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- 12/19/14--11:28: _In brief: Drive mak...
- 12/22/14--13:05: _Provider 'Bests' in...
- 12/23/14--06:28: _Digital gurus offer...
- 12/24/14--07:24: _In brief: ITC deliv...
- 12/24/14--07:19: _The year in review:...
- 12/24/14--07:16: _‘The future is outc...
- 12/24/14--07:15: _New enrollment prov...
- 12/31/14--08:21: _Groups set stage fo...
- 12/31/14--08:14: _In brief: AeroCare ...
- 01/06/15--09:39: _Connolly snags cont...
- 01/08/15--09:53: _Lawmakers set to re...
- 01/09/15--11:34: _Bid legislation: ‘C...
- 01/09/15--11:32: _CMS kick-starts new...
- 01/09/15--11:30: _Providers explore m...
- 01/09/15--11:25: _In brief: OIG adds ...
- 01/09/15--09:30: _OIG adds fifth bid ...
- 01/13/15--08:47: _M&A activity: Midwe...
- 01/14/15--08:16: _Have questions? PFQ...
- 01/15/15--07:40: _New DME RAC program...
- 01/16/15--11:24: _Bid bills need to m...
- 12/19/14--11:28: In brief: Drive makes buy, pharmacists rank high
- 12/22/14--13:05: Provider 'Bests' incumbent
- 12/23/14--06:28: Digital gurus offer advice
- 12/24/14--07:24: In brief: ITC delivers split ruling, Invacare names interim chairman
- 12/24/14--07:19: The year in review: Bidding, bundling and a buyout
- 12/24/14--07:16: ‘The future is outcomes data’
- 12/24/14--07:15: New enrollment provisions overreach, attorneys say
- 12/31/14--08:21: Groups set stage for action on audits
- 12/31/14--08:14: In brief: AeroCare deal dissolves, Inogen shareholders sell
- 01/06/15--09:39: Connolly snags contract for DME-specific RAC
- 01/08/15--09:53: Lawmakers set to reintroduce bidding bills
- 01/09/15--11:34: Bid legislation: ‘Cooperative effort, not roadblocks’
- 01/09/15--11:32: CMS kick-starts new audit program
- 01/09/15--11:30: Providers explore mediation in bid lawsuits
- 01/09/15--11:25: In brief: OIG adds study, shareholders approve big deal
- 01/09/15--09:30: OIG adds fifth bid study
- 01/13/15--08:47: M&A activity: Midwest Respiratory and Prism Medical
- 01/14/15--08:16: Have questions? PFQC will get them answered
- 01/15/15--07:40: New DME RAC program on hold
- 01/16/15--11:24: Bid bills need to move fast
PORT WASHINGTON, N.Y. –Drive Medical has acquired Youngstown, Ohio-based bed manufacturer Primus Medical. “This acquisition provides Drive with a complete portfolio of high-quality, long-term care beds, and will position Drive as a major manufacturer in this rapidly-growing market,” said Harvey Diamond, CEP of Drive Medical in a press release. Primus Medical manufactures full-function low beds, bariatric beds, lifts and chairs, therapeutic air and foam mattresses, lifts and slings. Primus’ Mark Shaw, president and COO, and Dan Halas, vice president of sales, will join Drive’s management team. Tony Crisitello, senior vice president of long-term care at Drive, will also head Primus’ long-term care division.
N.Y. provider creates new division
NIAGRA FALLS, N.Y. – Health System Services has formed a home modification division to help seniors age-in-place. The new division will offer grab bars, walk-in tubs, stair lifts and ramps. “We want to help caregivers sleep better at night knowing their loved ones are safe, and we want seniors to retain their independence as long as it is possible to do so,” saidRobert Miniccuci, president.Founded in 1996, Health System Services provides home medical and respiratory equipment.
Calling all ICD-10 volunteers
BALTIMORE – A second group of 850 volunteer providers will have the opportunity to participate in ICD-10 end-to-end testing with theMACs and the Common Electronic Data Interchange (CEDI) contractor from April 26–May 1. The purpose is to find out if providers are able to submit claims containing ICD-10 codes to the Medicare Fee-For Service (FFS) claims system;that CMS software changes made to support ICD-10 result in properly judged claims;and that accurate remittance advices are produced.Completed volunteer forms— available on your MAC website—are due Jan. 9.
Pharmacists rank ‘high’ on honesty, ethics
WASHINGTON – The majority of Americans say pharmacists have high ethical standards and are honest, according to a recent Gallup poll. “Americans place a high degree of faith and confidence in their pharmacists,” said John Sherrer, president of the National Community Pharmacists Association. “Pharmacists are expertly trained, easily accessible and, as this survey affirms, trusted medication experts.” The poll found that 65% of respondents rated pharmacists as having "very high" or "high" standards of honesty and ethics; behind nurses (80%) and tied with physicians. At the other end of the scale: car salespeople (8%) and members of Congress (7%).
Liberator reports sales increase
STUART, Fla. – Liberator Medical reported its net sales increased to nearly $75 million for its fiscal year 2014, an increase of 7.9%. Net income for the year, which ended Sept. 30, was $7.8 million, and the company had operating income of $12.7 million. "I am pleased to report that we were able to grow sales and profits in fiscal 2014,” said President and CEO Mark Libratore. “During the year we made investments in critical business systems, staff skills and financial controls while returning over $6.3 million to our shareholders.”
