WASHINGTON – CMS will likely move forward with Connolly as its contractor for the new national RAC for DMEPOS, home health and hospice, according to industry consultant Andrea Stark.

In its bid protest docket, the Government Accountability Office lists two protests filed by Performant Recovery on Jan. 6 and Feb.17 as dismissed. This means the protests had a technical or procedural flaw, such as timeliness or jurisdiction, or the agency has taken corrective action that addresses the protests, according to the GAO website.

“We speculate that the contract will proceed with Connolly unless Performant Recovery takes the opportunity to submit another bid protest, if the timeliness of a protest is made viable through the dismissal process,” Stark wrote on the MiraVista website.

CMS announced in December that it had picked Connolly, the current RAC for Jurisdiction C, as the new national RAC for DMEPOS, home health and hospice. The agency had to put its plans on hold, however, when Performant Recovery, the current RAC for Jurisdiction A, protested the award.

While the GAO’s decision likely green lights CMS to move forward with Connolly, Stark points out that nothing is official—yet.

“CMS has not directly addressed the status of these protests,” she wrote.

WASHINGTON – CMS will likely move forward with Connolly as its contractor for the new national RAC for DMEPOS, home health and hospice, according to industry consultant Andrea Stark.

In its bid protest docket, the Government Accountability Office lists two protests filed by Performant Recovery on Jan. 6 and Feb.17 as dismissed. This means the protests had a technical or procedural flaw, such as timeliness or jurisdiction, or the agency has taken corrective action that addresses the protests, according to the GAO website.

“We speculate that the contract will proceed with Connolly unless Performant Recovery takes the opportunity to submit another bid protest, if the timeliness of a protest is made viable through the dismissal process,” Stark wrote on the MiraVista website.

CMS announced in December that it had picked Connolly, the current RAC for Jurisdiction C, as the new national RAC for DMEPOS, home health and hospice. The agency had to put its plans on hold, however, when Performant Recovery, the current RAC for Jurisdiction A, protested the award.

While the GAO’s decision likely green lights CMS to move forward with Connolly, Stark points out that nothing is official—yet.

“CMS has not directly addressed the status of these protests,” she wrote.

Stakeholders launch #Tweet4CRT

WASHINGTON – NCART, U.S. Rehab and People for Quality Care have launched #Tweet4CRT to fight CMS’s plan to apply competitive bidding pricing to accessories for complex rehab wheelchairs. Stakeholders plan to use the social media campaign to boost congressional support for a “Dear Colleague” letter asking CMS not to make the change, scheduled to go into effect Jan. 1. The campaign encourages Twitter users to visit www.access2crt.org to send a specialized tweet to their representative asking him or her to sign on to the letter. Forty-four representatives have signed the letter so far—stakeholders are aiming to get many more. “Without action, the changes could impact up to 171 product codes with reductions from 20% to 50%,” stated Don Clayback, executive director of NCART, in the release.

HQAA gets seal of approval in Arkansas

WATERLOO, Iowa – The Healthcare Quality Association on Accreditation has been approved as an accreditation organization by Blue Cross and Blue Shield of Arkansas as of April 1, 2015. The recognition extends to the insurer’s affiliated companies, USAble Corporation and Health Advantage. “Now HQAA customers can apply to be preferred providers and, if approved, their customer base can expand to serve Blue Cross Blue Shield of Arkansas patients,” stated Mary Nicholas, president/CEO of HQAA in a press release. HQAA is a CMS-deemed authority for DMEPOS accreditation. It offers programs for HME, infusion/home IV compounding, pharmacy, physician practices and facility-based ventilator unit providers, as well as third-party billing organizations.

Stratice Healthcare partners with NewCrop

CARMEL, Ind. – Stratice Healthcare and NewCrop have partnered to provide an integrated HME ordering solution for electronic health record systems. As part of a nationwide rollout beginning in April, Stratice Healthcare will integrate NewCrop’s 180-plus EHR platform with its eDMEplus, a cloud-based electronic ordering system connecting healthcare providers with a nationwide network of more than 10,000 HME providers. “This partnership is the beginning of a dramatic shift in the way HME supplies are prescribed by care providers,” stated Jason Farmer, president of Stratice Healthcare in a release.

RESNA supports tech innovation

NEW YORK – RESNA has partnered with New York University and AT&T on Connect Ability, a competition offering more than $100,000 in prizes to developers for software, wearable and other technology solutions that enhance the lives of people with disabilities. Launched April 6 in New York City, the competition seeks to honor the American with Disabilities Act, which celebrates its 25th anniversary on July 26. NYU and AT&T are partnering with national experts like RESNA to help form teams of engineers and persons with disabilities in at least six metro regions with large numbers of computer science, rehabilitation science and engineering students.

Sigvaris sponsors lymphedema, wound care certification

PEACHTREE CITY, Ga. – Sigvaris and the International Lymphedema & Wound Care Training Institute have teamed up to offer what they say is the only certification program focused on wound care and lymphedema. The program, which includes 62.5 hours of online pre-course work followed by six days of labs and workshops, is designed to educate medical professionals as they help treat patients with chronic wounds, lymphedema and edema. The program is accredited by the physical therapy, occupational therapy and nursing state boards for 135 hours/150 contract hours of continuing education.

Associations recruit allies in bid fight

CHEYENNE, Wyo. – Members of Big Sky AMES met with Sen. Mike Enzi, R-Wyo., on April 7 to discuss the competitive bidding program. “Sen. Enzi pledged to support our industry and agrees with the need for reform,” said Aaron Durst, Big Sky president, in a newsletter from The VGM Group. “I think (he) will (be) a valuable ally in the future.” Competitive bidding pricing is scheduled to roll out nationwide in 2016 and is expected to hit rural areas especially hard. Big Sky has also met with the office of Sen. Mike Crapo, R-Idaho, and plans to meet with Sen. Steve Daines, R-Mont., this week. Other state associations, including the North Carolina Association of Medical Equipment Services and the Pacific Association of Medical Equipment Services, also have meetings with lawmakers scheduled.

