and catheters
INDIANAPOLIS –A claim review of power wheelchair-related options and accessories (K0820-K0829) from July 1, 2014, to Sept. 30, 2014, showed a denial rate of 81%. In the previous quarter, the rate was 84%. The most common reasons for denial:The face-to-face examination did not support why a manual wheelchair or a power operated vehicle wouldn't meet the beneficiary's mobility needs in the home; face-to-face examination did not support the beneficiary's mobility limitation…Also under claim review arecatheters (A4353) for same time period, and which showed a denial rate of 93%. In the previous quarter, the rate was 91%. The most common reasons for denial: The beneficiary did not meet one out of five criteria per local coverage determinations (LCD) for coverage of intermittent catheter kits (A4353); the supplier did not document a valid refill request from the beneficiary.
Exhibitors lining up for Medtrade Spring
LAS VEGAS – More than 150 manufacturers and providers have registered for the three-day conference, which is slated for March 30–April 1 at the Mandalay Bay Convention Center in Las Vegas. Registration opened last week. Among the 150 exhibitors already signed up is Ontario-based Broda.“From a regional perspective, we are quite interested in meeting with customers all across North America,” said Sue Wilson, vice president of customer care, in a press release. This year’s format has been redesigned to reduce overlap between conference sessions and expo floor time, by moving a majority of educational sessions to Monday, allowing attendees to browse the expo floor most of Tuesday and Wednesday.
ResMed unveils AirCurve 10
SAN DIEGO – ResMed debuted its new AirCurve 10 series, which includes three bilevel devices and an adaptive servo-ventilation device for patients with central sleep apnea or Cheyne-Stokes respiration. "We've developed the AirCurve 10 series for patients who need truly personalized support," said Greg Peake, president of ResMed’s sleep-disordered breathing global business unit. The AirCurve 10 includes built-in wireless connectivity and works with ResMed’s patient monitoring software, ResMed’s Airview.
NHIA opens registration for annual event
ALEXANDRIA, Va. – Early bird registration has opened for the 2015 National Home Infusion Association’s (NHIA) Annual Conference & Exposition. The event takes place March 23–26 in Phoenix. It will feature a full slate of educational programs, including an executive pre-conference, roundtables, networking and an exhibit hall. For more information, call 703-838-2663 or email gabriela.miranda@nhia.org.
Inogen to hold investor meeting
GOLETA, Calif. – Inogen will host an investor and analyst meeting and live webcast Dec. 15, from 11:30 a.m. to 3 p.m. EST. The meeting will include presentations from company executives and industry expert Thomas Williams, founder and managing director of Strategic Dynamic, according to a release. The webcast begins at noon and can be accessed at www.inogen.com/investor.
BRENTWOOD, Tenn. – American HomePatient (AHP) is reportedly considering a sale. The Deal has reported that the provider has retained Jefferies & Co., to explore a sale. AHP was acquired by Highland Capital Management in 2010 in an effort to avoid bankruptcy. At the time, it had $226 million in debt. Like many companies in the HME industry, AHP has struggled with reduced reimbursement rates. Founded in 1983, the provider offers respiratory services, HME and home infusion services through 250 locations to more than 1 million patients nationwide. In January 2014, Mark Lamp took over as president and CEO, replacing longtime head Joseph Furlong, who retired.
Pride appoints new CFO
EXETER, Pa. – Pride Mobility has named Mario Patone to the newly-created position of chief financial officer. In his new role, Patone is responsible for all areas of finance and accounting, as well as asset management, according to a press release. A certified public accountant, Patone has more than 20 years of experience with both public and privately-held companies and has held management and executive positions at accounting firms PricewaterhouseCoopers and Baker Tilly. Patone’s appointment was effective Dec. 1.
VGM Forbin names new president
WATERLOO, Iowa – Jeremy Kauten is the newest member of the VGM Group’s executive team. Kauten was promoted to president of VGM Forbin, VGM’s web development and marketing division. Kauten joined the company in 1999, and has worn several hats since then, including support desk and general manager. Forbin provides web design and development, custom programming, app development, web marketing, search optimization and social media consulting for more than 800 HME providers.
Binson’s: 10 million served
CENTER LINE, Mich. – Binson’s Home Health Care Centers filled order No. 10 million at its distribution center on Dec. 10. The order was filled by owner and president James Binson. The provider also recently launched its "Wilford Brimley" TV commercial campaign in local markets to promote its mail-order diabetes supply business. The actor has played roles in movies like “The China Syndrome” and “Cocoon.” Binson’s has been in business since 1953.
ResMed wins award
SAN DIEGO – ResMed took home this year’s Zenith Award for respiratory care industry excellence. Presented by the American Association for Respiratory Care (AARC), ResMed was one of six honorees selected from 400 eligible companies, according a press release. Established in 1989, the winners are chosen based on equipment quality, sales personnel, responsiveness, service record and advertising.
Noble House marks silver anniversary
DEERFIELD BEACH, Fla. – Noble House is celebrating 25 years in business, the company announced recently. The software billing company was founded in 1989 by Richard Mehan, who sought to develop a user-friendly DME/HME billing software that was also robust. Noble House plans to release a more powerful and expanded version of its software early in 2015.