Medicine Shoppe ‘opens shop’
Harrisburg, Ill. – The Medicine Shoppe opened a new Home Health Solutionslocation in Harrisburg, Ill. “We wanted to offer more products for our customers,” said Owner Steve Ledbetter. ”We have an expanded show room here and carry more products and a wider variety of them then we could in the pharmacy building.” Home Health Solutions offers a range of home medical and respiratory equipment, free delivery and set-up throughout southern Illinois.
Good works: 101 Mobility, Numotion
101 Mobilityin San Jose, Calif., donated an auto lift installation for a community fundraising project. The recipient, 9-year-old Isaac Ruiz, suffers from osteogenesis imperfecta, which causes painful bone fractures. “Isaac’s mother told us that Isaac watched the installation from his bedroom window and was excited and thankful for the new auto lift to transport his power wheelchair,” said Virgil Moore, owner of 101 Mobility in San Jose. The new Harmar AL-500 lift will allow Ruiz to use his power wheelchair outside the home…Numotion in Topeka, Kan., donated a new wheelchair charger to a homeless man whose wheelchair was damaged in a fire.
Short takes: Drive, Ki Mobility
Drive Medicalhas obtained ISO 13485:2003 certification. Valid for three years, ISO (International Organization for Standard) certification represents the requirements for a comprehensive quality management system for medical devices…Ki Mobility has received approval from the City Council of Stevens Point, Wis., to build their new global headquarters. The wheelchair manufacturer intends to build a70,000-square-foot facility, adding 170 jobs over three years…
People news: Farrell, Walling
Zimmer Holdings has appointed ResMed CEO Michael Farrell to its board of directors. Zimmer Holdings is a Warsaw, Ind.-based joint replacement technology manufacturer…Permobil has promoted Todd Walling to senior vice president of sales for the North American region. Walling joined the company in 2007 as the key accounts manager and area sales manager.
When Representative-Elect Brian Best won the Iowa House District 12 seat, the HME industry gained a man on the inside. HME News spoke with Best, the owner of Bestmed Respiratory and Western Iowa Sleep in Carroll, Iowa, about his plans to inject a little common sense into government.
HME news: What made you want to run?
Brian Best: I just wanted to pay it forward—we’ve been pretty blessed with our businesses. I wanted to try to go down to the state house and put a little common sense into government.
HME: How will your experience as an HME provider help you in office?
Best: I think it definitely helped me to understand what happens when one part of the government becomes really overbearing and unreasonable. When we talk about, for instance, competitive bidding or the effects of the Affordable Care Act, it’s hard to get something covered because of the amount of redundant paperwork that’s required. Those kinds of things make me want to fight for the little guy—for businesses.
HME: Once you’re in office, what kind of changes will you be looking to effect in regard to HME businesses?
Best: I don’t know how much I can do at the state level, because a lot of the problems HME is having (with Medicare) are on the federal level, but just to be an advocate for things that make sense. DME makes sense because it costs less because it helps keeps patients out of the hospital. The government doesn’t see the value of that. I want them to understand that there is value there.
ATLANTA – When Atlanta-based provider Chris Malcom hired an expert to boost his digital marketing, he quickly saw double digit increases to his online sales. Malcom attributes that to targeted e-mail campaigns that offer rewards programs similar to grocery card promotions.
Dave Henderson from EZ-Access has partnered with Malcom. He agrees that e-mail marketing works, but he warns to not overdo it.
“One offer could be to come back a third time and get 10% off,” he said. “The fourth time a 15% discount. Offer incentives for automatic reorders. However, you don’t want to slam customers with e-mails once a day—perhaps once every 10 days.”
Malcom and Henderson, along with Lisa Wells, founder of Get Social, and Christina Throndson of VGM Forbin, offered these tidbits and more at day one of Medtrade at the Georgia World Congress Center. Panelists agreed that it’s not too late to start digital marketing, but Throndson cautions that providers need a strategy.
“Plan before you start,” she said. “In the case of improving your website, you must have a ‘shopping cart’ that works. Know what you want the site to do for you. Use directories such as Yelp and Bing.”
Wells points out that using the many digital channels—Internet, e-mail, and text messages—can all be part of an integrated marketing strategy that includes old school print and phone efforts.
“In the cash market, you must also know how many people are looking at your site,” said Wells. “Look at the analytics. You know cash is where it’s at, so listen to your customers. Jan to March is deductible season, and that’s the best time to survey your audience as to what they are buying.”
All panelists agreed that new digital verbiage, and even different photos if possible, could help avoid Google identifying duplicate content—which could hamper a company’s visibility in the search engine. “Ask manufacturers for different content,” advised Henderson.
“Rewrite copy based on your company and your expertise,” added Thronson. “When you provide your own photos, at your own angles, you can brand them and it gives you brand recognition.”