Mediware ups its analytics game

LENEXA, Kan. – Mediware Information Systems and Rock-Pond Solutions have agreed to jointly distribute their software products and collaborate on new products. The combined offerings of the two companies provide an end-to-end technology solution for providers who deliver home infusion, home medical equipment and specialty pharmacy services, according to a press release. “The combination of Rock-Pond’s reporting and analytics software and our new, next generation CareTend software will meet the needs of our post-acute care customers for years to come,” stated Mediware President and CEO Thomas Mann in the release. Mediware released CareTend earlier this year.

CMS reverses cut to MA plans

WASHINGTON – CMS has reversed a small cut to 2016 payments to Medicare Advantage plans. The agency in February stated payments would decline 0.95%, but last week it stated they would go up 1.25%. “The final revenue increase is larger than the February advance notice largely because the Medicare actuaries recently updated Medicare per capita spending estimates for 2014 and 2015,” CMS stated in a press release. “Medicare per capita spending in 2014, 2015 and 2016 is still expected to be below historical standards.” The agency says payments will likely actually increase 3.25% as insurers deliver and bill for more intensive services.  

Geneva Woods Pharmacy, Frontier Medical integrate

ANCHORAGE, Alaska – Geneva Woods Pharmacy has completed its integration with Frontier Medical, positioning itself to meet the needs of patients, discharge planners and healthcare providers throughout Alaska. As part of the integration, Gabby Lujan, founder and CEO of Frontier Medical, and Dick Hobbs, COO of Frontier Medical, have joined GWP’s management team. The two companies, former competitors, pride themselves on offering long-term care pharmacy, HME, complex rehab and respiratory services to under-served rural markets. “We started Frontier because our rural markets needed help,” Lujan stated in a press release. “Frontier and GWP proved there is a better way to deliver measurable outcomes for Alaskans who previously lacked these services at home.”

WASHINGTON – The Senate on Tuesday passed a “doc fix” bill that contains binding bids language.

The House of Representatives passed a similar bill just before the Easter recess.

President Obama is expected to sign the bill into law, according to news reports.

The bill, which the Senate passed 92-8, staves off a 21.2% cut in payments to physicians.

The binding bids language in the bill has its roots in H.R. 284, which the House passed on March 16.

In addition to binding bids, H.R. 284 requires providers submitting bids as part of competitive bidding to prove they have met licensure requirements.

The reform comes too late for providers who submitted bids in the Round 2 re-compete, however. That bid window closed March 26.

WASHINGTON – Industry stakeholders took a quick victory lap last week, after binding bids language was passed as part of the “doc fix” bill, but then got back to work.

“This is a big step, finally, to have this legislation passed,” said Tom Ryan, president and CEO of AAHomecare.

President Obama signed the “doc fix” bill, which prevents a 21.2% cut to physician payments, into law on April 16. In addition to binding bids, the bill requires providers to provide proof of licensure.

CMS must apply the changes to the next Round 2, but stakeholders hope to work with the agency to get the changes implemented as soon as the next Round 1.

“Our champions in Congress said, ‘Let’s get this passed into law, and then we’ll see what we can do to improve upon that,’” said Cara Bachenheimer, senior vice president of government relations for Invacare.

The law will also give the industry a leg to stand on as it pushes forward with the next item on its agenda: Stopping the expansion of bid pricing into non-bid and rural areas on Jan. 1. Stakeholders have already drafted language and lined up champions for a bill to delay or phase-in these changes.

“We have to be very careful about expanding this program,” said Ryan. “We have had speculative bidders who caused artificially low single payment amounts and we are going to be relying on those SPAs in rural and non-bid areas. That’s really a warning light and we will take that message to the Hill.”

To strengthen its position, AAHomecare is aligning with other industry groups to create and present a unified strategy.

“We’ve shot ourselves in the foot too often,” said Ryan. “An aligned industry makes for a better chance of getting what we want accomplished.”

YARMOUTH, Maine – With compliance rates for CPAP therapy that fall somewhere between 51% and 75%, about half of the respondents to a recent HME NewsPoll admit there’s room for improvement.

But things could be looking up, with 58% saying their compliance rates have improved in the past year. One big reason for that: advances in technology, like the remote monitoring capabilities of today’s CPAP devices.

“The biggest impact on compliance has to be the use of modems,” wrote Spencer Burk, a patient care coordinator at American HomePatient in Austin, Texas. “We can see when patients are having issues before they forget to call.”

Indeed, 78% of respondents to the poll say they’ve leveraged technology to improve their compliance rates.

In addition to remote monitoring, mobile apps and web-based systems that patients can use to monitor and manage their therapy themselves are making a big difference, respondents say.

“SleepMapper is really gaining popularity with our patients,” said one respondent. “You need the patient buy-in.”

Respondents point out, however, that the secret to a good compliance rate is a combination of technology and what one respondent called “the old school approach.”

“Without a doubt, the biggest impact on compliance is patient education,” wrote Nancy Whiteley, the clinical sleep educator at S Baker Medical in Mobile, Ala. “I spend an hour with every new PAP setup that I do.”

During each setup, Whiteley says she covers: what is sleep apnea, what are the consequences if it’s left untreated, how does the device work, how do I care for it, why do I replace supplies?

“I cover what they can expect their first night through traveling with PAP,” she wrote. “I assure them there is no reason they can’t be 100% comfortable using PAP.”

While compliance may be most crucial during the first 90 days of therapy (not only to get patients started off on the right foot but also to secure reimbursement), it’s an ongoing effort, respondents say.

“Looking longer term, e.g. post-24 months, we note that adherence rates fall to the 40% or less rate,” wrote one respondent.

There’s no denying that CPAP can be a high-maintenance product category, respondents say.

“Now that most, if not all, insurances require compliance for resupply has forced our hand to update and maintain our compliance,” wrote Michael Thompson, a respiratory care practitioner at Personal Support Medical Suppliers in Philadelphia. “It will be interesting to see if the work is worth the reimbursement.”

YARMOUTH, Maine – Sleep disordered breathing is associated with early mental decline and Alzheimer’s disease, but treatment with CPAP therapy may delay the onset of problems, according to a new study. Researchers at New York University Langone Medical Center found people with sleep-disordered breathing became cognitively impaired an average of about 10 years sooner than those without the disorder. They also found, compared to those whose sleep disorder was untreated, those using CPAP therapy delayed the appearance of cognitive impairment by an average of 10 years. The study, which was published online in Neurology, analyzed information on the incidence of sleep-disordered breathing and the incidence of mild cognitive impairment and Alzheimer’s disease in 2,470 people with the average age of 73.

