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  • 01/16/15--11:22: Stakeholders challenge OIG
  • ‘We hope they will actually look at what is actually happening to utilization’
    01/16/2015
    Liz Beaulieu

    WASHINGTON – The Office of Inspector General (OIG) says it will use Medicare claims data to review the impact of competitive bidding on beneficiary access to DME, but industry stakeholders don’t want the agency to stop there.

    “If our industry is allowed to provide the information that we have been collecting for fair judgment, we are hopeful that the OIG would come to the same conclusion that the bid program has negative impacts on beneficiaries,” said Kelly Turner, director of advocacy for People for Quality Care, which has collected thousands of beneficiary complaints through a national hotline.

    But the industry doesn’t have the best track record with government investigations.

    A report on the Round 1 rebid of competitive bidding conducted in 2014 by the Government Accountability Office (GAO), for example, simply “parroted” CMS, stakeholders charged. It found that the number of beneficiaries decreased by about 22% in bid areas vs. 16% in non-bid areas due to overutilization, not a decrease in access.

    “We hope they will look at what is actually happening to utilization,” said John Gallagher, vice president of government relations for The VGM Group. “Not utilization dropped, ergo it must have been fraud. Rather that utilization dropped because patients did not get what they needed.”

    Lisa Wells, who works on Save My Medical Supplies, AAHomecare’s consumer campaign, says this is also a story that goes beyond data.

    “By working directly with Medicare beneficiaries, our industry knows that quality of care is not just a numbers game,” said Wells, president of Get Social Consulting. “It also comes down to ease of access to care and the right kind of care that keeps patients informed, engaged and independent.” 

    The industry does have this in its favor: The number of reports on competitive bidding is piling up, hopefully catching the eyes of lawmakers. This OIG study will be the agency’s fifth on the program.

    “The OIG turning its attention to the issues surrounding competitive bidding is a big deal because it helps lend credibility to our claims and will definitely help our efforts on the Hill,” said Anna McDevitt, who also works on Save My Medical Supplies and is the president of Laboratory Marketing. “It’s no panacea but it’s undeniable progress.”

     

     


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    01/16/2015
    Tracy Orzel

    YARMOUTH, Maine – Imagine having a claim denied because Medicare doesn’t like the handwriting on the prescription.

    That was the case for one provider who responded to a recent HME NewsPoll on audits, who was told the handwriting on the prescription didn’t match the doctor’s signature, and therefore it wasn’t valid.

    “Medicare told us the medical prescription was written by a girl—‘we can tell,’” said the provider. “Since when did Medicare become a handwriting expert?”

    The majority (72%) of respondents say they were audited more frequently in 2014 than 2013; 18% said they were audited less and 10% reported no change.

    To that end, 72% of providers have dedicated more resources to deal with the onslaught of audits; 16% of respondents reported that they haven’t.

    Respondents were also asked to share the most ridiculous reason they were denied.

    Many reasons were due to a mistake on Medicare’s part. For example, one provider said, the agency had a beneficiary listed as dead, then alive, then dead again, while others challenged common sense.

    Several providers reported receiving denials for wheelchairs for paraplegics and amputees, including one provider who said a power wheelchair for a paraplegic was denied because he also owned a truck. 

    “But I don’t believe his truck would fit in his apartment,” said the provider.

    A number of respondents expressed frustration about denials because contractors overlooked information. 

    “A RAC audit stated the patient's weight was missing when it was there in three different places,” said Craig Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment. 

    Also contributing to frustration: contractors not adhering to Medicare rules. One provider reported receiving a denial because the doctor didn’t include his credentials and the date next to his signature on the chart notes, even though the Medicare Program Integrity Manual said it was not required. 

    As one provider put it, “Our favorite denials are the denials that aren't actually denials, but where the person auditing the information does not know Medicare policy and denies the claim in error.”

     

     

     

     


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    01/16/2015
    HME News Staff

    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.

    Have questions? PFQC will get them answered

    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.

    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 second question 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.

    Medicare official resigns

    WASHINGTON –CMS Administrator Marilyn Tavenner, announced she will be stepping down from her post next month in an email to CMS staff. “It is with sadness and mixed emotions that I write to tell you that February will be my last month serving as the administrator for CMS,” she wrote. During her five-year tenure at the agency, Tavenner oversaw the rollout of the Affordable Care Act (ACA) and the expansion of Medicaid.

    M&A activity: Midwest Respiratory and Prism Medical

    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.

    Healthcare technology company meets managed care

    MINNEAPOLIS and HARTFORD, Conn. – Minneapolis-based Ability Network and Hartford, Conn.-based CareCentrix have partnered to enhance communication during as patients transition from the hospital to the home. “Ability and CareCentrix share a common vision: improving the healthcare experience in this country,” said Mark Briggs, Ability CEO, in a release. The two companies will integrate their software systems to automatically inform discharge planners when a patient’s DME and home infusion therapy needs to be managed by CareCentrix.

    Last week on Access Health: Guests from Hollister 

    LIBERTYVILLE, Ill. – Guests from Hollister were featured on the Jan. 14 episode of Access Health, a health and wellness series on Lifetime, to discuss catheters. Dale Spencer, a spinal cord injured author/speaker and consultant for Hollister, and Mary Wisner, a clinical education manager at the company, planned to speak with host Ereka Vetrini and medical expert Dr. Dennis Holmes about the different types of intermittent catheters available, and who may need to use catheters and why. Dale will also share his personal story. The episode will also be viewable at www.accesshealth.tv.

    Socks for sleep?

    NEW YORK – Wearing compression stockings during the day may slightly improve sleep apnea at night, according to a Reuters Health story on a new small study. In the study, 22 patients with obstructive sleep apnea who wore compression stockings during the day for two weeks saw their frequency of apneas decrease by 27% compared to 23 patients who didn’t wear the stockings, Dr. T. Douglas Bradley and colleagues have reported in Sleep Medicine. Bradley and his colleagues say the socks reduced sleep apnea in patients from the severe to moderate range. They believe fluid can move from the legs into the neck, restricting the flow of oxygen and causing obstructive sleep apnea. “Getting rid of excess fluid is one approach of treating sleep apnea,” Bradley told Reuters Health.

    ResMed shares near 52-week high

    SAN DIEGO – ResMed shares were recently traded at $59.83, falling just short of the stock’s 52-week high of $60.16. Volume was also up: 1,778,001 shares, compared to the average volume for the last 30 days: 942,838.

    People and places: Pride Mobility, 101 Mobility, Drive Medical

    Pride Mobilityhas named Randy Walsh vice president of Jazzy and Retail Mobility Sales. An industry veteran, Walsh has a decade of experience in the retail mobility industry…101 Mobilityof Little Rock, Ark., has appointed Phillip Jacuzzi as its new sales and service manager. Jacuzzi comes to 101 Mobility with 15 years of experience in the bus transportation industry…Drive Medical will exhibit its range of wheelchairs, bathing aids and pediatric equipment at Arab Health 2015. The manufacturer will showcase, specifically, its Expedition Plus Wheelchair, part of its range of travel wheelchairs. It’s the seventh year that Drive has exhibited at the event, which takes place Jan. 26-29 at the Dubai International Convention & Exhibition Centre.

     


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    01/23/2015
    Tracy Orzel

    COUNCIL BLUFFS, Iowa – The Midwest Association for Medical Equipment Services (MAMES) has created a task force to develop state licensure language for Iowa to protect local businesses and Medicare beneficiaries.

    The push to lobby the state to adopt licensure requirements is in response to Round 2 of competitive bidding and CMS’s decision to award 100% of the contracts for the Omaha-Council Bluffs competitive bidding area (CBA) to out-of-state companies.

    The task force is leaning toward language that would require DME providers to have a physical location within the state, or within a certain radius of the border, similar to laws in Alabama and Tennessee.