SAN DIEGO and BEIJING - The International Trade Commission on Dec. 23 (ITC) delivered a split ruling to ResMed and BMC Medical/3B Medical, two sleep manufacturers that have been ensnared in a global patent lawsuit. The ITC ruled that several of BMC’s masks infringe ResMed patents and entered an order prohibiting BMC from importing, advertising or selling these masks in the United States, according to a press release from ResMed. The masks are BMC Medical’s iVolve nasal mask, iVolve N2 nasal mask, Willow nasal pillows mask, iVolve full face mask. The ITC, however, sided with BMC/3B that ResMed’s patent on its humidifier is invalid, according to a press release from BMC/3B. ResMed plans to appeal, according to the company’s release.
Wright & Filippis hits refresh on O&P
ROCHESTER HILLS, Mich. – Wright & Filippis is rebranding its orthotics and prosthetics business. In July, the provider sold its HME and respiratory business to Lincare so it could focus on O&P, where it got its start 70 years ago. As part of the rebrand, Wright & Filippis has redesigned its website to feature new branding, better navigation and easy-to-read content; and updated the signage and logos at its 20 O&P facilities. “As we continue adapting to the ever changing healthcare environment, rebranding our locations is one of the many changes we’re making to improve our services,” said A.J. Filippis, chairman and CEO, in a release.
Maddak founder dies at 93
WAYNE, N.J. – Bel-Art Products and Maddak founder Kurt Landsberger died Dec. 19 at the age of 93, the company has announced. Landsberger launched Maddak as a subsidiary of Bel-Art in 1979 to manufacture aids to daily living to help people with temporary and permanent disabilities live more independently. Landsberger was recalled as a gracious boss who walked the production floor every day and greeted everyone by name. He officially retired in 2012. In July, Warminster, Pa.-based SP Industries acquired Bel-Art and Maddak.
Inogen expands manufacturing, secures reimbursement
GOLETA, Calif. – Inogen has expanded its manufacturing capacity by leasing a 23,890-square-foot area in Richardson, Texas, according to Zacks Equity Research. The move will lower the company’s average cost per square foot for manufacturing. In other news, Inogen has secured insurance reimbursement in Germany for its Inogen One G3 portable oxygen concentrator. The company estimates that Germany is the second largest market in Europe for medical oxygen systems.
Invacare names interim chairman
ELYRIA, Ohio – Invacare has appointed Dr. C. Martin Harris interim chairman of the company’s board of directors. Harris joined Invacare as a director in 2003 and was appointed its lead director effective May 17, 2012. He is the chief information officer and chairman of the Information Technology Division of the Cleveland Clinic Foundation. Harris steps into the role following the retirement of Mal Mixon. Invacare also has an interim president and CEO, Rob Gudbranson, following the departure of Gerald Blouch.
Lincare expands presence in Wisconsin
CLEARWATER, Fla. – Lincare has bought the DME business of Stevens Point, Wis.-based Ministry Health Care, according to news reports. Ministry Health Care is a mission-driven, integrated healthcare system of clinics and hospitals, primary care and specialty care physicians, home care and related services in Wisconsin and Minnesota, according to its website. Lincare already operates 10 locations in the state. It plans to continue to offer products and services at Ministry Health Care’s locations in Stevens Point, Woodruff/Arbor Vitae and Neenah.
Buying group, consultant offer digital marketing services
DAYTONA BEACH and TAMPA, Fla. – Independent Medical Co-Op (IMCO) and Get Social Consulting have teamed up to offer digital marketing services to HME providers. IMCO recently launched a dedicated membership group serving independent HME providers. Through its partnership with Get Social Consulting, IMCO now offers members digital marketing, social media and e-commerce services, as well as traditional marketing services. IMCO and Get Social Consulting will kick off their partnership with a free webinar, “10 Marketing Ideas to Drive Your Sales in 2015,” presented by Lisa Wells on Feb. 12.
Numotion’s board of directors and its CEO, Mike Swinford, have named Warren “Bud” DeGraff COO. He joins Numotion after an 18-year career at GE, where he was most recently general manager, diagnostics & clinical services…Asheville, N.C.-based Aeroflow Breastpumps has been nominated for a 2014 Cribsie New Arrival award. The award represents the best new brands and products of the year, with recommendations from the Cribsie Academy, a panel of industry leaders, experts and celebrities. The Cribsie Academy was founded in 2011 to honor innovation and achievement in the baby and kids industry.
YARMOUTH, Maine – Although it’s nothing new by now, competitive bidding remains the biggest issue to stupefy and stymie HME providers, according to a list of the most read stories in HME News in 2014.
A big reason why: CMS continued to tweak the program this year—the agency laid the groundwork to roll out the program nationwide and to change the pricing methodology for certain products (“In shock: CMS seeks to not only spread bid rates but also bundle payments”).
Additionally, CMS changed the name of the game for the Round 2 recompete this year (“CMS changes up areas, products in Round 2 recompete”).
Other issues dominating the headlines in 2014: the upcoming face-to-face requirement (“Face-to-face rule: Clarifications provide ‘breathing room’”) and ongoing audits (“Memo could be catalyst in audit battle”).
Of course, a list of the most read stories in HME News wouldn’t be complete without a mergers and acquisitions story, and this year it came courtesy of Lincare, which bought the HME and respiratory business lines of Wright & Filippis (“Wright & Filippis sells to Lincare”). Wright & Filippis now focuses on its orthotics and prosthetics, complex rehab and accessibility business lines.