Medline integrates with Brightree

MUNDELEIN, Ill. – Medline and Brightree now offer customers an integrated platform that allows ordering and drop-shipping products from a single interface. “Now more than ever, dealers need to find ways to remain competitive and efficient,” stated Dave Jacobs, president, post-acute sales division, Medline. “This new collaboration is an innovative way to simplify the ordering process so dealers can get back to what matters most—taking care of patients.” When a Brightree user creates a purchase order, a transmission is sent through a secure FTP connection to Medline, enabling providers to view item availability and pricing in real time. The user can then perform one-touch drop shipments, receive automatic confirmation and submit purchase orders directly to Medline. Brightree users can use the integrated e-purchasing feature at no additional cost.

Oncologix updates on earnings

LAFAYETTE, La. – Oncologix, a diversified medical holding company with operating divisions in medical devices, healthcare services and DME sales and distribution, expects to grow annualized revenues to $25 million by the end of 2015, it announced April 14. It also expects to achieve positive EBITDA of more than $2.6 million. “Our stock price does not accurately reflect the hard work and success of our operating activities and it remains severely undervalued,” CEO Wayne Erwin stated in the release. “With our continued execution on our acquisition and growth plan, we are confident that our stock value will rise in the coming year to its true, fair market values.” Oncologix is in the process of closing the acquisition of a DME company with annual revenues of about $9.8 million that will add $2.2 million in positive EBITDA.

Patientco adds millions of users

ATLANTA – Patientco added more than 2.4 million patients across multiple healthcare providers to its user base in the first quarter of 2015. The company, which helps providers collect patient payments, says enhancements like the new mobile-ready PatientWallet have helped to drive growth. “Healthcare organizations are learning how to factor patients into the traditional way they’ve operated from a revenue cycle perspective, which is not an easy task as most are dealing with shrinking margins, competing priorities and relying heavily on a new and powerful revenue source: patients,” stated Bird Blitch, CEO of Patientco, in a press release. “The Patientco team is dedicated to delivering modern, scalable and responsive technology to help our clients realize patient revenue success.” In response to the growth, Patientco has added 20 full-time employees.

Expert boosts Convaid’s webinar program

TORRANCE, Calif. – Convaid has aligned with seating and mobility expert Missy Ball, a PT and ATP, to expand its webinar program. The first webinar scheduled for April 17, entitled “The Use of Equipment to Improve Future Outcomes for Clients,” will discuss how to manage and facilitate best outcomes for wheelchair users with musculoskeletal issues. Ball, a 38-year healthcare veteran, is the former acting director and past assistant director of the physical therapy department at Children’s Hospital in New Orleans. Other webinars led by Ball: “Clinical and Technical Use of Tilt and Recline” on May 29, “The Place for Pediatric Dependent Push Wheelchairs in Early Intervention” on Aug. 7 and “Appropriate Seating and Mobility Needs for Specific Diagnoses” on Oct. 30. The webinars are free but there is a $20 processing fee for processing paperwork for 0.1 CEU credit.

State news: Colorado and Wisconsin

The governor of Colorado recently signed an amended bill that requires DME providers to obtain licenses. The bill was originally passed in 2014, but it was held up when the state attorney general expressed concerns that a brick-and-mortar requirement violated the Federal Commerce Clause. “To resolve the issue, the group from the Colorado Association of Medical Equipment Services and other Colorado DME suppliers decided to remove diabetic suppliers and small pharmacies from the bill and allow licensure requirements to be 100 miles from any of the supplier’s patients,” according to a bulletin from The VGM Group…The governor of Wisconsin has signed into law a bill that allows HME providers to provide home oxygen therapy without a pharmacist on staff. The bill, which takes effect May 1, paves the way for providers to dispense oxygen through a licensure program administered by the Pharmacy Examining Board. Under previous law, oxygen intended for medical use was considered a drug and could only be dispensed by a pharmacist licensed by the board or by a physician or other authorized practitioner.

Short takes: Numotion, Accelleron, Hasco Medical & more

Rocky Hill, Conn.-based Numotion will continue as a “National Premiere Sponsor” for the ALS Association in 2015. Part of the company’s commitment to the ALS community is its “ALS Fast Track Program.” For customers who qualify and for whom an evaluation is complete with all necessary documents received, Numotion will deliver equipment within 18 days…Guildford, Conn.-based Acelleron Medical Products has hired Jan Ferraro as director of education. Ferraro’s job: to educate pregnant women about the Affordable Care Act and breast pumps. Previously, Ferraro was a childbirth and parenting educator at Lawrence and Memorial Hospital in New London, and Yale-New Haven Hospital in New Haven…Addison, Texas-based Hasco Medical will have a grand opening for its new Ride-Away location in Parkville, Md., on April 18. The location will be first dealer in the country where people with disabilities can see the BraunAbility Explorer MXV wheelchair accessible SUV, Mobility SVM SUV Suburban and Allegiant Mobility Honda Pilot…The Board of Certification/Accreditation (BOC) has been cleared by the Agency for Health Care Administration in Florida to accredit HME providers in that state. BOC is one of five organizations to earn this recognition…The American Association of Breast Care Professionals will hold a Post Mastectomy Policy Summit on Aug. 3, in Memphis, Tenn.

BALTIMORE – CMS has detailed initial plans to implement a new Round 1 re-compete on Jan. 1, 2017.

Today’s announcement comes less than a week after President Obama signed a “doc fix” bill that includes provisions requiring providers to be licensed and to obtain bid bonds as part of the program. The bill stipulates that CMS must implement the changes for contracts “not earlier than Jan. 1, 2017, and not later than Jan. 1, 2019.”

Stakeholders hope to work with CMS to get the changes implemented in time for the Round 1 re-compete.

CMS plans to open bidding for the Round 1 re-compete in the same nine competitive bidding areas in the fall.

The affected product categories are: enteral nutrients, equipment and supplies;general home equipment;nebulizers; negative pressure wound therapy pumps; non-invasive pressure support ventilators; respiratory equipment; standard mobility equipment; and transcutaneous electrical nerve stimulation devices.