    “It will keep bidders out that aren’t serious about bidding our area,” said Colleen Brabec, who owns Mobilis in Council Bluffs, Iowa. “They’ll have to comply with state licensure and if they don’t, their bids get thrown out.”

    Round 2 contracts went to companies in Texas, Florida and Alabama. As a result, beneficiaries found themselves waiting up to three months for equipment, unless they chose to buy local with cash, stakeholders say. 

    It’s the local providers that have been left holding the bag, says MAMES Executive Director Rose Schafhauser. 

    “People say, ‘Can you get out here, my company’s not responding,’” she said. “We just don’t understand CMS’s process and why they would select a company that’s located in Florida to service Council Bluffs, Iowa,”

    MAMES hopes to have legislation in place before the March 25 deadline for submitting bids for the Round 2 re-compete.


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    01/23/2015
    HME News Staff

    ORLANDO, Fla. – Rotech has made its second acquisition in as many months: the respiratory equipment assets of a company in Natchitoches, La. The name of the company was not disclosed. “This purchase is another step in Rotech’s aggressive expansion plan,” stated Tim Pigg, CEO, in a press release. “We will be continuing to further leverage and expand our presence in existing and new markets with the support of our long-term oriented investors.” In December, Rotech acquired the assets of a specialty medical services provider in Cody, Wyo.

    AeroCare expands in Florida

    ORLANDO, Fla. – AeroCare has acquired Plant City, Fla.-based Matrix Medical, a provider of home medical equipment, supplies and respiratory equipment with nine locations throughout Florida. Terms of the deal were not disclosed. "We’re looking forward to working with them to pursue opportunities and to care for our patients," AeroCare founder and CEO Steve Griggs said in a local news article. In late December, a planned merger between AeroCare and MergeWorthRx fell through.

    VGM Insurance launches ‘Quarter Century of Caring Campaign’

    WATERLOO, Iowa – VGM Insurance Services plans to donate $25,000 to charities nationwide to mark 25 years in business. In what it is calling its “Quarter Century of Caring Campaign,” VGM Insurance will award $1,000 to a handful of providers each month from March to December; providers, in turn, will donate the $1,000 to local charities. VGM Insurance will award 25 $1,000 donations in all. Providers can participate by nominating their local charities at the VGM Insurance website: www.vgminsurance.com/25years. “We’ve made it easy for HME businesses to participate and make their case for donating to their local charities,” stated Mike Kloos, president of VGM Insurance, in a press release.

    PMD claims without G code are suspect, OIG says

    WASHINGTON – The Office of Inspector General (OIG) calls into question claims for power mobility devices (PMDs) without corresponding G-code claims in a new report. CMS introduced G0372 in 2005 for physicians to establish and document the need for PMDs. The OIG found that for PMD claims with corresponding G-code claims, Medicare paid the claims in accordance with federal requirements for face-to-face requirements of beneficiaries. It found for claims without corresponding G-code claims, however, that Medicare did not always pay the claims in accordance with federal requirements. Of 100 sample claims, the OIG found 53 claims met the requirements and 47 did not. On the basis of physician interviews, the agency concluded that many physicians are unfamiliar with the G code and the face-to-face requirements. The OIG recommends that CMS (1) adjust the 47 sample claims representing overpayments of $115,000 (2) require physicians to use the G code when prescribing PMDs and (3) require Part B contractors to educate physicians on the use of the G code and the face-to-face requirement.

    AdvaCare seeks to bridge care gap

    PITTSBURGH – AdvaCare Home Services has launched a program to help hospitals and other healthcare providers bridge the gap between in-patient and home care. The Patient Partner Program will use technology to continuously monitor patients and create detailed, individualized patient care plans and in-home assessments, according to a press release. “The program offers physicians and doctors an additional route that helps save lives and money,” said President Tammy Zelenko. “The focus is not only to help patients adjust to their diagnoses, but to make life-style changes, and educate them on their chronic diseases.”

    Provider branches into Missouri

    CAPE GIRARDEAU, Mo. – Alpha 3 Medical Equipment has opened its first location here. The company offers home medical and respiratory equipment and supplies. Alpha 3 has been in business more than 10 years and has additional locations in southern Illinois.

    Inogen CEO sells shares

    NEW YORK – Inogen President and CEO Raymond Huggenberger sold 25,722 shares Jan. 20 at an average price of $31.63 for a total transaction of $813,586. Huggenberger now owns 6,808 shares of stock for a total value of $215,337.

    Permobil hits the road

    LEBANON, Tenn. – Permobil has planned 30 stops for its 2015 PowerTrip Revolution Tour. The tour provides an opportunity to test-drive new Permobil and TiLite products, get one-on-one time with product technicians and therapy specialist, and hang out with one of the company’s three road teams (the Sons of Mobility, the Out’Casters and the Wheeled Horseman). Permobil will also select a Club V.I.P. at each stop to help showcase its new products. V.I.P.s will win exclusive PowerTrip swag, and be entered to win a brand new Permobil and a trip for two to Nashville. The tour kicks off in Seattle on March 17 and ends in Minneapolis on June 25.

    Maddak kicks off awards season

    WAYNE, N.J. – Maddak is challenging occupational therapy schools to compete against each other in product design as part of its Maddak Intercollegiate Challenge. The winning school is determined by the number of student entries received, with extra points given to the school with the student who wins first place. The winner last year: Cabarrus College of Health Sciences in Concord, N.C., which submitted 11 student entries. The challenge is part of the Annual Maddak Awards Competition for Product Design. The competition provides a forum for OT professionals and students to share their ideas and product innovations while competing for cash prizes. An awards ceremony will be held at the AOTA’s 95th Annual Conference & Expo in Nashville on April 16.

    AARP survey: Aging in place—with help

    CLACKAMAS, Ore. – Eighty-five percent of registered voters age 45 and older in Oregon say they would prefer to live at home with the help of family caregivers for as long as possible, according to a new AARP survey. The majority (90%) of respondents also said it’s important to have services that allow people to stay in their homes when basic tasks become too difficult to perform; 50% said they are currently providing or have provided unpaid care for an elderly loved one; and 76% said family caregivers needs more resources and training.

    People in the news: NRRTS, Inova Labs

    NRRTS has hired two new staff members: Mary Blake Vint as association affairs coordinator and Annette Hodges as webinar organizer. Vint will head up renewals and customer service, while Hodges will improve the NRRTS webinar program and interact with presenters and attendees…Inova Labs has hired Dale West as senior vice president of operations. West has 20 years worth of experience in the home healthcare industry, previously holding executive and senior leadership positions at Philips Respironics, Dynamics and Frito-Lay.


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    01/30/2015
    Liz Beaulieu

    YARMOUTH, Maine – A new rule that allows HME providers to carve up their competitive bidding contracts could make for more aggressive bidding in the Round 2 re-compete, industry attorneys say.

    CMS has lifted “the prohibition against subdividing a contract that would allow a contract supplier to sell a distinct company that furnishes a specific product category or (serves) a specific competitive bidding area.”

    “I think providers will be less cautious, conservative and fearful about biting off more than they can chew,” said Neil Caesar, president of the Health Law Center in Greenville, S.C. 

    The 63-day bid window for the Round 2 re-compete opened on Jan. 22.

    Providers will be more likely to bid in more geographies and for more product categories, knowing the new rule gives them some flexibility to exit certain lines of business if they need to, Caesar says.

    “If they find themselves in a position where they’ve bid on geographies or categories that are not profitable to pursue—it’s not a perfect way out, but it’s more flexibility than they had the first time around,” he said. 

    To best take advantage of the new rule, providers will want to form several “commonly owned” legal entities and include those entities in their bids, says industry attorney Jeff Baird.

    “If ABC is awarded a contract, then Commonly Owned Entity #1 can handle one product category/CBA combination, Commonly Owned Entity #2 can handle a different product category/CBA combination, and so on and so forth,” said Baird, chairman of the Health Care Group at Brown & Fortunato in Amarillo, Texas. “Then ABC can spin off the commonly owned entities, along with that portion of the contract associated with each entity’s product category/CBA.”