Speaking of O&P, perhaps in a nod to the increasing popularity of the product line, a story about the confusion over what constitutes custom vs. off-the-shelf orthotics made the list of most read stories this year (“Orthotics codes become trickier to bill”).
Rounding out the list of most read stories: a clash between a big-box retailer and sleep providers (“Walmart brochure ‘disparages’ providers”), a change to capped-rental status for certain complex rehab equipment (“CMS didn’t think through capped rental change, providers say”), a look inside a beleaguered national’s turnaround plans (“New Rotech CEO talks strategy”) and the industry’s plea to fix a broken audit system (“Audits: ‘We are in crisis,’ stakeholders say”).
Most read stories of 2014
YARMOUTH, Maine – Sixty-three percent of the respondents to a recent HME Newspoll say they use outcomes data to market themselves to referral sources.
The type of data that they feel is most important: clinical data (33%).
“Clinical outcomes are the benchmark of effective and efficient health care,” wrote one respondent. “No matter how good the salesperson, or the equipment design or ease of use—if the patient isn’t better off, what do all the features and benefits matter?”
Respondents say they also believe patient satisfaction data (29%), readmission data (19%) and patient compliance data (19%) are important.
Those HME providers offering outcomes data have a receptive audience in referral sources. Fifty-four percent of referral sources say they like to see outcomes data from providers, according to recent research conducted by Emerge Sales and HME News.
Furthermore, 63% of referral sources say the availability of outcomes data sways them to use one HME provider over another.
“We use it as a differentiating quality,” wrote respondent Joe Dietlin of Pediatric Home Service in Roseville, Minn. “Also, our partners want to see it.”
The type of data that referral sources feel is most important is readmission data (70%), followed by patient satisfaction data (67%), patient compliance data (60%) and clinical data (51%), according to the research.
As for those respondents who don’t currently use outcomes data to market themselves—83% say they plan to change their ways.
“The future is here and the future is outcomes data,” wrote one respondent.
Still, some HME providers would rather invest their dollars elsewhere.
“We haven’t been able to set aside capital to purchase a better software solution or record keeping of patient outcomes,” wrote one respondent. “We’ve put a higher emphasis on continuing to expand our base of retail/self-pay consumers.”
BALTIMORE – Broad new enrollment provisions required by the Affordable Care Act could put HME providers at greater risk of losing their Medicare billing privileges, say industry attorneys.
“(CMS has established) very nebulous criteria for taking really devastating action against providers,” said Elizabeth Hogue, a private practice attorney in Burtonville, Md. “It’s very scary.”
The provisions, released this month, allow CMS and its contractors to deny the enrollment of providers and owners affiliated with an entity that has unpaid Medicare debt; deny the enrollment or revoke the billing privileges of a provider if a managing employee has been convicted of certain felony offenses; and revoke billing privileges of providers that have a pattern or practice of billing for services that do not meet Medicare requirements.
That last provision really prickles industry attorneys. With contractors routinely denying claims for technical reasons and a huge backlog in the appeals process, providers could be unfairly penalized, they say.
“So many of the appeals are overturned,” said Edward Vishnevetsky, an associate at Munsch Hardt Knopf & Harr. “If they are now able to take away your billing practices based on this, I think that’s a violation of due process.”
Attorneys also take issue with the lack of definition for debt in the provision denying the enrollment of providers affiliated with unpaid Medicare debt.
“Does it become a debt the minute the appeals process is exhausted? asked Hogue. “Or is it a debt when the contractor says you were overpaid?”
Here, too, the appeals backlog could result in unfair penalties against providers, says Vishnevetsky. If a provider is in the middle of an appeal and is having its ongoing claims recouped, it may decide to transfer existing patients to another company so it can continue to provide care to them.
“Providers still need to be doing something to make money, said Vishnevetsky. “If there’s nothing more to recoup—if you are not satisfying your debt—you may not be able to have an ownership interest in anything else.”
WASHINGTON – Even though the American Hospital Association (AHA) lost its bid to get a court to intervene in a huge backlog of appeals of Medicare claims, the lawsuit keeps the controversial program in the spotlight, industry stakeholders say.
The U.S. District Court for the District of Columbia ruled in December not to require the Department of Health and Human Services (HHS) to meet statutory deadlines for timely review of claim denials. The judge said that Congress, not the court, should take up the issue.
“It’s very disappointing, but it might give us more impetus with Congress to get audit legislation passed,” said Kim Brummett, senior director of regulatory affairs for AAHomecare.
While Medicare statute requires that appeals at the administrative law judge (ALJ) level be resolved within 90 days, it’s currently taking more than 500 days, according to the Office of Medicare Hearings and Appeals (OMHA).
Both the AHA and AAHomecare succeeded in getting lawmakers to introduce bills to reform the audit program in 2014, but neither bill was passed. AAHomecare plans to reach out to the AHA in early 2015 to find out what its plans are for a new bill, Brummett says.
“If they go to Congress, it makes more sense for us to go to Congress, too,” she said.
The AHA will also likely continue exploring its legal options.
“We expect to appeal the decision,” said President and CEO Rich Umbdenstock in a statement.
