Are you the publisher? Claim or contact us about this channel


Embed this content in your HTML

Search

Report adult content:

click to rate:

Account: (login)

More Channels


Channel Catalog


older | 1 | .... | 23 | 24 | (Page 25) | 26 | 27 | .... | 61 | newer

    0 0

    06/05/2015
    HME News Staff

    WASHINGTON – Providers who CMS considers to be at high risk of defrauding Medicaid should expect fingerprint-based background checks on Aug. 1, the National Law Review reports. CMS released a State Medicaid Director Letter on June 1 providing guidance to states on the criminal background check and fingerprinting requirements for Medicaid provider enrollment. The letter starts a 60-day clock for state Medicaid programs to implement these enhanced provider screening requirements, according to the review. CMS implemented a similar provision for Medicare in August of last year.

    Rotech loses VA bid

    ORLANDO, Fla. – A federal court judge has ruled against Rotech Healthcare in a bid protest for a Department of Veterans Affairs contract.

    Federal claims judge Nancy Firestone ruled the VA’s decision to award the $46.3 million contract to Community Surgical Supply Medical was reasonable because CSS’s abilities and past performance were close enough to Rotech’s that the price difference of about $5.3 million was reason enough to change contractors, according to Law360.

    Rotech had argued that CSS’s bid was unrealistically low, that Rotech’s technical and past performance should have been rated higher, and that CSS couldn’t complete a transition in 45 days.

    Rotech’s original bid was $16.5 million higher than CSS’s. Rotech lowered its bid by $11 million, but the remaining difference was the deciding factor in CSS’s winning the contract, according to Law360

    “Rotech’s argument that the VA’s decision lacked a rational basis or was contrary to the solicitation fails,” Firestone said in a decision that remained under seal until June 1. “The court finds that none of the alleged errors in the price realism analysis warrant disrupting the contract award.”

    Rotech won a one-year contract from the VA, worth $68.3 million, in 2013.

    Pride Mobility expands in Mississippi

    EXETER, Pa. – Pride Mobility Products is investing $2 million in a new facility in Pontotoc, Miss., according to the Memphis Business Journal. The move will create 150 jobs, the journal reports. Pride Mobility will build its new facility in a building that formerly housed a manufacturing operation for Genesis Furniture, according to the journal. “We’re privileged to draw from such a dedicated local workforce, where the success of our venture will extend not just to the employees but to their facilities and the community,” Scott Meuser, chairman and CEO, told the journal.

    VGM links up with CRM provider

    WATERLOO, Iowa – The VGM Group has partnered with PlayMaker CRM to help HME providers better manage their relationships with referral sources. “Too often we hear from members that the CRM options in HME are not built for medical providers,” said Clint Geffert, president of VGM and Associates. “PlayMaker brings the CRM concept to HME in a way that is designed for post-acute providers.” Playmaker’s TargetWatch tool also allows providers to manage accounts, contacts, referrals, events and expenses; capture more market share by identifying high-value physicians and facilities; access information on iOS or Android devices; automate reporting; and increase sales and efficiency. It also integrates claims data from VGM Market Data.

    DME Data Solutions launches data application

    SAN DIEGO – DME Data Solutions has released a new Windows-based application that uses outcome measures to drive sales, it announced in a press release. The Patient Trend Reporting System combines device data with baseline diagnostic data, patient health assessments and satisfaction survey results. Data is available on-demand and users can generate reports on a regular basis. “A referral or payer can look at a one-page report and immediately see the patient’s baseline and how the patient has progressed since starting therapy,” said Ken Ravazzolo, president, in the release.

    OIG report includes DME items

    WASHINGTON – The Office of Inspector General included in its semiannual report to Congress a recommendation that the New York Medicaid program could have saved an estimated $8.9 million for selected DME by using pricing from Medicare’s competitive bidding program. Under recently completed actions and settlements, the OIG also reported that it has ordered OtisMed Corp., a biotech company that manufactures and sells knee replacement devices, to pay $34.4 million in fines and $5.1 million in forfeiture after pleading guilty to distributing, with intent to defraud and mislead, adulterated medical devices; and has ordered Maritza Velazquez, an office manager at Lutemi Medical Supply, a DME company in Carson, Calif., to pay $3.4 million in restitution after pleading guilty to conspiracy to commit healthcare fraud.