Calling all home infusion nurses
ALEXANDRIA, Va. – The National Home Infusion Foundation (NHIF) is accepting applications for its new Lynn Giglione Memorial NHIF Scholarship Award for Home and Specialty Infusion Nursing. “The scholarship supports the mission of the Foundation to advance home and specialty infusion leadership, education and research, as well as to further elevate infusion practice to the highest level of patient care and value,” said foundation Chairman Christopher Maksym. All applications must be received by January 12, 2015.
Hasco teams up with taxi service
ADDISON, Texas – Hasco Medical’s Ride-Away has partnered with Uber to offer discounts and preferred financing rates on wheelchair accessible vehicles in the Washington, D.C., area. “Our partnership with Uber is a major milestone and provides strong validation of our leading vehicular mobility solutions,” said Hasco CEO Hal Compton. Launched in 2011, Uber is a taxi service company that connects riders and drivers through a mobile app.
iPush hosts wheelchair giveaway
CUMMING, Ga. – The iPush foundation is holding its first Annual Wheeling for the Holidays Contest. From Dec. 9 to Dec. 23, the foundation wants visitors to its Facebook, Twitter and website to submit their story of “What do you push for?” One winner will be chosen to receive a custom-fitted Eagle Tornado wheelchair, built by Eagle Sportschairs and donated by At Home Medical. “As a quadriplegic myself, I have strong desire to give back to the wheelchair community,” iPush founder Chris Malcom says. “In the spirit of giving, it seemed like the perfect time of year to start what we hope becomes an annual contest to help people in need with a brand new wheelchair.” To participate: https://app.e2ma.net/app2/audience/signup/1774775/1705734/?v=a
BALTIMORE – Registration for the Round 2 recompete opens Dec. 18, and the bid window opens Jan. 22, 2015, CMS announced yesterday.
“Today marks another step forward in ensuring access to quality health care for millions of Medicare beneficiaries, stated CMS Acting AdministratorMarilyn Tavenner.
The seven product categories included in the Round 2 recompete are: enteral nutrients and equipment; general home equipment; nebulizers; negative pressure wound therapy pumps; respiratory equipment; standard mobility equipment; and transcutaneous electrical nerve stimulation devices.
The Round 1 recompete has saved Medicare $580 million over three years, according to CMS. Round 1 and the national mail-order program for diabetes supplies have saved Medicare $2 billion during the first year.
Round 2 recompete timeline:
Registration for user IDs and passwords opens
Authorized officials are strongly encouraged to register no later than this date
Backup authorized officials are strongly encouraged to register no later than this date
CMS opens bid window for Round 2 recompete and the national mail-order recompete
Registration closes
Covered document review date for bidders to submit financial documents
Bid window closes
CMS announces single payment amounts, begins contracting process
CMS announces contract suppliers, begins contract supplier education campaign
CMS begins supplier, referral agent, and beneficiary education campaign
To enroll, suppliers must provide the following on their CMS -855S application:
For CMS’s fact sheet: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-s...
WASHINGTON – After a disappointing week in which both the House and the Senate went home without passing any HME industry legislation, stakeholders have begun regrouping for 2015.
“I think the window simply closed on us,” said Tom Ryan, president of AAHomecare. “We have to be ready to come out of the box in 2015. It’s not over yet.”
The industry certainly got a lot further with its efforts to reform the bidding program in 2014, including its first Senate bill, S. 2975, which was introduced Dec. 4, by Sens. Rob Portman, R-Ohio, and Ben Cardin, D-Md.
“We were happy to get that bill—it added legitimacy to the effort and concerns of our lawmakers on the need for binding bids,” said Ryan. “Some of the old school who were against us are much more empathetic.”
The plan now is to get the Senate bill and its companion, H.R. 4920, which garnered 68 cosponsors, reintroduced as soon as possible after the 114th Congress convenes on Jan. 6.
With the opening of the bid window slated for Jan. 22, there’s no time to waste, said Jay Witter, who met with the Speaker’s office last week.
“They understand the time pressure we are under,” said Witter, senior vice president of public policy at AAHomecare. “If something doesn’t happen quickly, it will be difficult to make changes (after the fact).”
Adding to that sense of urgency: CMS has shortened the bid window to 63 days, instead of the usual 90 days. The window closes March 25—one week ahead of the March 31 deadline to pass a new sustainable growth rate (SGR) or “doc fix” bill.
“The SGR is an opportunity to include a number of other Medicare issues,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “That shortened bid window is eyebrow-raising.”
Stakeholders were also critical of the latest competitive bidding report from the Government Accountability Office (GAO), which examined the Round 1 recompete, Round 2 and the national mail-order program.
“They didn’t do any independent analysis and they didn’t ask some of the critical questions,” said Bachenheimer. “They just parroted CMS.”
Meanwhile, AAHomecare and other industry stakeholders have begun to identify priorities for the new year. Topping the agenda: prior authorizations and audit reform.
Although a bill to reform the audit process, H.R. 5083, also failed to pass, the $1.1 trillion “CRomnibus” spending bill, signed into law Dec. 16, contained language that was “very critical of the backlog,” said Witter. That backlog of appeals at the ALJ currently numbers more than 900,000 and growing.
“There are other efforts out there (with regard to audits) and we’re talking to the American Hospital Association and other groups that want relief,” he said. “With the Senate Finance committee looking to do some audit reform, there’s going to be some audit legislation.”