Industry attorney Edward Vishnevetsky says the AHA is smart to stick with its lawsuit despite the district court’s decision, because it can’t rely on Congress.
“The legislative route would work if lawmakers had the time to understand the whole system,” said Vishnevetsky, an attorney with Munsch Hardt. “They’re bombarded with reports that say the system has curbed millions and millions in fraud, and unless they have time to delve into the details, it’s impossible to convince them otherwise.”
Vishnevetsky believes the AHA could very well get the district court’s decision overturned on appeal.
“It’s a constitutional issue, because there is no due process,” he said. “Yes, there’s a way to go through a process and get a remedy, but the process is not working the way Congress approved. Justice delayed is justice denied.”
Whether relief comes by way of legislation or a legal decision, the timing could be just right “to get some action,” says industry attorney Steve Azia.
“This is an issue that applies to everyone,” he said. “Everyone is showing some interest, and everyone is moving in the right direction.”
ORLANDO – A merger agreement between AeroCare and MergeWorthRx (MWRX) has been terminated. Under the terms of the deal, announced in October, MWRX, a Miami-based specialty purpose acquisition company, had until Dec. 26 to either complete the merger or dissolve, according to a press release. MWRX formed in July 2013 to merge with one or more target businesses. AeroCare, which offers respiratory products and services to more than 150,000 patients through 175 locations in 20 U.S. states, has annual revenues of $150 million.
NHIA schedules fly-in
ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) encourages its members to fly into Washington, D.C., in February to meet with lawmakers to talk up efforts to require Medicare to pay for home infusion services and related supplies under Part B. The NHIA is targeting the following dates: Feb. 4-5, 11-12 or 25-26. The association will set up meetings, prepare materials and coach members on conducting meetings with lawmakers. In September, Reps. Eliot Engel, D-N.Y., and Pat Tiberi, R-Ohio, introduced The Medicare Home Infusion Site of Care Act.
Inogen shareholders sell
GOLETA, Calif. – Two Inogen shareholders have moved stock this month. Scott Wilkinson sold 15,735 shares on Dec. 29 at an average price of $30.52 per share for a total transaction of $480,232. Versant Ventures sold 9,785 shares on Dec. 23 at an average price of $29.74 for a total transaction of $291,005. Versant Ventures is a majority shareholder in the company, owning at least 10% of its shares.
In the spirit: Convaid, Pride Mobility Products
Torrance, Calif.-based Convaid recently donated one of its Rodeo wheelchairs to Arthur Day, a nine-year-old who was born with cerebral palsy and other health issues. Day’s previous wheelchair was stolen from the lobby of his apartment complex in Los Angeles. Convaid representatives set out to get Day a new wheelchair in time for Christmas after hearing about his story on a local TV station. Helping to make the donation happen: Joe McKnight, an ATP at Access Medical…The Beamsville, Ontario, office of Pride Mobility Products raised $5,000 for Community Care of West Niagara. Managing Director Brian Fisher and his team raised the money through a “12 Days of Christmas” daily raffle. Pride has its Canadian headquarters in Beamsville.
People news: Strong, Mahler, Bragdon
Health System Services (HSS) has hired Michael Strong to lead its new home modification division. Strong has more than five years of experience in the field. Prior to joining the Niagara Falls, N.Y.-based HSS, he worked for Prism Medical…New England Orthotic and Prosthetic Systems (NEOPS) has promoted David Mahler to COO and Terri Bragdon to chief administrative officer effective Jan. 1. Mahler has been with the Branford, Conn.-based NEOPS for 14 years and Bragdon has been with the company for 11 years.
WASHINGTON – CMS has awarded a national contract to identify overpayments specifically for DME, home health and hospice to Connolly, the agency announced Dec. 30.
CMS announced its plans to create a fifth recovery audit contractor (RAC) back in 2013.
Wilton, Conn.-based Connolly is already the RAC for Jurisdiction C, the largest of the four jurisdictions.
Along with the RAC, CMS will implement a number of improvements to its audit program, including requiring the RACs to wait 30 days before sending claims to the MACs for adjustment, keeping the RACs from collecting contingency fees until the second level of appeals is exhausted and putting in place a provider relations coordinator.
The four existing RACs will continue to identify overpayments in Jurisdictions A, B, C and D, but they will focus on hospitals and other healthcare providers.
WASHINGTON – AAHomecare urges HME stakeholders to reach out to their senators and representatives this week to get them to sign on as original co-sponsors for upcoming competitive bidding legislation.
Reps. Patrick Tiberi, R-Ohio, and John Larson, D-Conn., and Sens. Rob Portman, R-Ohio, and Ben Cardin, D-Md., intend to reintroduce binding bid legislation in the House of Representatives and Senate early next week, the association has announced.
“Now is the time for our members to step in and tell the Congressmen that they need to support this bill,” stated Tom Ryan, president and CEO of AAHomecare, in a release. “With the Round 2 re-compete right around the corner, we don’t have the luxury of waiting to see if congressmen are going to get on board.”
The bid window for the Round 2 re-compete closes March 25.
Last June, Tiberi and Larson introduced H.R. 4920, a bill that would require providers to obtain bid bonds and provide proof of licensure before submitting a bid. Portman and Cardin introduced a similar bill in December.