    LEVO finds representation in Canada

    MINNEAPOLIS – LEVO, a manufacturer and distributor of standing wheelchairs, has announced a new partnership with NuVision Rehab Group of Canada. As part of the partnership, NuVision, which represents rehab, mobility and home accessibility manufacturers from around the world, will assume responsibility for all sales of LEVO products throughout Canada. “LEVO has a long tradition of providing outstanding service to more than 35 countries around the world by partnering with organizations like NuVision,” stated Dan Johnson, president of LEVO and CEO of parent company Dane Technologies. “We are pleased to have NuVision and their knowledgeable team be our exclusive representatives in Canada.”

    Short takes: Univita, NMEDA, RESNA and more

    Univita Healthhas appointed Jack Greenman as CFO. Prior to joining Univita, Greenman served as executive vice president and CFO at Scott Holdings, where he managed assets after the sale of Vista Healthplans for $685 million…For the second year in a row, the National Mobility Equipment Dealer Association is a gold-level sponsor of RESNA’s annual conference. The “New Frontiers in Assistive Technology” conference takes place June 10-14 at the Sheraton Denver Downtown…RESNA’s Communication Technologies & Computer Access Special Interest Group seeks comments on a draft position paper, “Procedures and Guide to Support the Use of Speech Generating Devices as Augmentative and Alternative Communication.” The paper has been posted for a 30-day comment period…Ottobock plans to raise money for acquisitions and investments in research, development and marketing with an initial public offering in Germany. The manufacturer plans to list on the Frankfurt stock exchange in 2017, in a move that could be worth upward of $2 billion…Wright & Filippis relocated in May to a larger location in Dearborn, Mich. “We’ve been in Dearborn for about 30 years now, and always have a great relationship with Dearborn,” said CEO A.J. Filippis in a release. The new location offers customers better access and closer parking, as well as a “more intimate clinic setting.”

    People news: AAH, FAHCS

    AAHomecarehas announced new officers and board members who were elected during the association’s Washington Legislative Conference.Elected officers for 2015-2016 are: John Letizia, Laurel Medical Supplies, chairman; Steve Ackerman, Spectrum Medical, vice chairman; and Jay Broadbent, Alpine Home Medical, treasurer.Board members at large include: David Chester, Roberts Home Medical; Melissa Cross, O.E. Meyer Company; Robert Fahlman, Preferred Homecare; and Mike Kloos, The VGM Group…The Florida Alliance of Home Care Servicesseated its new executive committee at its Spring Conference and Exhibit May 28. Gene Sego of Sego’s Medical is president, Chris Townsend of Taffi Medical is president-elect, Deanna Rollyson of Matrix Medical is past president, Ron Jenkins of Respitec remains treasurer, and Karin Cole of All American Medical Equipment is secretary. 


    0 0

    06/12/2015
    HME News Staff

    BOSTON – A new study strongly disputes CMS’s claim that Medicare beneficiaries have experienced no disruption in access to diabetes supplies as a result of competitive bidding.

    A study by the National Minority Quality Forum, which was presented June 7 at the American Diabetes Association’s 75th Scientific Sessions, concludes that beneficiaries in the program’s initial nine test markets are receiving only a portion of the supplies they need, according to a press release.

    “A propensity score matched analysis, which assessed CMS data from 2009 to 2012, finds the number of beneficiaries with only partial SMBG acquisition increased by 23% in the test markets compared to 1.7% in the non-test markets,” the forum stated in the release. “Propensity score matching was adopted to reduce selection bias due to imbalance in study covariates.”

    Furthermore, the study concludes that the difficulty beneficiaries are experiencing getting the supplies they need has coincided with a higher number of deaths and hospitalizations in the test markets in 2011, the year competitive bidding was implemented.

    More specifically, the number of deaths in the analysis was nearly twice as high in the test markets compared with the rest of the Medicare population (102 vs. 60 deaths), and nearly 1,000 beneficiaries in test markets were admitted to the hospital compared to 460 beneficiaries in non-test markets (at a cost of $10.7 million vs. $4.7 million).

    "Results of the study show that beneficiaries are suffering following the implementation of the CMS program, and this disruption will be perpetual, as the process requires suppliers to resubmit bids every three years," stated Dr. Jaime Davidson, clinical professor of medicine at the University of Texas Southwestern Medical Center, and author of the study, stated in the release.

    The forum calls on CMS to be held to the same standards as other clinical trials involving humans.