    Providers can form the “commonly owned” legal entities before or after they submit bids, Baird says.

    “ABC may want to wait to form commonly owned legal entities until after ABC is awarded the bid contract,” he said. “ABC can ask the CBIC to add the commonly owned legal entities to ABC’s bid contract.”

     


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    01/30/2015
    Liz Beaulieu

    WASHINGTON – CMS has been enforcing the written order prior to delivery (WOPD) requirement for a year now, but compliance is still a road filled with potholes for many HME providers, industry stakeholders say.

    One big reason, says AAHomecare’s Kim Brummett: The DME MACs are requiring more than the minimum five elements outlined in the Affordable Care Act (ACA): beneficiary name, DME item ordered, prescribing practitioner’s NPI number and signature, and date of order.

    “The MACs all say providers need more than that, like date stamps,” said Brummett, senior director of regulatory affairs for AAHomecare. “It’s a little over the top.”

    CMS began enforcing the WOPD requirement Jan. 1, 2014. It still hasn’t started enforcing another part of the requirement, the face-to-face exam. CMS implemented both the WOPD and face-to-face back on July 1, 2013.

    Compounding the problem, says industry consultant Mary Ellen Conway: Even when providers know what to get, they often have to wrestle with referral sources to get it.

    “It depends on the referral source, but there are plenty of places that are trying to give you the least information possible,” said Conway, president of Capital Healthcare Group. “You have to keep bugging them.”

    Additionally, there are still kinks in the system that make it difficult for providers to comply, like hospital residents who aren’t enrolled in PECOS and, therefore, don’t have NPI numbers, says industry consultant Mary Stoner.

    “We’re still running into that,” said Stoner, president of Electronic Billing Services. “What is CMS going to do about that? Do they impose penalties? Do they make it advantageous in some way for the practitioner to enroll in PECOS?”

    Industry consultant Andrea Stark’s issue isn’t with the DME MACs going above and beyond what’s outlined in the ACA—nine to 14 elements for WOPD are outlined in the Program Integrity Manual, she says—but with how they re-invoke the requirement after, say, a change in supplier or a change in insurance.

    “What’s still problematic is that the MACs are interpreting this to be a perpetual, renewable protocol that follows the patient on an annual or semi-annual basis,” said Stark, a reimbursement consultant with MiraVista. “That’s an area that still needs to be vetted.”

    Even a year in, there’s no doubt that complying with the WOPD requirement is still a lot of work for providers, Brummett says.

    “I think, for the most part, providers are doing a good job going back to physicians for additional information,” she said. “Prepayment audits are so heavy, they don’t have a choice.”


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    01/30/2015
    HME News Staff

    ORLAND, Fla. – Rotech Healthcare has purchased the respiratory assets of a local DME provider in the Gulfport, Miss. area. “We are pleased to expand our existing services in the Gulfport area,” said CEO Tim Pigg in a press release. “Rotech will continue to look for expansion opportunities and pursue asset purchase agreements with the best local providers across the country.” In the last two months, Rotech has acquired assets from Specialized Medical Services in Cody, Wyo., and an unnamed company in Natchitoches, La.

    Drive Medical becomes more Specialised

    PORT WASHINGTON, N.Y. – Drive Medical has acquired U.K.-based Specialised Orthotic Services (SOS), a manufacturer and distributor of specialized seating and mobility products. “The acquisition of Specialised Orthotic Services extends our already significant presence in Europe and expands our portfolio of products in the specialized seating and rehabilitation market,” stated Harvey Diamond, CEO of Drive Medical, in a press release. The acquisition complements Drive Medical’s Wenzelite line of mobility and seating products. Specialised Orthotic Services is known for its P Pod, Nessie and a wide range of other postural seating systems. “(These products) will enhance our global product offering in this market segment,” stated Richard Kolodny, president of Drive Medical, in the release. “We are confident that we will achieve additional growth in this area through the introduction of Drive’s complementary product lines to the SOS customers.” Terms of the deal were not disclosed.

    Lawmakers reintroduce home infusion bills

    WASHINGTON – Stakeholders are back with new bills that seek to require Medicare to cover home infusion therapy. Sens. Johnny Isakson, R-Ga., and Mark Warner, D-Va., and Reps. Eliot Engel, D-N.Y., and Pat Tiberi, R-Ohio, introduced “The Medicare Home Infusion Site of Care Act of 2015” on Jan. 28 in the Senate and House of Representatives. Medicare will cover most infusion drugs but, unlike private payers, it provides only limited coverage for related supplies, services and equipment. “Home infusion therapy has been the accepted standard of care within the private sector for more than three decades, providing patients with high–quality infusion care in a setting that is often cheaper and more comfortable than a hospital or doctor's office—their homes,” said Warner, in a press release. The bills are similar to those introduced in past legislative sessions, including one introduced by Engel and Tiberi in September. Stakeholders hope to bolster support for the bills with a study, released in 2014, which found that Medicare could save $80 million over a 10-year period by covering home infusion therapy. The study was conducted by Avalere, a non-partisan healthcare policy firm.

    Rovi staffs up in preparation for product launch

    CARSON, Calif. – Rovi Mobility Products, which plans to introduce its first product, the Rovi X3, early this year, has hired Eli Anselmi as director of education. Most recently, Anselmi was a consultant for Convaid in clinical education and product design. “We are thrilled to have someone of Eli’s caliber join our organization at such an early stage and we look forward to the depth of experience he adds to our team,” stated Cody Verrett, president of Rovi Mobility, in a press release. Rovi Mobility is the complex rehab division of Shoprider.

    Aeroflow launches new breastpump commercial

    ASHEVILLE, N.C. – Aeroflow Breastpumps launched a TV campaign aimed at educating pregnant women on how to qualify for a free breastpump through their insurance under the Affordable Care Act. Maria Eilers, marketing manager at Aeroflow, said in a press release that the company is eager to “educate moms on their breastfeeding benefits and help them through what could be an extremely stressful and confusing process.” The new commercial is currently airing on TLC, ABC Family, Lifetime, HGTV, SYFY, Lifetime Movie Network and Investigation Discovery. Aeroflow Breastpumps is a subsidiary of Aeroflow Healthcare. 

    Shield upsizes operations

    VALENCIA, Calif. – Shield HealthCare has moved its sales and distribution operations in Chicago to Elmhurst, Ill. A new, larger facility there will allow the provider of home medical supplies to gain efficiencies as it responds to its growing customer population, according to a press release. Shield offers a variety of disposable medical supplies, including incontinence, enteral nutrition, urological and wound care supplies.

    Medtrade involves attendees in retail product awards

    LAS VEGAS – Show organizers are shaking up the retail product awards at this year’s Medtrade Spring, March 30 to April 1 at the Mandalay Bay Events Center. Attendees of “The Best New Retail/Cash Opportunities” session will hear 10 finalists present their products and will have the opportunity to ask them questions. After the session, not only the judges but also the attendees will vote for winners. Show organizers will tabulate the votes and announce the winners on April 1. 

    Short takes: Inogen, ResMed, Shield HealthCare, Mercy Health

    Goleta, Calif.-based Inogen will donate an Inogen One G3 portable oxygen concentrator to Holocaust survivor Ben Fainer in honor of International Holocaust Remembrance Day 2015. Fainer endured six different Nazi concentration camps between the ages of 9 and 15 before being liberated. Now an author and traveling speaker, Fainer suffers from lung disease…ResMed Director Gary Pace sold 48,000 shares of stock on Jan. 26 in a transaction valued at $3.2 million. The stock was sold at an average price of $66.77…Shield HealthCare has named the winner of its 14th annual “What Makes Caregiving Rewarding” story contest: a woman named Cheryl in Denver. Cheryl honored her grandmother, who recently celebrated her 100th birthday…Mercy Health Mall in Janesville, Wis., has been accredited by the Community Health Accreditation Program (CHAP).