The deadline for original co-sponsors is Friday, Jan. 9.
WASHINGTON – Legislation to reform the competitive bidding program is expected to be reintroduced in both the House of Representatives and the Senate early this week, say industry stakeholders.
“To have our champions working collaboratively to drop both bills, hopefully on the same day, is good,” said Tom Ryan, president and CEO of AAHomecare.
Reps. Patrick Tiberi, R-Ohio, and John Larson, D-Conn., and Sens. Rob Portman, R-Ohio, and Ben Cardin, D-Md., intend to re-introduce legislation that would require providers to obtain bid bonds and provide proof of licensure before submitting bids.
Stakeholders have spent the past few weeks working to gain additional original co-sponsors for the bills. Working in their favor: Lawmakers are ready to get to work.
“There’s always a sense of new energy at the beginning of a new session,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “They have two years and the ability to do something before elections interfere with daily agendas.”
Of course, the industry needs something to happen much quicker than that. With the bid window slated to open Jan. 22 and close March 25, the sense of urgency is high.
“Our supporters realize that timing is critical,” said Bachenheimer.
The hope is for the bills to get placed on the suspension calendar for a quick vote.
“We’ve been talking with the speaker of the house and the committees of jurisdiction, and making every attempt to make that happen,” said Ryan. “We’re not seeing roadblocks, we are seeing cooperative effort.”
WASHINGTON – A sweeping new program to identify overpayments specifically for DME, home health and hospice is underway.
CMS announced on Dec. 30, amid the quiet of the holidays, that it selected Connolly as the recovery audit contractor (RAC) to oversee the national program.
“The announcement came a lot earlier than I thought,” said Wayne van Halem, president of the van Halem Group. “I thought we’d have until mid-2015.”
Wilton, Conn.-based Connolly is already the RAC for Jurisdiction C, the largest of the four jurisdictions.
With Connolly’s background, industry stakeholders suspect it will be up and running in no time, starting with the reviews it already has in the pipeline. Those include a number of automated reviews, and complex reviews for power mobility devices and lower limb prostheses.
“From there, they’re going to start looking at other high-dollar items,” van Halem said. “When I think about where there’s a lot of money being spent, I think of vents.”
Connolly has neither the best nor the worst reputation among the RACs, stakeholders say.
“When I saw it was Connolly, I don’t want to say I was relieved, but we’ve worked with them in the past and we’re familiar with their processes,” said Sylvia Toscano, owner of Professional Medical Administrators.
One big thing to keep an eye out for when dealing with Connolly, stakeholders say: Historically, the contractor has not made good use of the open discussion period to work with providers before starting the recoupment process.
“In some circumstances, like with high-volume providers, they have a tendency to start taking away money without requesting additional documentation,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “We find a lot of their denials get overturned on appeal.”
The good news, stakeholders say, is that CMS is implementing a number of improvements to the RAC program, starting with Connolly. Those improvements include requiring the RACs to wait 30 days before sending claims to the MACs for adjustment, keeping the RACs from collecting contingency fees until the second level of appeals is exhausted and putting in place a provider relations coordinator.
“We’re very anxious to get these improvements in place,” said Andrea Stark, a reimbursement consultant with MiraVista. “They ensure not only that the RAC is transparent in what it’s doing, but also that it’s auditing with integrity.”
WASHINGTON – The HME providers suing the federal government for breach of contract as part of the original Round 1 of competitive bidding are now working on a schedule for mediation.
The providers met with the judge in the case, Patricia Campbell-Smith, on Jan. 8 and agreed to submit a schedule for mediation by Feb. 11, according to Jerry Stouck, a shareholder with Greenberg Traurig, the law firm representing one of the providers, Cardiosom.
“I’m surprised that the government is willing to engage in the mediation process,” he said. “It’s an encouraging sign.”
Cardiosom paved the way for the lawsuits when it got a U.S. Court of Federal Claims judge to rule in its favor in late June, saying the provider is entitled to damages for being awarded contracts and then having them rescinded as part of an 18-month delay to the program in 2008. There are a total of nine lawsuits representing 15 providers.
Elements of the schedule will likely include a date by which CMS has to supply the providers with sales volume data so they can determine lost business, a date by which the providers have to supply a summary of damage claims, and a date by which all the parties will sit down with a mediation judge, according to Stouck.
“We don’t know exactly what the schedule will be, but that will be the process,” he said.
In parallel, the providers will also submit a schedule for litigation activities, says Stouck.
“The issue of whether the government is liable or not has already been decided in the Cardiosom case, but the issue is whether Cardiosom should or shouldn’t be applied to all the cases,” he said.
Whether or not mediation is successful, the process in and of itself will help to prepare the providers for the possible next step: a series of trials, probably some time next year, says Stouck.
“It will allow us to jump into the courtroom more quickly,” he said.
WASHINGTON – The Office of Inspector General (OIG) has agreed to investigate the impact of competitive bidding on access to DME. Back in July, 137 lawmakers, including Rep. Tom Price, R-Ga., asked the OIG to conduct the study.