Ventilators, a new category, will be bid only in eight CBAs: Charlotte-Concord-Gastonia, N.C.; Chester, Lancaster and York counties, S.C.; Dallas-Fort Worth-Arlington, Texas; Kansas City-Overland Park-Ottawa, Kan.; Kansas City, Mo.; Miami-Fort Lauderdale-West Palm Beach, Fla.; Orlando-Kissimmee-Sanford, Fla.; Riverside-San Bernardino-Ontario, Calif.

CMS also stated that it has updated the nine CBAs to reflect zip code changes.

More information on specific items in each product category, and a list of zip codes in each category, will be available on the CBIC website.

BALTIMORE – Wave goodbye to audits of older claims for DME supplied to Medicare beneficiaries during a Part A stay.

After working with AAHomecare, CMS has issued a “technical direction letter” to the recovery audit contractors advising them to limit audits to those claims paid on or after April 1, 2015, the association stated in a bulletin.

“By presenting the facts instead of being guarded, we’re building credibility and trust, and this type of collaborative discussion is the result of that,” said Kim Brummett, vice president of regulatory affairs at AAHomecare. “CMS heard us, and within a matter of weeks, we had a common sense fix that will provide significant relief to suppliers.”

Because the RACs have been auditing older claims, providers have been unable to re-file claims due to the timely filing requirement.

A new process for handling these claims, called an informational unsolicited response, will be implemented for dates of service starting April 1, 2015. As part of the new process, the RACs will automatically compare DMEPOS claims paid to Part A claims. If a DMEPOS claim has been paid where the from date of service is during the Part A stay, the payment will be automatically recouped.

AAHomcare advises providers to monitor their electronic remittance notices and, when a recoupment is made, do research to determine when the patient was in Part A stay and submit amended claims post-discharge if the patient had continued to use the equipment/supplies.CMS limits audits of older claims

KNOXVILLE, Tenn. – The Association for Tennessee Home Oxygen & Medical Equipment Services in February formed a Complex Rehab Committee.

“I think this is an opportunity for complex rehab providers in Tennessee to connect with each other more—to share information and ideas,” said Ashley Plauché, ATHOMES executive director.

The committee hopes to offer educational opportunities, and to mobilize providers on legislative issues and keep them updated on regulatory affairs, says James Rogers, committee chairman and CEO of Chattanooga, Tenn.-based Phoenix Rehab & Mobility and PPS Orthotic & Prosthetic Services.

“It’s become a pretty important state for CRT,” he said.

Not only is Tennessee the home of industry giants National Seating & Mobility and Permobil, it also plays host to the International Seating Symposium (ISS) conference.

The committee, which is open to all ATHOMES members, is comprised of ATPs, providers like Numotion and manufacturers like Pride Mobility.

The committee, which met for the first time at ISS in February, is currently focused on supporting H.R. 1516, a bill to create a separate benefit for complex rehab, and efforts to get CMS to reverse its plans to apply competitive bidding pricing to complex rehab wheelchair accessories. 

WILD ROSE, Wis. – HME providers in Wisconsin will now be able to dispense oxygen without a pharmacist on staff. 

Gov. Scott Walker on March 23 signed a bill allowing HME providers to obtain a license to dispense oxygen from the Pharmacy Examining Board. The act goes into effect May 1. 

Had the act not been passed, providers and their patients would have been left in the lurch, says Jim Spellman, director of the Wisconsin Association of Medical Equipment Services and owner of New Berlin, Wis.-based Home Care Medical.

“Oxygen providers wouldn’t have been able to dispense oxygen and bill insurance for it,” he said. “If that happened, who would provide oxygen for our clients?” 

Under previous law, only pharmacists licensed by the Pharmacy Examining Board, a physician or authorized practitioner were permitted to dispense oxygen because it is considered a prescription drug.

While that may have been the law, Spellman says that wasn’t the case in practice.

“Oxygen providers have been operating under a wholesale distributer license (issued by the Pharmacy Examining Board) for years,” he said. 

In 2014, however, CMS noticed the fine print on Wisconsin’s state statute and issued a letter stating that providers without a licensed pharmacist on staff were considered non-compliant. 

“We were able to get the governor to write a letter to CMS asking for a one-year extension,” said Spellman. 

CMS granted the extension, giving WAMES an opportunity to get a bill drafted and introduced.

Rick Adamich, a WAMES board member and president of Waukesha, Wis.-based Oxygen One, hopes the association’s success will drive up membership. 

“I think our efforts have underscored the value of being part of a state association and what a state association can do,” he said. “We showed we could come together and affect change.”

RALEIGH, N.C. – Billing for patients with both Medicare and Medicaid got a little easier on March 1 for HME providers in North Carolina.

A glitch in NCTracks, the system that processes claims for the state’s Medicaid program, meant providers had to manually correct rental claims for these so-called dual eligibles.

“It’s money that we had tied up in A/R, and extra cost and time, that we won’t have anymore,” said Craig Rae, owner of Penrod Medical Equipment in Salisbury.

A fix to the system, in the works for nearly 20 months, now allows Medicaid to pay for rental claims for a full month, instead of one day. What tripped the system in the first place: Medicare pays by the month, Medicaid pays by the day.

While the fix resolves the majority of issues, there still appears to be a “minor hang-up” in the system for claims for diabetes supplies, says Andrea Stark.

“It still can’t process a future through date,” said Stark, a reimbursement consultant for Mira Vista. “Even though Medicare allows you to bill from the ship date, Medicaid requires you to bill at the end of a utilization period.”

Additionally, the North Carolina Association for Medical Equipment Services would like to see some retroactive relief, says Beth Bowen, executive director. 

“NCAMES is still working with (Medicaid) to attempt to have all Medicare crossover claims subject to cost sharing that were processed by NCTracks prior to March 1 to be reprocessed to reimburse providers for the entire Medicare cost sharing amount,” she stated in a bulletin to members.

The likelihood of that happening is good, Stark says.

“While no timeframe was set, the initial conversation with Medicaid suggested they are considering a mass adjustment of underpaid claims remaining from the prior 20 months,” she said. hme

While reporting for this issue, I had conversations with two very smart women, Tammy Zelenko and Michelle Templin, about how referral sources and payers have no idea what HME providers actually do.

I expect this of most lawmakers, but referral sources and payers?

Templin, vice president of strategic development for Managed Health Care Associates, which owns The MED Group, interacts with a number of payers in her work to promote the company’s ACO Network, a national network of post-acute providers.