    People in the news: BOC, Ottobock, Inova Labs

    The Board of Certification/Accreditation (BOC) has announced its 2015 Executive Committee. Elected to another one-year term are Chairman James Hewlett, DMEPOS consultant for ConsultantsPRN; Vice Chairman R. Jeffrey Hedges, president of R.J. Hedges and Associates; Treasurer James Newberry, owner/practitioner at Mahnke’s Orthotics-Prosthetics; and Immediate Past Chairman John Kenney, vice president of Ongoing Care Solutions. BOC also welcomes L. Bradley Watson, owner/practitioner at Clarksville Limb & Brace and Rehab as secretary; and William Powers, a retired COO of the American Nurses Association, as member at large… Ottobock has hired Rod McCrimmon as director of marketing for Ottobock North America. He will lead the product marketing team that manages prosthetics, orthotics, bracing and mobility. McCrimmon comes to Ottobock from St. Jude Medical, where he was the director for integrated lab marketing. Ottobock has also hired Cali Solorio as a marketing manager. She will focus on supporting new product introductions and the orthopedic rehab business. She previously worked as senior marketing manger at Inova Labs…Inova Labs has announced that Dennis Meteny will join the company’s board of directors as a non-executive director. Meteny was vice president and CFO at Respironics from 1984 to 1994, and president and CEO from 1994 to 1999.


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    02/03/2015
    HME News Staff

    WASHINGTON – There have been delays in processing new Medicare applications for DME providers due to CMS’s new fingerprinting initiative, the Midwest Association for Medical Equipment Services (MAMES) reports.

    “MAMES has been hearing from suppliers and consultants on what appears to be added delays,” reads the association’s Feb. 2 bulletin.

    CMS began phasing in fingerprint-based background checks for HME and home health providers last year. Initially, it’s requiring the checks for newly enrolling and other high-risk providers. Eventually, however, it will require fingerprinting for all individuals with a 5% or greater ownership in an HME or home health company.

    MAMES reports that during a recent meeting of the National Supplier Clearinghouse Advisory Committee (NSCAC) and the National Supplier Clearinghouse, the following questions about the delays were addressed:

    Question: Can you please provide an outline of the process from when the CMS855S application is received to when a fingerprint is initiated by CMS to when it is returned to the NSC?

    Answer: Once fingerprints are reviewed by CMS, the NSC receives ‘pass’ or ‘fail’ notification. Application processing will not begin until the NSC receives CMS notification.

    Question: What are the percentages of applications that are going for fingerprinting and what is the average time added to processing the applications because of this?

    Answer: All new applicants are subject to fingerprinting. Response time of the practitioner, quality of fingerprints or discrepancies can cause delays in processing. No official timeframe has been determined.

    Question: Is it possible to proactively submit fingerprinting prior to being asked for this by the NSC?

    Answer: As Accurate Biometrics is processing in response to the individuals identified by CMS, fingerprints should only be submitted when requested.

    Question: Several states—one example is Florida—require fingerprints for state licensure and for Medicaid. If a provider has these fingerprints on file, is there any reciprocity with CMS?

    Answer: The NSC is not able to use fingerprints for Medicaid or any other entity for Medicare application processing.


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    02/06/2015
    Theresa Flaherty

    WASHINGTON – President Obama’s fiscal year 2016 budget rehashes an old proposal to apply competitive bidding rates to Medicaid reimbursement.

    The HME industry has beat back that idea in the past and will continue to do so, say stakeholders.

    “We’ve had good sound arguments for why Medicare and Medicaid are different programs with different requirements and different populations,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “We’ll beat that drum again.”

    The budget, released Feb. 2, also contains a reference to the face-to-face requirement, but it doesn’t offer any details, except to say that the Office of Management and Budget estimates it would be budget neutral.

    “They are finding, particularly in more rural areas where you have one of these practitioners doing the face-to-face exam, that it can be logistically difficult to get the physician to sign off on it,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

    Meanwhile, industry stakeholders have not let up on their efforts to push forward a pair of bi-partisan bills that would modify the competitive bidding program to require proof of licensure and binding bids. H.R. 284 has 39 co-sponsors; S. 148 has four original co-sponsors.

    “The committees tell us they are looking to advance both bills at the earliest opportunity and they are well aware that the bid window is open now and time is of the essence,” said Seth Johnson, vice president of government affairs for Pride Mobility Products.

    One powerful group that still doesn’t understand the problems associated with competitive bidding: the AARP. At a Jan. 22 hearing before the House Energy and Commerce Subcommittee on Health, AARP President-Elect Eric Schneidewind, spoke in favor of accelerating and expanding competitive bidding.

    “Competitive bidding is already saving Medicare and beneficiaries billions of dollars,” he said. “Additional categories, such as home oxygen, clinical lab services and non-durable products, could save billions more.”

    The industry has met with the AARP many times over the years, to no avail. The association is fixed on reduced co-payments, and not access issues or other costs, say stakeholders.

    “The AARP has spoken out in support of the program and has said things that clearly show from our perspective that they simply are not as updated as they should be as to the current state of the bidding program,” said Johnson. “That’s certainly not due to a lack of trying our part. We need to continue our educational efforts, not only with AARP but also other organizations.”


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    02/06/2015
    HME News Staff

    CLEARWATER, Fla. – Linde AG has named Kristen Hoefer CEO of Lincare, it announced today. She succeeds the retiring John Byrnes. Hoefer has spent 20 years at Abbott Laboratories, where she has held management positions in several divisions of the company. Most recently, she was in charge of the company’s pharmaceutical business in Western Europe. “We’re delighted that we’ve been able to attract the caliber of Kristen Hoefer, a proven healthcare executive with international experience,” said Dr. Wolfgang Büchele, CEO of Linde AG, in an article posted on gasworld.“I am confident that she will continue to apply and develop the successful approach we’ve adopted to date in our strategically important healthcare business.”The appointment is effective March 1.Lincare offers respiratory, home infusion and home medical equipment services and supplies through more than 1,100 locations in 48 states.

    Fingerprints slow application process

    WASHINGTON – There have been delays in processing new Medicare applications for DME providers due to CMS’s new fingerprinting initiative*, the Midwest Association for Medical Equipment Services (MAMES) reports.

    “MAMES has been hearing from suppliers and consultants on what appears to be added delays,” reads the association’s Feb. 2 bulletin.

    CMS began phasing in fingerprint-based background checks for HME and home health providers last year. Initially, it’s requiring the checks for newly enrolling and other high-risk providers. Eventually, however, it will require fingerprinting for all individuals with a 5% or greater ownership in an HME or home health company.

    MAMES reports that during a recent meeting of the National Supplier Clearinghouse Advisory Committee (NSCAC) and the National Supplier Clearinghouse, the following questions about the delays were addressed:

    Question: Can you please provide an outline of the process from when the CMS855S application is received to when a fingerprint is initiated by CMS to when it is returned to the NSC?

    Answer: Once fingerprints are reviewed by CMS, the NSC receives ‘pass’ or ‘fail’ notification. Application processing will not begin until the NSC receives CMS notification.

    Question: What are the percentages of applications that are going for fingerprinting and what is the average time added to processing the applications because of this?

    Answer: All new applicants are subject to fingerprinting. Response time of the practitioner, quality of fingerprints or discrepancies can cause delays in processing. No official timeframe has been determined.

    Question: Is it possible to proactively submit fingerprinting prior to being asked for this by the NSC?

    Answer: As Accurate Biometrics is processing in response to the individuals identified by CMS, fingerprints should only be submitted when requested.

    Question: Several states—one example is Florida—require fingerprints for state licensure and for Medicaid. If a provider has these fingerprints on file, is there any reciprocity with CMS?