“We plan to review documents from providers and Medicare claims data for a nationally representative sample of beneficiaries to determine and compare the rates at which beneficiaries successfully obtained needed items subject to competitive bidding,” Inspector General Daniel Levinson wrote to Price. The OIG has already reviewed Round 1 of the program and will start work this year to review Round 2. The agency is also conducting a limited scope review in 11 states related to allegations that unlicensed suppliers received contracts under Round 2. Additionally, the OIG has reviewed the impact of the program on market shares for diabetic testing strips.
Shareholders approve deal
MINNEAPOLIS – Medtronic shareholders last week approved a $43 billion dollar acquisition of Covidien. The deal still requires approval from the High Court of Ireland, according to local newspapers.The deal was first announced in June 2014. The combined company, Medtronic PLC, will retain offices in Minneapolis but have its headquarters in Ireland, where Covidien is based. That has drawn criticism for being a “tax dodge,” according to reports. The combined company will have a comprehensive product portfolio and broad geographic reach, with 87,000 employees in more than 150 countries.The deal is expected to be finalized in the last week of January or early February.
AxelaCare keeps home infusion market hot
LENEXA, Kan. – Private equity-backed AxelaCare Health Solutions has expanded its home infusion network outside of the New York-New Jersey metro area with the acquisition of Ambient Healthcare. Davie, Fla.-based Ambient provides intravenous therapies and nursing care in the southeastern United States. It has 16 infusion pharmacies, bringing AxelaCare’s total number of pharmacies to 34. AxelaCare made a number of acquisitions in 2014, including Advanced Care in New York in October, ARC Infusion in California in February and SCP Specialty Infusion in Chicago in January. New York-based PE firm Harvest Partners bought AxelaCare in 2013 from Excellere Partners.
Provider seeks government contracts
WEST CHESTER, Pa. – Advanced Medical Homecare Supplies will apply for GSA Schedule so that it can pursue federal contracts, including Veterans Affairs contracts, it announced Jan. 5. The company hopes the contracts will enable it to expand sales of Relaxis, a device that improves quality of sleep in patients with restless legs syndrome. "Getting our company on a GSA schedule will expand our reach not only to the federal level, but also to numerous state and county agencies throughout the region as they will be able to take advantage of our home care products at set government pricing," stated Michael Hanlon, president, in a release
Mediware integrates with A/R Allegiance
LENEXA, Kan. – Mediware Information Systems has entered into an agreement with A/R Allegiance Group, which provides private pay collection services to HME providers, as an integrated solution provider. Per the agreement, Mediware will offer its users access to CollectPlus, a billing service offered by A/R Allegiance. “This relationship will complement the services offered by Advantage Reimbursement, our billing and collection service for the home infusion market,” stated Kelly Mann, Mediware’s CEO, in a press release.
Jurisdiction D finds 21% error rate for concentrators
INDIANAPOLIS –A documentation compliance review for oxygen concentrators (E1390) from Sept. 1, 2014, to Nov. 30, 2014, resulted in an overall error rate of 21%, according to the Jurisdiction D DME MAC. The most common reasons for denial: proof of delivery (POD) was not submitted or was invalid; no documentation to support the beneficiary had been seen and evaluated by the treating physician within 30 days prior to the date of the initial Certificate of Medical Necessity (CMN); and no request documentation received within the allotted timeframe.
Numotion partners for a cause
ROCKY HILL, Conn. – Numotion will be a 2015 platinum camp sponsor for the Ryan Martin Foundation, it announced Jan. 5. The sports-based foundation was launched in 2011 and offers youth mentoring and basketball camps for wheelchair users. "Numotion is proud and honored to establish a partnership with the Ryan Martin Foundation,” stated Scott Ritchotte, area vice president of sales for Numotion, in a release. “Both organizations share common goals of promoting independence and quality of life for individuals with disabilities.”
UPitt launches new wheelchair network
PITTSBURGH – The University of Pittsburgh will create an International Society of Wheelchair Professionals (ISWP), it announced in December. “For at least the last 30 years, there has been a need for an international society to help improve the quality of wheelchair service delivery, standardize and coordinate services, and improve the quality of wheelchairs,” stated Rory Cooper, a faculty member at UPitt who will serve as co-director of the ISWP. The project is being funded by a two-year, $2.3 million sub-award from the U.S. Agency on International Development.
Sigvaris enlists lymphedema expert
PEACHTREE CITY, Ga. – Sigvaris has joined forces with Robyn Bjork of the International Lymphedema & Wound Care Training Institute to help spur innovation for patients with lymphedema, CVI and venous ulcers. “We have already learned so much from the conversations and trainings we have had with Robyn,” stated Scot Dube, president and CEO of Sigvaris North America, in a press release. “Her insights are going to help us create new ways to care for patients and help improve the quality of life for many patients worldwide.” Bjork is a physical therapist and an expert in wound care and lymphedema management. She is also co-founder and president of an international medical mission organization, ILWTI Medical Missions. Recently, the World Health Organization asked Bjork to write a chapter on wound care and lymphedema management for its publication.
Roscoe strengthens product offerings
STRONGSVILLE, Ohio – Roscoe Medical has hammered out an exclusive distribution agreement with Endevr, inventor of Strengthtape, an elastic athletic tape designed to relieve pain and provide support to muscles, joints and tendons without restricting motion. Roscoe will market the tape to home healthcare providers, physical therapists, chiropractors, medical wholesalers and e-commerce companies in North America.