“The perception, from the payer perspective, is, ‘Oh yeah, the DME people, they deliver walkers and wheelchairs,’” she told me. “Yes, that’s one aspect of it, but not all it. There are higher end things that they do.”

Templin says providers need to do more to rebrand themselves.

Cue in Zelenko, president of AdvaCare Home Services.

Zelenko has organized the services that her company provides—clinical care, patient advocacy, respiratory programs, technology and outcomes—into a formal and organized program called the Patient Partner Program (See story page 14).

“What we do is so complicated that people don’t understand it,” she said. “This spells out the value-added services we provide.”

Zelenko has started shopping the program around to hospitals. She says the hospital, the patient and the payer all reduce their costs as a result of the program—the hospital sees fewer ER visits and readmissions, the patient sees fewer co-pays and the payer pays for less expensive care in the home. What does AdvaCare get? An increase in referrals.

“This is really a new way for us to market ourselves,” she said. “We, as an industry, are doing a terrible job of that.”

 Templin agrees.

“There’s a need for the HME provider to be seen as not purely a supplier but as an active participant and collaborator,” she said.

BALTIMORE – Despite widespread concerns and a new law that will eventually require modifications to the program, the next phase of competitive bidding mostly mirrors the recently completed Round 2 re-compete.

“CMS doesn’t seem to be making any modifications to improve the program,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Over the last two years they’ve been telling Congress, ‘Oh, we’ve been making improvements; we’re flexible and we’re responsive.’ We are not seeing that actually happening.”

CMS on April 21 announced initial plans for Round 1 2017, with bidding expected to open sometime this fall. Of the eight product categories providers will submit bids for, seven were included in the Round 2 re-compete. The eighth, non-invasive ventilators, is new and is likely a reaction to a recent spike in billing for the vents, which cost Medicare about $1,500 per month, say stakeholders. Vents will only be bid in eight of the nine competitive bid areas.

Also like the Round 2 re-compete, CMS is still grouping certain products together—like CPAP and oxygen—in ways that don’t reflect how they are actually provided.

“In their own analyses of data from the National Suppliers Clearinghouse, they know the percentage of those who do one or the other, so to keep bundling them together is concerning,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “It will be interesting to see what people bid (in the Round 2 re-compete) or if they even bid at all.”

The original nine CBAs have been split into 13 so that no area crosses state lines, in response to licensure issues that cropped up in earlier rounds of bidding.

CMS’s roll out of Round 1 2017 comes less than a week after President Obama signed a “doc fix” bill that includes provisions requiring providers to be licensed and to obtain bid bonds as part of competitive bidding. CMS must apply the changes to the next Round 2, but stakeholders would like to see that timeframe pushed up.

“I think what we’ve got to do is continue to push to make sure our champions are pushing for an earlier date,” said John Gallagher, vice president of government relations for The VGM Group.

At the end of the day, stakeholders say, they are fairly confident that providers will bid sensibly.

“We have to believe that people have gotten smarter,” said Brummett. “Low-balling the bidding in areas you don’t even service—it’s a waste of time and it hurts everybody.”

BALTIMORE – Wave goodbye to audits of older claims for DME supplied to Medicare beneficiaries during a Part A stay.

After working with AAHomecare, CMS has issued a “technical direction letter” to the recovery audit contractors advising them to limit audits to those claims paid on or after April 1, 2015, the association stated in a bulletin.

“By presenting the facts instead of being guarded, we’re building credibility and trust, and this type of collaborative discussion is the result of that,” said Kim Brummett, vice president of regulatory affairs at AAHomecare. “CMS heard us, and within a matter of weeks, we had a common sense fix that will provide significant relief to suppliers.”

Because the RACs have been auditing older claims, providers have been unable to re-file claims due to the timely filing requirement.

A new process for handling these claims, called an informational unsolicited response, will be implemented for dates of service starting April 1, 2015. As part of the new process, the RACs will automatically compare DMEPOS claims paid to Part A claims. If a DMEPOS claim has been paid where the from date of service is during the Part A stay, the payment will be automatically recouped.

AAHomcare advises providers to monitor their electronic remittance notices and, when a recoupment is made, do research to determine when the patient was in Part A stay and submit amended claims post-discharge if the patient had continued to use the equipment/supplies.

F2F requirement gets easier

WASHINGTON – The recently passed “doc fix” bill includes a provision that expands who can conduct the face-to-face exam required for DME. The provision modifies the requirement to allow physicians, physician assistants, practitioners, or specialists to conduct the exam. Industry stakeholders have long held that limiting who can document the face-to-face exam to physicians would result in delays in equipment and services. CMS implemented the face-to-face requirement on July 1, 2013, but it hasn’t started enforcing the requirement yet, some say, because the agency has also been waiting for Congress to make this change. CMS also implemented the written order prior to delivery requirement on July 1, 2013, and it started enforcing the requirement on Jan. 1, 2014.

Invacare sells, then leases back, properties

ELYRIA, Ohio – Invacare has secured $23 million in a sale and leaseback transaction. The company has sold and leased back under long-term leases five of its properties located in Ohio and Florida. The net proceeds from the transaction will be used to reduce debt on the company’s revolving asset-based credit facility, according to a press release. ''We are pleased that we have completed this sale and leaseback transaction, which is part of our ongoing plan to proactively manage cash and debt in our current environment,” stated Matthew Monaghan, president and CEO, in a press release. “This transaction will not affect our day-to-day operations, but it does allow us to strengthen our balance sheet and address the current cash needs of the business.” The total annual rent for the properties will be $2.275 million for the first year and will increase annually over the 20-year term of the leases based on the applicable geographical consumer price index.

Univita expands telehealth programs

MIRAMAR, Fla. – Univita Health has expanded its Re-admission Reduction Solution and Hospital to Home programs in the Orlando metro area. The two programs use telehealth and specially trained nurses to reduce readmissions among high-risk patients with heart failure, COPD, diabetes and kidney disease, according to a release. The Re-Admission Reduction Solution resulted in an 81.8% reduction in readmissions for one health plan, according to a study. “We estimate that by avoiding these unnecessary re-admissions, the health plan in the study saved an estimated $54,000 annually per patient and, more importantly, helped their members stay out of the hospital and remain in the comfort of their own home while improving their outcomes and quality of life,” said Dr. Victor Valdes, executive vice president of clinical innovation at Univita.