    Answer: The NSC is not able to use fingerprints for Medicaid or any other entity for Medicare application processing.

    http://www.hmenews.com/article/fingerprinting-new-opportunity-mistakes-a...

    CMS approves 100% of TeamDME! claims

    NASHVILLE – CMS has approved 835 test claims submitted with ICD-10 diagnosis codes by TeamDME! In accordance with the Health Insurance Portability Accountability Act (HIPAA), claims for services provided on or after Oct. 1, 2015, must be submitted with ICD-10 diagnosis codes. “We've been working hard on ICD-10 over the past two years,” said Kent Barnes, TeamDME!’s vice president of marketing. “It is exciting to see the approval, assuring our customers of our preparedness for the upcoming changes.” TeamDME! is a medical billing software company based in Brentwood, Tenn.

    Mediware releases single homecare solution

    LENEXA, Kan. – Mediware Information Systems has released CareTend, a new software solution that combines the features of all its homecare solutions into one platform. The solution allows providers in HME, home infusion, home health agency and specialty pharmacy to seamlessly expand from their current service line into other markets. It also includes a new interface that offers easier navigation and greater personalization. “We have designed data conversion utilities and incentives to make converting to the new platform as easy as possible,” stated President and CEO Thomas Mann, in a press release. “However, we understand the investment our customers have made in their existing Medicare products, and we will continue to work to ensure their satisfaction with their current solutions.”

    Supplier celebrates 20 years of business with rebrand

    SUNRISE, Fla. – Wolf Medical Supply celebrated its 20th anniversary with a new logo design for its WOLF-Pak product line. “This fresh, new design encapsulates our vision of providing the highest quality, state-of-the-art products for the next 20 years and beyond,” said Bruce Stewart, director of marketing and operations. Founded in 1995, Wolf Medical offers IV and infusion related products.

    Billing software gets boost from CollectPlus

    BILLINGS, Mont. – Computers Unlimited has announced the integration of TIMS HME software with CollectPlus, a billing and collection service powered by A/R Allegiance Group. Added features include auto posting payments, dashboard sign-on and enhanced statement design at no additional cost to TIMS users.

    BioMedical firm acquires wound device maker

    LANGHORNE, Pa. – Alliqua BioMedical, a maker of wound care products, has agreed to acquire Eden Prairie-based Celleration for $30.4 million in stock and cash, according to an article in the Philadelphia Business Journal. Celleration is the manufacturer of MIST Therapy, an ultrasound system for treating acute and chronic wounds. Celleration had revenues of about $8.7 million in 2014. The deal will nearly double the size of Alliqua’s sales force, said CEO David Johnson in the article.

    Study: CPAP use could lead to higher BMI

    PLAINSBORO, N.J. – Oh the irony. CPAP use could cause an increase in body mass index (BMI) in users who are heavier, according to a new study from the University of Massachusetts Medical School in Worcester. Study author Dr. Frank Domino reviewed medical literature of controlled trials for more than 3,000 patients. After adjusting for, among other things, age, gender, baseline BMI, baseline weight, OSA severity and CPAP compliance, he found that a high baseline weight could predict an increase in BMI or an increase in weight. Domino said future study is needed.

    NHIA releases updated coding standards

    ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) has released the 2015 edition of the NHIA National Coding Standard. The document presents HCPCS per diem "S" codes as a comprehensive coding system for home infusion therapy claims and provides procedures for their use, information about what's included in the home infusion per diem, and detailed coding examples for both typical and unusual claims. The coding standards are available at no cost. FMI: www.nhia.org.

    CareTouch hits milestone

    DENVER – CareTouch Communications hit a major milestone in January: It surpassed 6 million patient encounters. The company contacts patients on behalf of HME providers to replenish their medical equipment and supplies. It uses several communication tools: a live call staff, automated phone services and the web. “Surpassing 6 million patient encounters is a testament to the need for quality patient care through professional outreach services,” stated Matthew Dolph, CEO of CareTouch in a press release.

    ResMed, Brightree integrate again

    SAN DIEGO and ATLANTA – ResMed’s AirView patient management system now directly integrates with Brightree’s billing and business management software solution. "Directly integrating with ResMed's comprehensive AirView patient management system gives Brightree users added capabilities within the software environment and workflows they rely on every day, making it easier for HMEs to focus on patient care as well as long-term business goals," stated Dave Cormack, president and CEO of Brightree, in a press release. The two companies have partnered in the past to integrate ResMed’s U-Sleep compliance solution with Brightree’s solution and to make ResMed’s products available directly from Brightree’s solution. This partnership is made possible by ResMed’s Data Exchange program, a comprehensive suite of software and service solutions that allows sleep and respiratory treatment data from ResMed's AirView and U-Sleep patient management platforms to be integrated with electronic medical records, billing, and care management applications.

    Short takes: Inogen, Save My Medical Supplies

    InogenDirector Timothy Petersen sold 601,000 shares of stock at an average price of $31.95 in a transaction Jan. 29 valued at $19.2 million. He then sold 99,000 shares at an average price of $30.88 in a transaction on Feb. 2 valued at $3.06 million…ResMed COO Robert Andrew Douglas sold 6,333 shares of stock at an average price of $62.35 in a transaction Feb. 3 for a total value of $395,000…Abilities Expo has come onboard as a supporter of Save My Medical Supplies, AAHomecare’s consumer advocacy campaign. The Abilities Expo, now in six cities across the country, offers three days of exposure to the latest in products, education and activities for all disabilities.


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    02/13/2015
    HME News Staff

    SAN DIEGO – ResMed has acquired Jaysec, a provider of Internet-based solutions for HME providers, it was announced Feb. 10. ResMed will now offer Jayec products, including GoJaysec, an automated resupply program that directs patients to a self-serve portal. "Jaysec's products streamline key business practices, such as resupply, allowing home medical equipment providers to focus on delivering quality care for their patients," said Raj Sodhi, president of ResMed's Healthcare Informatics Global Business Unit. The Knoxville, Tenn.-based Jaysec was founded in 2002 and serves nearly 110 HME providers in the U.S., including a number of national providers.

    Study finds access issues for insulin pumps

    CHICAGO – Contract suppliers aren’t making insulin pumps and replacement supplies available to Medicare beneficiaries in competitive bidding areas, says the American Association of Diabetes Educators. The AADE surveyed 29 suppliers in the nine initial CBAs to ask about the availability of specific brands and models of insulin pumps and supplies. Of those suppliers, only 17 (58%) reported carrying insulin pumps and only 18 (62%) reported carrying replacement supplies. Of those who offer insulin pumps, many carry only one brand. “This failure to comply with the program results in limited access to necessary equipment for people with diabetes,” said James Specker, director of federal and state advocacy for AADE. “This action has significant and dramatic ramifications for Medicare spending on diabetes, as well as the health of patients who rely on insulin pumps to help manage their disease.” CMS included insulin pumps in the external infusion pump product category as part of the Round 1 re-compete, despite the HME industry’s protests. Contract suppliers are required to provide all products in each category. The AADE recommends that CMS enforce its requirements that suppliers make all Medicare-covered pumps and supplies available; and remove pumps and supplies from the “overly broad” external infusion pump category.

    Customer retention pays off at Liberator Medical

    STUART, Fla. – Liberator Medical Holdings reported net sales of $20.2 million for the three months ended Dec. 31, 2014, an 8.5% increase compared to the same period in 2013. The increase was primarily due to the company’s continued emphasis on a direct response advertising campaign to acquire new customers and its emphasis on customer service to maximize reorder rates. “Our growth this quarter was driven by a 10% improvement in revenue from our existing customers,” stated Mark Libratore, president and CEO, in a press release. “Customer retention has been and will continue to be a priority.” Liberator reported net income of $2.4 million, a 14.2% increase. The company also reported cash of $11.95 million as of Dec. 31, 2014, compared to cash of $12.26 million as of Sept. 30, 2014, a decrease of $307,000. The decrease was due to $1.75 million of cash used in investing activities, partially offset by $1.46 million of cash provided by operating activities.