WASHINGTON – The Office of Inspector General (OIG) has agreed to investigate the impact of competitive bidding on access to DME.
Back in July, 137 lawmakers, including Rep. Tom Price, R-Ga., asked the OIG to conduct the study.
“We plan to review documents from providers and Medicare claims data for a nationally representative sample of beneficiaries to determine and compare the rates at which beneficiaries successfully obtained needed items subject to competitive bidding,” Inspector General Daniel Levinson wrote to Price. “For a purposive sample of cases when beneficiaries appear not to have received needed items, we plan to explore why they did not receive items.”
The OIG has already reviewed Round 1 of the program and will start work this year to review Round 2. The agency is also conducting a limited scope review in 11 states related to allegations that unlicensed suppliers received contracts under Round 2.
Additionally, the OIG has reviewed the impact of the program on market shares for diabetic testing strips.
Industry stakeholders are confident the study will confirm their concerns about competitive bidding’s negative impact on access to DME.
“AAHomecare will continue to work with Dr. Price, the OIG and other members of Congress on the issue,” stated Tom Ryan, the association’s president and CEO in a release.
OMAHA, Neb. – Midwest Respiratory & Rehab has acquired Community HME, a diversified HME provider with locations in Baraboo and Richland Center, Wis.
The deal allows Midwest Respiratory, which has 10 locations in Nebraska, Iowa, Missouri and South Dakota, to crack the Wisconsin market.
“The acquisition of Community HME has further expanded our regional capability to provide exceptional service to our patients and referral sources,” stated President Edward Delashmutt in a press release. “We have been constantly dedicated to serving rural communities with the same high standard of care that our metropolitan customers have come to expect.”
Community HME will retain its name and continue to operate its locations.
Prism bulks up on accessibility
TORONTO – Prism Medical has announced that its wholly owned subsidiary Angel Accessibility has acquired substantially all of the assets and business of Angel Accessibility Solutions, a British Columbia-based provider of safe patient handling and elevating products and services.
Angel Accessibility paid $3.675 million for Angel Accessibility Solutions, according to a press release.
As part of the deal, Prism acquired the exclusive rights to distribute and service bathing, transfer and transport devices and hygiene products on behalf of Beka-Hospitec in Canada, except for Quebec and the Atlantic Provinces.
Prism expects the deal to be accretive to its earnings for the financial year ending Nov. 30.
WATERLOO, Iowa – People for Quality Care (PFQC), an advocacy group and division of The VGM Group, has launched a Q&A series to address questions about home care and HME.
“The series was created in response to the many questions medical equipment users and HME groups have asked us,” said Kelly Turner, director of advocacy for PFQC, in a press release.
PFQC encourages users to post questions on twitter using the hashtag #PFQCQNA. The group will take the questions it receives and set out to get them answered.
The first question in the series: Is homecare reform a priority for Congress? So far, the question has received responses from Sens. Mike Enzi, R-Wyo., and John Thune, R-S.D., and Reps. Diane Black, R-Tenn., and Tom Price, R-Ga.
The next question in the series will address issues that Medicare beneficiaries are experiencing with wheelchair repairs.
“We want readers and stakeholders to really drive this series,” said Lalaina Rabary, communications and marketing specialist for PFQC.
WASHINGTON – Performant Recovery has filed a Government Accountability Office (GAO) bid protest against CMS.
The protest, filed Jan. 6, comes on the heels of the agency’s announcement that it had selected Connolly as the recovery audit contractor (RAC) to oversee the national program for DME, home health and hospice.
Wilton, Conn.-based Connolly is the current RAC for Jurisdiction C, while Performant Recovery in Livermore, Calif., is the contractor for Jurisdiction A.
The national program is on hold until the GAO announces its decision on the protest, which it must make by April 16. Until a decision is made, the four current RACs will continue auditing DME claims in their respective jurisdictions.
WASHINGTON – With the bid window for the Round 2 re-compete of competitive bidding set to open this week, industry stakeholders are eyeing their options to fast track a pair of bills to reform the bidding program.
“We want to get this legislation passed quickly,” said Jay Witter, senior vice president of public policy at AAHomecare. “We are hopeful we can get on the suspension calendar.”
Both bills, introduced Jan. 12, would require providers to obtain bid bonds and provide proof of licensure before submitting bids. H.R. 284, introduced by Reps. Patrick Tiberi, R-Ohio, and John Larson, D-Conn., had 27 original cosponsors and has since added four additional cosponsors. S. 148, introduced by Sens. Rob Portman, R-Ohio, and Ben Cardin, D-Md., has four original cosponsors.
“The fact that they dropped on the same day for our cause and that they came out of the chute with cosponsors is, to me, something to tip our hats about and say we made a big difference last year,” said Tom Ryan, president and CEO of AAHomecare.
With the bidding window for the Round 2 re-compete slated to open later this week, stakeholders want to avoid a long, drawn process. The suspension calendar, held every week that Congress is in session, allows lawmakers to consider a number of suspension bills. There is typically five minutes of debate, followed by a voice vote.
“Both bills are equally important, but it’s likely the House bill would move first,” said Witter. “The House is ready to go on this and up-to-date. The likelihood of it passing is very good.”