    “A clinical trial's safety review board looking at these findings would stop a trial out of an abundance of caution for patients,” stated Gary Puckrein, PhD, president and CEO of the forum, and lead author of the study. “CMS undertook the competitive bidding program without an independent safety review board so policymakers have to assume the responsibility. They should suspend the competitive bidding process until CMS can effectively monitor the program and ensure that Medicare beneficiaries are protected from potentially harmful consequences."

    The forum is a Washington, D.C.–based not-for-profit, non partisan, independent research and education organization dedicated to improving the quality of health care that is available for and provided to all populations.

    Fight for access ‘rolls on’ at conference

    WASHINGTON – Mobility advocates met with 200 congressional offices to discuss complex rehab, Medicaid and other issues during United Spinal’s fourth-annual Roll on Capitol Hill last week.

    “Your courage to speak out and shed light on the issues that affect your quality of life is something that should be commended,” said Tom Aiello, a United Spinal Association board member, during welcome remarks. “There's no question, your voice will make a difference for our entire community." 

    More than 100 attendees gathered in Washington, D.C., for the conference, which was held June 7-10, to shape policies affecting those living with spinal cord injuries and disorders. 

    The conference also outlined legislative initiatives and policies designed to improve members’ lives, including bills H.R. 1516 and S. 1013, which would create a separate recognition for complex rehab wheelchairs under Medicare. 

    The conference also touched on the 25th anniversary of the Americans with Disabilities Act (ADA) and the 5th anniversary of the Affordable Care Act.

    “It's important to remember that the Affordable Care Act and the (ADA) have a very important relationship, as you think about the work you're doing here in D.C. at Roll on Capitol Hill and the importance of access to health care and health related services as a civil right," said keynote speaker Sharon Lewis, principal deputy administrator for the Administration for Community Living and HHS' senior adviser on disability.

    NSM makes buy in Denver

    FRANKLIN, Tenn. – National Seating & Mobility has acquired Denver-based USA Mobility, it announced June 4. Employees of USA Mobility, including branch manager Tom Johnson, have joined the NSM Denver team. “We pride ourselves on our customer service and expect our new colleagues to make us stronger yet,” said Johnson. It’s the latest in a string of acquisitions for NSM since 2013, including, most recently, the November acquisition of the custom seating and mobility business of Indianapolis-basedHome Health Depot. The USA Mobility deal closed May 29.

    Golden unveils new website

    OLD FORGE, Pa. – Golden Technologies has launched a new, mobile-friendly website, it announced last week. The site features a link on every product page where a consumer can click, fill out a brief form, and the information will be sent to the nearest Golden Flagship Retailer. “We are always looking at ways to drive traffic to our retailers,” said Patricia O’Brien, director of marketing and merchandising. The new site also features product accessory buttons that link to specific fabric upgrades and accessory options for each lift chair.

    NST taps new VP

    CONCORD, N.H. – National Sleep Therapy has named Kelly Bacon as vice president of operations and resupply. Bacon will oversee NST’s customer service and resupply teams in Maine, Massachusetts, New Hampshire and Vermont, according to a press release. She has worked in the DME field for most of her life, but has also worked in the finance and mortgage industries. “I’m excited to be an integral part of such a dynamic, pioneering and visionary company,” said Bacon. NST made Inc. Magazine’s 5000 list of one of the fastest growing private U.S. companies.

    New entrant in complex rehab market ready to ship

    TONAWANDA, N.Y. – The new ROVI X3 power base with Motion Concepts power positioning is ready to ship. The wheelchair from ROVI Mobility, a division of Shoprider, and Motion Concepts, is initially being offered in the K0856 and K0861 codes. “The new ROVI X3 power base gives providers and clinicians easy access to the modularity and function of Motion Concepts Ultra Low Maxx power positioning technology and Invacare Matrx Seating and positioning via one order form and one phone call to provide a complete solution to power mobility needs,” according to a press release. Shoprider announced plans to enter the complex rehab market in September 2013.

    Study: Disconnect on diabetes awareness

    BETHESDA, Md. – More than half of the U.S. public doesn’t know that diabetes can cause other major health issues, according to a new survey.

    Although 64% of Americans know someone with diabetes, 57% don’t realize the disease can cause heart disease, kidney failure and blindness, among other issues, according to a study from Telcare, a digital health company.