    Med Emporium sets stage for growth, acquisitions

    CHARLOTTE, N.C. – Med Emporium, a provider of clinical respiratory services in the Southeast, has completed a minority recapitalization with Culbro, a New York-based, family-controlled private equity firm. The founders of Med Emporium, William Conn, CEO, and Mary Ann Largen, COO, will continue to lead the company. Edgar Cullman and David Danziger of Culbro will join the company in a board capacity. “We are excited to announce our partnership with the team at Culbro, which will enable us to continue our rapid organic growth, while also opening up the possibility of strategic acquisitions,” stated Conn in a press release. Med Emporium specializes in ventilator therapy and services through clinical evaluation, monitoring and treatment of patients with pulmonary, neuromuscular and restrictive disorders.

    Associations partner for ‘grander program’

    NEW BEDFORD, Mass. – The Home Medical Equipment & Services Association of New England and the New York Medical Equipment Providers Association will team up to present the Northeast Post Acute Care Symposium, slated for May 11-13 at the Foxwoods Resort Casino in Ledyard, Conn. The program will provide an overview of state and federal efforts to shift from fee-for-service to value-based care, including the rise of accountable care organizations. “It is imperative, as associations representing the HME providers, that we create a grander program that will provide both insight into the changing world of government based insurance and align our members to these new entities,” said Carol Napierski, executive director of NYMEP.  FMI: karyn@homesne.org

    OIG says New York could save big on DME

    WASHINGTON – The New York Medicaid program could have saved $8.9 million in 2011-2012, if it had established a competitive bidding program for durable medical equipment, according to a new report from the Office of Inspector General. The OIG reviewed 70 DME items and found that for 54 items average Medicare payments rates were significantly lower than New York Medicaid rates. The state disagreed with the OIG’s recommendation to establish a competitive bidding program.

    Provider included in new book from Wheel:Life

    TAMPA, Fla. – Wheel:Life, an online community for wheelchair users worldwide, has published “Reconnecting: Relationship Advice from Wheelchair Users” as an e-book on Amazon.com. The book features six people who use wheelchairs sharing their perspectives on friends, family and relationships, including Chris Malcolm, the founder of iPush and vice president of At Home Medical Products. “Wheel:Life continuously receives inquiries from people who are seeking advice on relationships with their friends, family, co-workers and loved ones, especially from those who are new to using a wheelchair,” said author Lisa Wells, president of Get Social Consulting. “While Wheel:Life doesn’t have all of the answers, we are thrilled to provide meaningful support by offering this book filled with personalized advice from wheelchair users.”

    Oncologix wins with EsteemCare

    GRAND RAPIDS, Mich. – Oncologix, a medical holding company, says it has seen increased referrals and revenue growth from its recently acquired subsidiary, EsteemCare, a DME company in South Carolina that is a Medicare contract supplier for respiratory products. New marketing initiatives by EsteemCare have resulted in the company expanding its footprint in two new markets. Additionally, EsteemCare has made changes to its internal operational processes to focus on increased respiratory therapy staffing and enhanced procurement procedures, resulting in a 25% increase in gross margins and an 11% increase in revenues within the first four months of operations. Oncologic acquired EsteemCare in September 2014.

    Ricon agrees to consent order

    PANORAMA CITY, Calif. – Ricon Corp. has agreed to a consent order that requires the company to pay a $1.75 million civil penalty and to receive increased oversight by the National Highway Traffic Safety Administration for continuing to sell defective wheelchair lifts even after issuing a recall of the lifts to remedy a potential fire hazard, according to the Department of Transportation. Beginning in September 2012, Ricon recalled more than 4,000 wheelchair lifts that it sold to manufacturers of vans and buses. The recall remedied a defective cable that could spark a fire. In January 2014, however, Ricon informed the NHTSA that it had mistakenly continued to produce and sell the lifts with the safety defect. In March 2014, after an investigation by the NHTSA, it issued another recall for 356 defective lifts.

    German court upholds injunction in ResMed vs. BMC

    SAN DIEGO – ResMed announced Feb. 12 that the Munich District Court has upheld an injunction against Chinese medical device manufacturer BMC Medical. The injunction prohibits BMC from offering, selling or distributing infringing mask products in Germany. The court has upheld an injunction first rendered in November 2013 that respiratory mask assemblies, such as BMC’s Willing and FeaLite nasal pillow masks, infringe ResMed’s European patent EP 1356842. BMC will not be allowed to sell infringing mask products at least until the German Federal Patent Court addresses BMC’s challenges to the validity of the patent.

    Accreditors in the news: ACHC, BOC

    The Cary, N.C.-based Accreditation Commission for Health Care has partnered with the Virginia Association for Home Care and Hospice. Per the partnership, ACHC will offer special pricing for accreditation to VAHC members, and VAHC will provide educational support for members going through initial or renewal accreditation…The Board of Certification/Accreditation recently earned NCCA reaccreditation for its pedorthist certification program for another five-year period. BOC first received accreditation for the program in 2008. About 275 professionals are currently certified BOC pedorthists.

    People and places: Laboratory Marketing, BioScrip and RemZzzs

    Ryan McDevitt has joined Anna McDevitt at Laboratory Marketing. Ryan McDevitt will add business development consulting to the company’s brand development services. With Ryan McDevitt on board, the company will transition to Laboratory Tactical Consulting. Previously, Ryan McDevitt was a senior account manager with Brightree…Elmsford, N.Y.-based BioScrip will nominate David Golding, Michael Goldstein and R. Carter Pate to its board of directors at the company’s annual shareholder meeting. BioScrip has entered into an agreement with DSC Advisors and Cloud Gate Capital, which own about 7.2% of the company’s outstanding shares, that will allow Golding to attend all board meetings as a non-voting observer and serve on the governance, compliance and nominating committee. Golding has more than 30 years of experience in the healthcare industry within the home infusion and specialty pharmacy, hospital and retail sectors. He is the former executive vice president of specialty pharmacy at CVS/Caremark…Robert Rutan, developer of the RemZzzs CPAP Mask Liner participated in the NFL Players Association’s 10th annual “Smocks & Jocks” Art Show during the week of the Super Bowl. Rutan is working with Carl Eller, a former player for the Minnesota Vikings and Hall of Famer, on a campaign to promote CPAP therapy success and compliance. Eller, who uses the company’s liners, had two pieces of art up for auction to benefit charities. 


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    02/20/2015
    Tracy Orzel

    HONOLULU – The Healthcare Association of Hawaii (HAH) joined forces with the Hawaii Long Term Care Association in January to create a single healthcare trade association for the state.

    The move brings long-term care, hospital, home health/HME and hospice under one umbrella—not a common combination, acknowledges George Greene, HAH president and CEO.

    “It is very rare and a lot of it has to do with the unique collaborative business atmosphere in Hawaii,” he said in an email to HME News. 

    The unification of the two trade associations will give the industry a stronger voice when speaking out about crossover issues facing long-term care and home health/HME, says Greene. 

    “Both segments of the healthcare industry are feeling increasing pressure by federal programs, such as Medicare and Medicaid, to cut costs,” said Greene. “For both, national models aimed at cutting costs often do so without taking into account the much higher cost of doing business in Hawaii.”

    HME providers needn’t worry that their specific issues will get lost, says Greene. Already this year, the HAH has drafted legislation requiring HME providers to have a local presence. In Round 2 of competitive bidding, multiple contracts were awarded to companies located thousands of miles away.

    “HAH is very active nationally and at the state level about Medicare DMEPOS competitive bidding,” said Greene. “Not only does it impact local businesses, who are being asked to operate below costs, but it has had a profound effect on patient care and discharges from long-term care facilities and hospitals.”