OIG: CMS overpays for infusion drugs

WASHINGTON – CMS could have saved $251 million over an 18-month period if it paid for DME infusion drugs using an average sales price methodology, according to a new report from the Office of Inspector General. While most Part B drugs are paid at 106% of the ASP, infusion drugs are paid at 95% of the average wholesale price. Between the second quarter of 2013 and the third quarter of 2014, at least 42% of infusion drugs were paid at amounts that were more than twice their estimated acquisition costs, the report says. The OIG recommends that CMS either seek a legislative change requiring infusion drugs to be paid using ASP, or include the drugs in the next round of competitive bidding. CMS partially concurred with the first recommendation and concurred with the second.

NASDAQ puts Inogen on notice

GOLETA, Calif. – Inogen has received a notice from the NASDAQ stating it’s not in compliance with a rule requiring timely filing of periodic financial reports with the Securities and Exchange Commission. Inogen received the notice on April 15 after failing to file its Form 10-K for the fiscal year ended Dec. 31, 2014, on two separate occasions. “The NASDAQ notice has no immediate effect on the listing or trading of Inogen’s common stock on the NASDAQ Global Select Market,” the company stated in a press release. “Under NASDAQ rules, Inogen has 60 calendar days from the date of the letter to submit a plan to regain compliance.” Inogen announced March 12 that it would not meet the March 31 deadline for filing the form due to an internal investigation into its accounting practices. The company announced on April 1 that it filed a Form 12b-25 to get an extra 15 days to file the form, but then it announced April 14 that it still wasn’t ready. If the NASDAQ approves Inogen’s plan to regain compliance, the company will have until Oct. 12, 2015, to file the form. “Inogen expects to submit a plan to regain compliance or file its Form 10-K within the timeline prescribed by NASDAQ,” the company stated. Inogen says documentation issues are to blame for the delay in filing.

Moneyline: Respira, InfuSystem

Linthicum, Md.-based Respira has acquired Respiratory Therapy Associates of PA, expanding its reach in the mid-Atlantic region. Respiratory Therapy Associates services Pennsylvania and Delaware. The acquisition also allows Respira, primarily a sleep and respiratory therapy company, to expand into long-term care, ventilation and hospice care. Respiratory Therapy Associates is now part of a Respira umbrella that includes Respira Medical, which provides sleep, respiratory and HME services to civilians; Respira Medical Military, which provides care to the Armed Forces and Department of Defense; and Respira Technical Services, which develops and manages safety and health planning for the U.S. Strategic Petroleum Reserves for the Department of Energy. Chuck Ciccone, the president of Respiratory Therapy Associates, is now vice president of Respira. The acquisition increases Respira’s employee rolls from 60 to about 100…Madison Heights, Mich.-based InfuSystem, a national provider of infusion pumps and services, has acquired the assets of Alpharetta, Ga.-based Ciscura. Per the deal, InfuSystem will acquire about 1,600 infusion pumps, a four-person sales team, and facilities management personnel. The company will establish a new Southeast facility near Atlanta.

Glucose testing supplies have 99% error rate

YARMOUTH, Maine – National Government Services, the DME MAC for Jurisdiction B, conduced a widespread prepayment probe review of glucose testing supplies (A4253KX) between Oct. 22 and Jan. 1 and found all but one of 100 claims were denied. The top reasons for denials were: no medical records were submitted; the proof of delivery record did not include the beneficiary signature; the detailed written order did not include a physician signature that complied with CMS’s signature requirements; the proof of delivery record did not include the delivery address; no documentation to support the specific reason for additional materials; and refills of quantities of supplies that exceed the utilization guidelines were dispensed with no documentation within the past six months that the beneficiary is testing at a frequency that corroborates the quality of supplies that have been dispensed.

Short takes: 101 Mobility, Buffalo Wheelchair, 3B Medical

101 Mobilityrecently joined VetFran, a network of franchise brands that offers benefits to aspiring veteran franchisees and employees. The Wilmington, N.C.-based provider will offer a $5,000 discount on its franchise fee to qualified military veterans…Buffalo Wheelchair has opened a retail location. Buffalo Home Medical Supply offers bath safety, bracing and other DME items…Advance Home Care Supply now offers delivery of adult incontinence products. The Southfield, Mich.-based provider will allow customers to enroll in automatic delivery for 5% off every order…3B Medical has received 510K FDA clearance for its Luna Positive Airway Pressure Platform. The Luna offers remote compliance monitoring and QR coding…HME providers in North Carolina met with Republican Sen. Richard Burr’s office this week to discuss Medicare issues like competitive bidding and audits, and their impact on providers and beneficiaries…Philadelphia-based BurmansRx has been recognized as a 2015 Philadelphia Smart CEO Family Business. The award honors family businesses that are growing and successful, according to a press release…Atlanta-based GF Health Products has received a flag that was flown over the U.S. Capitol Building in recognition of its efforts to manufacture products in the U.S. The company, which has three manufacturing facilities in Doraville, Ga., Fond du Lac, Wis., and Hazelwood, Mo., received the flag from Rep. Tom Price, R-Ga.

WASHINGTON – A pair of hearings this week shined another light on the HME industry’s issues with audits and competitive bidding.

On Tuesday, the Senate Finance Committee held a hearing on Medicare audits and the difficulty that providers face appealing denied claims.

“When any Medicare contractor decides that a claim should not be paid, it has a real effect on beneficiaries and providers, which is why it is so important that the appeals process allow these appeals to be heard in a timely and consistent fashion,” said Sen. Orrin Hatch, R-Utah, committee chairman, in his opening remarks.

A massive backlog at the Office of Medicare Hearings and Appeals means wait times of more than two years before a provider gets assigned an Administrative Law Judge hearing.

Among those who testified at yesterday’s hearing was Chief ALJ Nancy Griswold, who first called attention to the problem in a December 2013 memo.

On Monday, audits were also on the agenda at a hearing of the Small Business Administration. A handful of HME providers testified about the impact of not only audits but also competitive bidding on their businesses.

WASHINGTON – While most of the attention on recently passed legislation has focused on binding bids, another provision aimed at improving the competitive bidding program has essentially already taken effect: licensure.