    Furthermore, 63% of Americans don’t know the difference between Type 2 and Type 1 diabetes, according to the survey.

    “The index clearly shows the striking knowledge gap among both the general public and those living with diabetes, and the serious need for increased public awareness and advocacy for additional funding research," said Andy Flanagan, CEO OF Telcare. "What is needed is a different approach to disease management, one that creates meaningful data that medical professionals can use to help provide the level of personalized care consumers demand." 

    More than 1 in 10 Americans (29.1 million) has diabetes. The majority of those (27.85 million) have been diagnosed with Type 2 diabetes.

    The survey also found that 70% of people are interested in using technology to track their family’s health and fitness. The most trusting of technology: millennials (18 to 34 years old), 55% of whom trust a health app over a health professional alone for advice. 

    Former Olympian set to headline Heartland Conference

    WATERLOO, Iowa – Amy Van Dyjen will give the keynote speech at this year’s VGM Heartland Conference held June 15-18 in Waterloo, Iowa. Van Dyjen, a six-time Olympic gold medalist and paraplegic, severed her spinal cord in an ATV accident one year ago, leaving her paralyzed from the waist down. Van Dyjen’s story gained national attention in May when she stood on her own for the first time since the accident on Good Morning America. This year’s conference will also feature VGM TIP talks—short talks from business innovators and a political expert—as well as the unveiling of Access Day USA, a national campaign to provide home modifications for people in need. 

    Sleep Specialists device used in OSA study

    BALA CYNWYD, Pa. – Sleep Specialists’ Zzoma Positional Device was used in a study researching cost effectiveness of positional therapy to help treat obstructive sleep apnea (OSA), the medical device company announced last week. Conducted by Temple University of Philadelphia, the study found that with the 24% of patients who had positional OSA therapy and used the Zzoma Positional Device, the result was a cost savings of 21% compared to if all patients were treated with CPAP therapy. “The new study only solidified what we already knew: incorporating positional devices into sleep apnea treatment algorithms are highly cost effective,” said Sila Yesilsoy, COO of Sleep Specialists in a release. 

    Tricare implements new breast pump policy

    FALLS CHURCH, Va. – Service members and their spouses will be able to receive free breastfeeding supplies, lactation services, and any manual, electric or hospital grade breast pump under a new policy. Beneficiaries can present their prescription at a pharmacy or medical equipment provider and receive a breast pump at no charge or purchase the pumps from any retailer and submit their receipt and a copy of their prescription to Tricare for reimbursement. Those who purchased a breast pump or other supplies covered by the policy on or after Dec. 19, 2014, can also seek reimbursement. In addition to breast pumps, the policy covers pump power adapters, tubing and tubing adaptors, locking rings, bottles, bottle caps, shield or splash protectors, and breast milk storage bags. The policy will be implemented July 1, 2015. 

    Negative pressure wound therapy market poised for growth

    LONDON – The global market for negative pressure wound therapy will expand from $700 million in 2014 to about $1.07 billion by 2021, representing a compound annual growth rate of 6.2%, according to new research from consulting firm GlobalData. The increase will be driven primarily by increasing physician awareness of the technique and its various applications, according to the firm. “As the education of physicians improves and they gain access to more robust clinical data from large, randomized trials, the outlook for the NPWT market looks strong, with room for further product improvement with next-generation devices and accessories,” stated Premdharan Meyyan, GlobalData’s analyst covering medical devices, in a release.

    Older and younger patients benefit from CPAP therapy equally

    SEATTLE – There’s little difference in improvement for older vs. younger patients treated with CPAP therapy, according to a study from the Sleep Disorders Center at the University of Iowa. Researchers evaluated data from 88 patients with both mild and moderate-to-severe newly diagnosed obstructive sleep apnea and categorized them into age groups: younger (less than 55 years) and older (65 or older). After four months of therapy, they found there was a 37% reduction in the Epwroth Sleepiness Scale in both groups. The study was presented last week as part of SLEEP 2015.

    Short takes: BioScrip, Compression Solutions, Inogen

    Elmsford, N.Y.-based BioScrip has extended the expiration date of its offer to exchange up to $200 million in aggregate principal amount of 8.875% senior notes due 2021. The offer will expire on June 16 instead of June 9 at 5 p.m. EST…Tulsa-based Compression Solutions hosted a grand opening on June 11 for its new $24 million facility. The 20,000-square-foot building allows the company to consolidate its three separate facilities into one space, putting its 40 employees under one roof…Goleta, Calif.-based Inogen has been honored as “Company of the Year” at the South Coast Business & Technology Awards. “The prestigious award is given to a company that is a market leader as demonstrated by its profitability, business development and completion of its strategic objectives,” said Susan Rodriguez, co-chairwoman of the award’s Steering Committee.