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    02/20/2015
    Theresa Flaherty

    BIRMINGHAM, Ala. – Blue Cross Blue Shield (BCBS) of Alabama has tapped Connolly to audit Medicaid claims, and industry stakeholders are not happy about it.

    “Our folks are scared to death they will have the same experience with BCBS claims that they’ve had with Medicare claims where Connolly is concerned,” said Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association. “Connolly has a record for denying Medicare claims for egregious reasons.”

    The insurer made the announcement in December but provided little in the way of details, including whether or not Connolly would be auditing other providers besides DME providers, and what sort of limitations it might have to work under.

    Of particular worry: BCBS doesn’t have an adequate process in place for appealing Connolly’s findings, says Hamilton.

    “That’s a concern if they are going to start requesting inappropriate refunds on claims we’ve been paid,” he said.

    Connolly is the recovery audit contractor for Medicare in Jurisdiction C, which includes Alabama, and was recently awarded a national contract to identify overpayments specifically for DME, home health and hospice. 

    Connolly has drawn the ire of providers in the past by overreaching on audits, including seeking out older claims for power mobility devices that are less likely to meet current standards, or requiring proof of a sleep study when Medicare doesn’t pay for the study.

    “Our BCBS rep was unaware of their bad reputation,” said Hamilton.


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    02/20/2015
    Liz Beaulieu

    YARMOUTH, Maine – It turns out the top strategy for many HME providers in Round 2 competitive bidding areas isn’t whether or not to bid higher or lower as part of the re-compete, but not to bid at all.

    “We’re submitting no bids,” said Dave Anderson of Anderson’s Medical Products in Terre Haute, Ind., a respondent to the most recent HME Newspoll. “We are just outside a CBA and winning bids did not bring us any more business—probably less—and all our bids can do is drive prices down, so why bother?”

    CMS is accepting bids as part of the Round 2 re-compete until March 25. The agency plans to announce payment amounts in the winter of 2016 and winning contract suppliers in the spring of 2016, and to go live with the program July 1, 2016. 

    A number of respondents echoed Anderson’s sentiments, adding that low reimbursement rates (a reduction of 45%, on average, as part of Round 2) and high audit rates make Medicare a losing proposition.

    “We have chosen not to bid,” said Kevin Jones of All American Medical Equipment & Supplies in Oklahoma City, Okla. “The money coming in from private and state insurance is much more secure. We have watched business after business close their doors because they are getting hammered by audits. Without Medicare, my business has run much smoother.”

    In addition to private payers and Medicaid, a number of respondents cited a focus on retail instead of Medicare.

    “We opted out of the bids,” said Steve Rogers of Padgett’s Medical in St. Cloud, Fla. “We’re selling retail DME to patients who are waiting 1-2-3 weeks for Medicare-covered items.”

    For those submitting bids, the majority of respondents reported they will bid higher, in fewer categories and in fewer geographies, according to the poll.

    For providers like Jody Wright, however, there’s only way to bid, whether it’s Round 2 or the Round 2 re-compete or whatever comes after that.

    “Our strategy hasn’t changed: bid responsibly, in our own CBA and don’t expect to be awarded a contract,” said Wright of Rocky Mountain Medical Equipment/Major Medical Supply in Lakewood, Colo.


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    02/20/2015
    HME News Staff

    ORLANDO, Fla. – Rotech Healthcare continues rolling up DME companies with four new acquisitions, it announced Feb. 18. Rotech has bought the respiratory assets of two providers in Arkansas, serving Magnolia and Mountain Home; and two providers in Florida, serving Fort Myers and Orlando. “With the recent purchases in Arkansas and in Florida, we are gaining momentum,” said CEO Tim Pigg. The most recent buys are the latest in a string of acquisitions that kicked off in December. Already this year, Rotech has acquired the respiratory assets of providers in Natchitoches, La., and Gulfport, Miss.

    Brightree, PPM Fulfillment integrate

    ATLANTA – Brightree and PPM Fulfillment, a warehouse and logistics provider specializing in drop shipping CPAP supplies, now offer an integrated interface. Brightree Fulfillment Services allows customers to streamline business processes and improve time to reimbursement with direct-to-patient shipping of supplies from PPM Fulfillment, reducing shipping and inventory costs, according to a press release.

    OIG finds inappropriate payments to prosthetic provider

    WASHINGTON – A report from the Office of Inspector General found that San Antonio, Texas-based Prosthetic Science has received $25,125 in inappropriate Medicare payments. The OIG reviewed 166 claims totaling $1,785,355 for the period of January 1, 2012, through June 30, 2013. According to the report, the claims are considered inappropriate for the following reasons: one claim was not supported by any documentation, two claims were not supported by a physician order, and seven HCPCS codes were not included on detailed written orders. Prosthetic Science agreed with the findings, which it attributed to human error.

    Developer of ordering platform expands

    CARMEL, Ind. – Stratice Healthcare, the developer of an electronic ordering platform for the healthcare industry, plans to add 2,000 square feet to its 3,500-square-foot operations center here by the end of the year to accommodate and expand its e-prescribing platform. “Through our cloud-based platform, Stratice is poised to help lead the next chapter in innovation and interoperability for healthcare systems by forever changing the way home and durable medical equipment and supplies are prescribed for the end-user,” said John Brady, CEO and co-founder, in a press release.

    Sleep association now offers products

    LITITZ, Pa. – The American Sleep Association will offer sleep products to its members and viewers through affiliate relationships with top manufacturers, distributors and retailers, it announced Feb. 17. The association will offer CPAP and BiPAP/Bilevel devices and accompanying supplies, as well as anti-snoring mouthpieces. The ASA seeks to improve public awareness about sleep disorders, and to provide a portal for communication between patients, physicians/healthcare professionals, corporations and scientists.

    Convaid donates EZ-Rider

    TORRANCE, Calif. – Convaid recently partnered with Fighting for Families to surprise four-year-old Lydia Hayden, who was born with cerebral palsy, with a new Convaid EZ-Rider wheelchair. Fighting for Families is a Chicago-based nonprofit organization that raises money to provide support and ancillary services to families with children who have been diagnosed with cerebral palsy. Darren Nordquist, a business development representative with Convaid, worked with Lydia to ensure that the wheelchair fit and met her exact specifications for safety, comfort and positioning.

    HASCO ends 2014 on high note

    ADDISON, Texas – HASCO Medical, a provider of wheelchair accessible vans, parts and service, expects net revenues of about $22.7 million for the fourth quarter ended Dec. 31, 2014, a 15% increase compared to $19.7 million for the same period in 2013. The company expects net revenues of $91.2 million for all of 2014, a 25% increase compared to $73.1 million for 2013. “Our team’s relentless execution in the fourth quarter led to an unprecedented 25% growth in sales for the year, in spite of the cold weather and mid-year retirement of the Ford E-series line of vans,” stated CEO Hal Compton.

    HASCO Medical expects service sales of about $4.2 million for the fourth quarter, a 36% increase. The company credits increased repairs, lift installs and sales of high-end electronic mobility controls driving equipment for the boost in service sales. HASCO also credits its successful quarter on a new customer relationship management solution and in-store enhancements aided by partners BraunAbility, Harmar, Pride Mobility Products and Q’Straint. Looking ahead to this year, Compton said, “As a consolidator, we are poised in 2015 to make acquisitions and find new locations that support our growth plan.”

    Lakeland Pharmacy pursues gov’t contracts

    BRANSON WEST, Mo. – Lakeland Pharmacy will expand the sales of its home respiratory equipment by applying for distribution and pricing agreement certification and pursuing government contracts, the company announced Feb. 17. Many federal agencies, including Veterans Affairs, use DAPA certification as a way of procuring goods and services, knowing the companies with this certification have been thoroughly vetted, according to a press release. “The opportunity to service government accounts opens up significantly more markets throughout the region as our goal continues to be to expand sales of our in-home respirator and oxygen concentrator product line,” stated Jim Parten, home medical director at Lakeland Pharmacy. Lakeland Pharmacy specializes in caring for patients suffering from chronic respiratory failure and thoracic restrictive disease.