“This is not something that Congress should have had to do but a lot of folks were completely incensed that CMS was just blithely offering contracts to companies,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “This sends a strong message from Congress to CMS that you better be sure the people you offer contracts to are licensed.”

That includes for the Round 2 re-compete, for which the bid window closed on March 26.

CMS’s own rules dictate that providers meet licensure requirements for the states in which they submit bids, but when contracts were awarded in Round 2 back in 2013, hundreds went to suppliers that didn’t meet those requirements, including more than 100 in Maryland.

Adding insult to injury: Many contracts went to providers located hundreds or thousands of miles from competitive bid areas. Since then, several states, including Alabama, have enacted licensure laws that require providers to have a physical presence in the state.

“I think most providers are being smarter, but what you don’t know are the wild cards—the speculators throwing out bids that are not committed to serving beneficiaries in those areas,” said Bachenheimer.

Some providers say they have learned from earlier rounds of competitive bidding what not do. Jamie Blair, for one, stuck to his own backyard yard when he recently rebid in the Round 2 re-compete.

“Last time, we bid around the country and won, and went the subcontracting route,” said Blair, vice president of Genesis Respiratory Services in New Boston, Ohio. “This time, we just bid in areas where we actually had service. It’s not worth it. It was more of a hassle.”

BALTIMORE – CMS has drawn another thick line between ventilators and Bi-level PAP devices.

The agency this week published an MLN Matters article announcing that it is revising its 855S enrollment application to make vents a separate product category.

“Right now, it’s kind of lumped in there with CPAPs and BiPAPs,” said Andrea Stark, a reimbursement consultant with MiraVista.

CMS has already published a number of bulletins clarifying the correct coding and coverage criteria for ventilators vs. Bi-level PAP devices. One big emphasis: Although the disease categories that qualify both products for coverage may appear to overlap, vents are covered only for more severe and life-threatening forms of the diseases.

By modifying the 855S form, CMS makes it clear that providers who furnish vents—not only invasive vents, but also non-invasive vents—must meet specific accreditation requirements, including “frequent and substantial servicing.”

“Providers need to meet the quality standards for invasive vents, even if they’re only providing non-invasive vents,” said Wayne van Halem, president of The van Halem Group. “They can’t drop off a non-invasive vent at a patient’s home and walk away.”

By modifying the form, CMS is also giving itself more leverage to take action against providers who aren’t in compliance with these accreditation requirements.

“It gives CMS one more way of enforcement,” Stark said. “The agency can revoke supplier numbers if providers aren’t in compliance.”

The change is most likely to affect providers that are looking at vents as a new product category and see non-invasive vents as a less intimidating way to enter the market.

“The message from CMS is you need to provide the full spectrum of vents or don’t do it at all,” Stark said.

The move is probably not CMS’s last on vents. The agency has already put non-invasive vents under widespread prepayment review and has included them in Round 1 2017 (see related story), both moves largely due to a spike in billing. The No. 1 provider of E0464, alone, received $4.5 million from Medicare in 2013, according to data obtained from CMS through a Freedom of Information Act request and featured in the HME Databank. 

What could be next: Certain stakeholders are pressing CMS to issue more specific coverage criteria for vents (there’s a National Coverage Determination, but no Local Coverage Determinations) that take into account clinical research supporting technological advancements.

“There’s no doubt this is not the last of the changes,” Stark said.

WASHINGTON – A pair of hearings last week shined another light on the HME industry’s issues with audits and competitive bidding.

On April 28, the Senate Finance Committee held a hearing on Medicare audits and the difficulty that providers face appealing denied claims.

“When any Medicare contractor decides that a claim should not be paid, it has a real effect on beneficiaries and providers, which is why it is so important that the appeals process allow these appeals to be heard in a timely and consistent fashion,” said Sen. Orrin Hatch, R-Utah, committee chairman, in his opening remarks.

A massive backlog at the Office of Medicare Hearings and Appeals means wait times of more than two years before a provider gets assigned an Administrative Law Judge hearing.

Among those who testified at yesterday’s hearing was Chief ALJ Nancy Griswold, who first called attention to the problem in a December 2013 memo.

On April 27, audits were also on the agenda at a hearing of the Small Business Administration. A handful of HME providers testified about the impact of not only audits but also competitive bidding on their businesses.

AAHomecare asks CMS to review prepayment process

WASHINGTON – AAHomecare submitted comments to CMS last week in response to the agency’s request to the Office of Management and Budgetfor information about how its contractors perform prepayment reviewof claims. While AAHomecare acknowledged CMS’s duty to identify fraud, the association took issue with the way CMS has exercised that right and offered recommendations on how to reduce unnecessary burdens on providers. AAHomecare’s recommendations include requiring contractors to: develop, officially publish, and adhere to consistent documentation standards that apply prospectively in the four DME MAC jurisdictions;request only the level and quality of information necessary to perform a review;implement procedures to prevent repeat audits of a beneficiary’s claims for the same piece of equipment; and allow contractors to rely on documentation available in a provider’s records to verify physicians’ signatures or proof of delivery. The association also submitted comments regarding CMS’s request to the OMB for information on the onsite survey tool used by the National Supplier Clearinghouse for onsite inspections. AAHomecare called for CMS to allocate more resources to improve inspector training.

VGM plans $20M expansion

WATERLOO, Iowa – The VGM Group last week secured an incentive package from the town of Waterloo for a $20-million expansion of its national headquarters, the Waterloo-Cedar Falls Courier reports. City Council members voted 5-0 on Monday to provide up to a $750,000 grant to buy land for the 73,000-square-foot, four-story addition on the south side of the current building. The town has also agreed to provide 75% property tax rebates for 10 years and complete a road extension costing an estimated $185,000, according to the newspaper. The addition is designed to house up to 275 employees, primarily to accommodate growth in VGM’s Homelink division, President Jim Walsh told the newspaper.

Apria heals all wounds—with help from Mölnlycke

LAKE FOREST, Calif. –Apria has agreed to use Mölnlycke Health Care’s Safetac technology and Avance Negative Pressure Wound Therapy (NPWT) to minimize skin reactions and pain during dressing removal and to limit the spread of wound fluid. “Our partnership with Mölnlycke Health Care is consistent with our focus on providing a positive patient experience throughout the continuum of care, from hospital to home,” stated Dan Starck, CEO of Apria, in a release. Mölnlycke’s products will be available for same-day local delivery.