    0 0

    06/16/2015
    HME News Staff

    WASHINGTON – CMS needs to do a better job overseeing Medicaid managed care, the Government Accountability Office says in a report public released June 18.

    The GAO found that the program integrity units of five states and the Medicaid Fraud Control Units of seven states that were included in its review focus their efforts on Medicaid fee-for-service payments, not Medicaid managed care payments. This, the GAO points out, despite the fact that Medicaid managed care is growing at a faster rate than fee-for-service.

    Moreover, while CMS has delegated oversight of Medicaid managed care to states, it does not require them to audit these payments.

    “Unless CMS takes a larger role in holding states accountable, and provides guidance and support to states to ensure adequate program integrity efforts in Medicaid managed care, the gap between state and federal efforts to monitor managed care program integrity will leave a growing portion of federal Medicaid dollars vulnerable to improper payments,” the GAO stated in its report.

    Of the $431.1 billion that the government spent on Medicaid in fiscal year 2013, $14.4 billion or 5.8% were improper payments, according to the GAO.

    The GAO recommends that CMS increase its oversight by:

    1.   requiring states to audit payment to and by managed care organizations;

    2.   updating its guidance on Medicaid managed care program integrity; and

    3.   providing states additional support for managed care oversight, such as audit assistance from existing contractors.

    CMS asked for clarification on the first recommendation, and concurred with the second and third recommendations.

    On the first recommendation, the GAO said it would like to see CMS take the added step of requiring states to audit the appropriateness of payments to and by managed care organizations to better ensure Medicaid program integrity.


    0 0

    Will HME providers get their chance?
    06/18/2015
    HME News Staff

    WASHINGTON – Recent settlements of pending appealed claims between CMS and hospitals have given stakeholders hope that a settlement with HME providers is also possible.

    As of June 1, CMS has paid $1.3 billion from the Medicare Trust Fund to settle 300,000 pending appealed claims from more than 1,900 hospitals, according to an update.

    Back in August, CMS offered “an administrative agreement to any acute-care hospital or critical access hospital willing to resolve their pending appeals (or waive their right to request an appeal) in exchange for timely partial payment (68% of the net payable amount).”

    CMS made the offer to help break a logjam at the Office of Medicare Hearings and Appeals.

    Stakeholders have been in talks with OMHA on settlement options more geared toward HME providers.

    “The current settlement options offered by OMHA are not appealing to the DMEPOS industry based on strict criteria that OMHA has established to be eligible,” AAHomecare stated in a bulletin this week.

    Stakeholders hope options for HME providers will be a talking point during an OMHA conference call on June 25 to discuss updates on its initiatives.

     


    0 0
  • 06/19/15--11:11: Medicaid cuts add up
  • ‘We will not be able to continue providing recipients with equipment,’ said one poll respondent
    06/19/2015
    Tracy Orzel

    YARMOUTH, Maine – A whopping 70% of respondents to a recent HME Newspoll said their state Medicaid programs have reduced reimbursement in the past year.

    Respondents say these reductions are making it difficult to service patients, if it all.

    “This new cut means that, in many cases, we will not be able to continue providing recipients with the equipment/supplies that they need,” said Jeff Burkett, DME Manager at Mount Vernon, Ill.-based TMS Mobility & Rehab, which saw a 16.75% cut in Medicaid reimbursement rates in May*.

    Of those respondents who reported a reduction in reimbursement, the majority (50%) have seen reductions of 15% or more.

    Some states, like Rhode Island, have taken the extra step of reducing rates retroactively.

    “It’s truly an unfair practice,” said one respondent. “Providers perform with the expectation of a specific allowed amount, and then subsequently learn that the fee will be adjusted after the fact.”  

    Of the 30% of respondents who reported no recent reductions in Medicaid reimbursement, 67% said their state Medicaid program is considering a reduction.

    Another looming possibility: a provision included in the 21st Century Cures Act that would limit the federal portion of state Medicaid fee-for-service rates for HME to the Medicare competitive bidding rates.