    NCAMES sees ‘Happy Days’ at winter meeting

    CARY, N.C. – The North Carolina Association for Medical Equipment Services (NCAMES) saw nearly a 10% increase in attendance at this year’s winter meeting compared to last year’s, it announced Feb. 13. It was the second year in a row that the association saw double-digit growth in attendance at the meeting, according to a press release. The two-day event, “Breaking Bad Habits for Happy Days, at the Sheraton Raleigh Hotel on Feb. 12 and 13, featured education on VA contracting, audits and more. NCAMES also welcomed its new president, David Chandler of Liberty Medical Specialties, and new officers at the meeting. “We have a robust agenda for 2015 to make some meaningful changes in North Carolina for equipment suppliers and the patients we serve,” Chandler stated. “Through advocacy, communication, education and networking, NCAMES will continue to thrive and provide solutions to impact positive changes in care.”

    Preferred Home Medical names contest winner

    TYLER, Texas – Preferred Home Medical has given Daniel Hernandez, who has spina bifida, a Pride Mobility Sport Rider, a three-wheeled, motorcycle-inspired sport scooter, for liking and sharing the company’s Facebook page. Hernandez was the winner among 1,187 likes, 1,008 photo likes and 1,050 Facebook shares. The scooter, valued at $3,800 to $5,000, has two speeds, a front headlight, a speedometer, a full suspension system, an adjustable high-back, seat and brake and hazard lights. Preferred Home Medical says the contest was a way to get the word out about its product selection and services, as well as the struggles that people with disabilities face.

    People in the news: Amigo Mobility

    Amigo Mobility has appointed Joe Mooney COO and Brent Lynch operations manager. “My goal is to continue Amigo’s outstanding environment of quality, grow existing markets and expand into new markets, while leveraging engineering and customer service,” Mooney stated in a press release. Tim Drumhiller, formerly president, will remain an active part of the company as an adviser and partner in new business ventures.


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    02/24/2015
    HME News Staff

    WASHINGTON – CMS has proposed a very small decrease in payments to Medicare Advantage plans for 2016, the agency announced Feb. 20.

    CMS says it wants to pay private insurers 0.95% less next year. When more intensive services are factored in, however, the agency says it expects overall payments to increase about 1.05%.

    “The proposed rates will enhance the stability of the Medicare Advantage program and minimize disruption to seniors and care providers,” stated Andy Slavitt, CMS Principal Deputy Administrator, in a press release.

    CMS is currently accepting comments on the proposal and plans to publish a final version on April 6.

    The agency has reported record high enrollment in Medicare Advantage plans each year since 2010, a trend continuing in 2015 with a total increase of more than 40% since the Affordable Care Act was passed.

    Additionally, CMS reports that premiums for these plans have fallen nearly 6% from 2010 to 2015.

    In past years, proposed decreases in payments to Medicare Advantage plans have been reversed. In 2014, for example, a 1.9% decline turned into a 0.4% increase.


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    02/26/2015
    HME News Staff

    WASHINGTON – Rep. Renee Ellmers, R-N.C., introduced a bill on Monday that would increase access to disposable medical technologies for Medicare beneficiaries.

    Co-sponsored by Rep. George Butterfield, D-N.C., the Patient Access to Disposable Technology Act of 2015, H.R. 1018, would establish “disposable medical technology” and incorporate it into existing DME coverage, allowing Medicare beneficiaries to use less expensive equipment at home.

    “Many of our constituents rely on disposable medical devices that provide healing in the home setting following hospital stays,” stated Ellmers in a press release. “While private health plans cover these innovative devices, Medicare does not—which results in patients returning to the more-expensive hospital setting to receive the care they need.”

    Under the current DME benefit, descriptions of eligible equipment are limited to items such as crutches, wheelchairs and oxygen tanks.


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  • 02/27/15--11:56: House fast tracks bid bill
  • If passed, however, it would not apply to Round 2 re-compete
    02/27/2015
    Theresa Flaherty

    WASHINGTON – Industry stakeholders last week hailed a favorable vote that pushed legislation to reform the competitive bidding program a step closer to passage.

    “There’s finally been recognition by key lawmakers that there’s a problem that needs to be fixed,” said Tom Ryan, president and CEO of AAHomecare.

    The House Ways and Means Committee marked up H.R. 284, along with a handful of other non-controversial, bipartisan healthcare bills (see related story), on Feb. 26. The committee unanimously voted to pass the bill, which would require providers to obtain bid bonds and provide proof of licensure before submitting bids.

    While that was a huge step forward, the picture wasn’t all rosy, acknowledge stakeholders. That’s because, even if passed into law, the bill wouldn’t apply to the Round 2 re-compete, where bidding has been underway for more then a month already.

    “With the bid window open that would have required them to halt and restart the program,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “CMS has convinced the Congressional Budget Office that that would incur a cost to the government because they would not be able to implement the program July 1, 2016.”

    The mark up cleared the way for H.R. 284 to move to the House floor for a vote, possibly as early as this week.

    “We’re preparing the bill for floor action and have talked with leadership about an expedited process,” said Jay Witter, senior vice president of public policy for AAHomecare. “We have meetings in the Senate looking for quick action there, too.”

    If the bill is passed, stakeholders say it will provide a solid building block to build the industry’s case against expanding the program through future rounds of bidding or through a nationwide expansion, says Ryan.

    “We have to sit back and get an idea of what we’ve accomplished and take that win,” he said. “Every day we have to prove there are access issues, prove there are quality of care issues.”

    For Ryan, who, as founder and CEO of Farmingdale, N.Y.-based Homecare Concepts also wears a “provider hat,” it’s frustrating that the bill isn’t in time to help providers currently submitting bids, but he says the only other option was for it to go nowhere.

    “We were between a rock and a hard place,” he said  “This is still a significant movement.”


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    02/27/2015
    Liz Beaulieu

    WASHINGTON – A new bill in the House of Representatives paves the way for CMS to start enforcing the face-to-face requirement.

    Industry stakeholders say the agency has been waiting for Congress to expand the types of healthcare providers who can document the face-to-face encounter required for DME prescriptions.

    Reps. Kevin Brady, R-Texas, chairman of the House Ways and Means Committee, and Jim McDermott, D-Wash., ranking member of the committee, introduced a bill Feb. 24 that would do just that.

    “CMS has supported this behind the scenes,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “That’s why they’ve been waiting for full enforcement.”

    H.R. 1021, the Protecting the Integrity of Medicare Act, would, among other things, expand who can document the face-to-face encounter required for DME prescriptions to include physician assistants, nurse practitioners and clinical nurse specialists.

    CMS implemented the face-to-face requirement on July 1, 2013, but hasn’t started enforcing it yet. The agency implemented the written order prior to delivery requirement at the same time and started enforcing it Jan. 1, 2014. 

    Allowing PAs, NPs and clinical nurse specialists to document face-to-face encounters will help providers avoid delays in delivering equipment and services because they won’t have to wait for physicians to sign off on the prescriptions.

    “It reduces the complexity of what’s already a monstrosity of paperwork,” said Andrea Stark, a reimbursement consultant with MiraVista.

    Once CMS begins enforcing the face-to-face requirement, providers will need to secure medical records that prove the face-to-face encounter occurred before delivery, said Stark.

    “Some providers are already attempting to collect these medical records in case of an audit or due to a prepay review, but the timeline for having fully executed and signed documents in their possession and date stamped before delivery is a new level of compliance,” she said. “It’s going to be the next hurdle to clear.”

    Stakeholders say H.R. 1021 is on a fast track to being passed by the House—the bill is bipartisan, budget neutral and has already been marked up.

    “In terms of Congress’ usual speed, this is lightning speed,” Bachenheimer said. “There is huge political momentum behind this, and I would expect movement on it relatively soon.”

     


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