Repair program launched

PORTLAND, Ore. – DME Repair and Training has launched a repair training and credentialing program. The training offers 110 hours of foundational and hands-on experience with repair for DME, including walkers, wheelchairs, hospital beds, lift chairs, scooters and power chairs. The credential establishes requirements and codes of ethics for technicians servicing DME. “The levels of professionalism are constantly raising in the DME industry, and professionally training and credentialing service technicians is a vital evolution toward serving clients,” said Matthew Macpherson, program developer.

Moneyline

Toronto-based Prism Medical reported revenues of $12.2 million for the first quarter of 2015, an increase of 23% compared to the same quarter the previous year. First quarter net income from continuing operations was $402,000 or $0.08 per common share vs. $179,000 or $0.02 per common share. Adjusted EBITDA was $1.4 million…LifeCare Pharmacyhas acquired Reuss Pharmacies. Reuss is a community pharmacy offering prescriptions, DME and home healthcare products. The San Antonio-based LifeCare offers compounding services and retail goods, according to a press release from Generational Equity, an mergers and acquisition firm that advised Reuss on the deal…Langhorne, Pa.-based Alliqua Medical, a provider of advanced wound care products, has announced pricing of an underwritten public offering of 6.6 million of its common stock at a price to the public of $4.55 per share. It expects to close the offering on May 4. Alliqua will use net proceeds from the offering to fund the expansion of its marketed products, explore additional products platforms and increase working capital, according to a press release.

Short takes

Medtrade will take place Oct. 26-29 at the Georgia World Congress Center in Atlanta. Registration is scheduled to open June 22 with early-bird rates…DeVilbiss Healthcare was named one of five finalists in the Pennsylvania Governor’s ImPAct Awards in the Jobs That Pay Category. Also a finalist is Golden Technologies CEO Richard Golden in the Entrepreneur ImPAct category. The awards honor companies that have had a substantial impact on growing the economy…WHILL teamed up with Stanford graduate and undergraduate students and Prof. David Jaffe for an engineering course called “Perspectives in Assisted Technology.” As part of the course, students designed, fabricated and tested prototypes for improving the experience for WHILL users traveling at night. The final design uses LED strips on various parts of the device to improve visibility for the user, and for drivers and pedestrians. Using three knobs, users can control color settings and light intensities…BioScrip, a provider of infusion and homecare management services, has named Jeffrey Kreger senior vice president, CFO and treasurer. Kreger joins BioScrip with more than 25 years of experience in financial and executive leadership roles. Most recently, he served as senior vice president of finance with LHC Group, a NASDAQ-listed post-acute healthcare services company…The National Mobility Equipment Dealers Association is sponsoring the fourth annual National Mobility Awareness Month contest. As part of the contest, wheelchair users will have the chance to win one of four wheelchair accessible vans by submitting a video detailing how they’ve personally triumphed over mobility challenges. Chairiot Mobility, BraunAbility, VMI and El Dorado Mobility have agreed to provide the vehicles and conversions…Attendance was up 10% at this year’s MAMES Spring Convention and Exhibition, held April 22-24 in Omaha, Neb. During the convention, MAMES member Greg Lord, director of Great Plains Rehabilitation Services in Bismarck, N.D., was named the winner of the 2015 MAMES Above and Beyond award. The award honors those who go the extra mile in the HME industry on a state, regional or national level. 

LLEIDA, Spain– A new study has found that monitoring patients with obstructive sleep apnea syndrome (OSA) in a primary care setting is equally effective as monitoring them in sleep units.

The study was conducted by Respiratory Research Group and led by Dr. Ferran Barbé, head of respiratory at the University Hospital Arnau de Vilanova (HUAV) in Lleida, Spain.

For six months, 101 patients with OSA received primary care management at one of eight primary care centers in Lleida, while 109 patients received sleep unit management atthe University Hospital Arnau de Vilanova. Both groups consisted of predominantly middle-aged obese men with severe OSA.

At the end of six months, the mean CPAP compliance for the primary care group was 4.94 hours per night, while the mean CPAP compliance for the sleep unit group was 5.23 hours per night.

The study also revealed that primary care monitoring resulted in 60% savings. On average, the total cost per patient in the primary care group was €144 ($162), while the total cost per patient in the sleep unit group was €356 ($401). The cost difference was related to the monitoring performed by specialist nurses in the sleep unit. 

WASHINGTON – With the HME industry’s “biggest challenge around the corner,” it’s more important than ever for providers to attend next week’s Washington Legislative Conference, AAHomecare officials say.

That challenge: CMS’s plan to roll out competitive bidding pricing nationwide on Jan. 1, 2016.

“We can’t get off the radar of Congress,” said Tom Ryan, president and CEO of AAHomecare. “We’re a pretty good blip on their screen right now.”

The industry scored a victory in April when the president signed into law a “doc fix” bill that included a provision requiring binding bids* and proof of licensure for future rounds of the program.

Stakeholders are working with industry champions in Congress on a bill to delay or phase in the national rollout, but it won’t be ready in time for the Hill visits during the conference, Ryan says.

“That doesn’t mean we can’t go out and prepare our members of Congress,” he said.

Attendees can use the industry’s recent victory as a pivot point to lobby against the national rollout, Ryan says.

“The pricing that’s being used today is based on a flawed system that was fixed by an act of law a month ago,” he said. “That pricing is still out there, and they want to use that pricing to expand the program.”

Other talking points during the visits will include moving up the effective date for the binding bids, reforming the audit program and creating a separate benefit for complex rehab.

In addition to conducting Hill visits, attendees will hear from Sean Cavanaugh, deputy administrator for the Center for Medicare at CMS, and several yet-to-be named members of Congress.

The conference won’t be all work and no play: AAHomecare has also scheduled an open reception on May 20 to honor Mal Mixon, the former chairman and CEO of Invacare. Rep. Pat Tiberi, R-Ohio, will be on hand to give Mixon a Legislative Advocate Lifetime Achievement Award. Going forward, the association will give out its annual Legislative Advocate Award in Mixon’s honor.

AAHomecare officials expect a good turnout for the conference—as good as last year, if not better.

“The binding bids win has built up momentum,” said Beth Ludwick, senior director of communications. “People are ready to keep that energy going.”