    Even without reductions, some respondents say they’re struggling to break even.

    “Our state hasn't raised reimbursement rates in more than eight years for DMEPOS, putting it far lower than Medicare rates,” said one respondent. “Our new governor wants to do a massive expansion of more enrollees, but there is no plan to raise reimbursement rates to prevent us from losing money on each patient we see.”

    The states that are reducing Medicaid reimbursement are being shortsighted, respondents say.

    “Colorado Medicaid has given us an increase in the last two years,” said the respondent. “We had major cuts a few years back and they are trying to make up for those cuts with surplus money they have in the budget.”


    0 0
  • 06/19/15--11:09: Heartland draws crowd
  • Keynote speaker Amy Van Dyken tells attendees: ‘You learn to push through the challenges’
    06/19/2015
    HME News Staff

    WATERLOO, Iowa – The VGM Group’s Heartland Conference posted impressive numbers this year.

    The annual event saw a 15% increase in attendance and 13 new vendors, according to group officials.

    “This year’s Heartland Conference was a success,” said Christa Miehe, vice president of strategic projects. “We are pleased that so many members made the trip to Waterloo.”

    In all, there were 530 attendees and more than 70 vendors, according to VGM.

    The four-day event featured a keynote speech from Amy Van Dyken, a six-time Olympic champion and former competitive swimmer. Dyken suffered a major spinal cord injury in 2014, severing her T11 vertebrae.

    Her message to attendees: “You learn to push through the pain and the challenges.”

    That message and others resonated with attendees like Kim Barbour of Major Medical Supply in Denver.

    “I loved her comment, ‘Who are you to tell me what I can and cannot do?’” she said. “That is the attitude that drives success. Like Amy, I try to have a positive look on life. I come to work with a smile, because I know my staff is doing amazing things.”

    The keynote speech was followed by a myriad of education and training sessions. Attendees also enjoyed social events like the hog roast and fireworks during the event.


    0 0

    06/19/2015
    HME News Staff

    WASHINGTON – A nationwide sweep led by the Medicare Fraud Strike Force has resulted in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals.

    The individuals have been charged for their alleged participation in Medicare fraud schemes involving about $712 million in false billings, the Department of Health and Human Services announced last week.

    “This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement,” said Attorney General Loretta Lynch. “The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”  

    The defendants are charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of anti-kickback statutes, money laundering and aggravated identify theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, DME and pharmacy fraud.

    In one case in Los Angeles, for example, a doctor is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for DME, including more than 1,000 expensive power wheelchairs and home health services that were not medically necessary and often not provided.

    Including this week’s enforcement actions, nearly 900 individuals have been charged in national takedown operations, involving more than $2.5 billion in fraudulent billings. 

    The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion.

    GAO finds fragmented oversight of Medicaid

    WASHINGTON – CMS needs to do a better job overseeing Medicaid managed care, the Government Accountability Office says in a report public released June 18.

    The GAO found that the program integrity units of five states and the Medicaid Fraud Control Units of seven states that were included in its review focus their efforts on Medicaid fee-for-service payments, not Medicaid managed care payments. This, the GAO points out, despite the fact that Medicaid managed care is growing at a faster rate than fee-for-service.

    Moreover, while CMS has delegated oversight of Medicaid managed care to states, it does not require them to audit these payments. 

    “Unless CMS takes a larger role in holding states accountable, and provides guidance and support to states to ensure adequate program integrity efforts in Medicaid managed care, the gap between state and federal efforts to monitor managed care program integrity will leave a growing portion of federal Medicaid dollars vulnerable to improper payments,” the GAO stated in its report.

    Of the $431.1 billion that the government spent on Medicaid in fiscal year 2013, $14.4 billion or 5.8% were improper payments, according to the GAO.

    The GAO recommends that CMS increase its oversight by:

    1. requiring states to audit payment to and by managed care organizations; 

    2. updating its guidance on Medicaid managed care program integrity; and 

    3. providing states additional support for managed care oversight, such as audit assistance from existing contractors.

    CMS asked for clarification on the first recommendation, and concurred with the second and third recommendations.

    On the first recommendation, the GAO said it would like to see CMS take the added step of requiring states to audit the appropriateness of payments to and by managed care organizations to better ensure Medicaid program integrity.

    Hospitals take up CMS on offer. Will HME providers get their chance?

    WASHINGTON – Recent settlements of pending appealed claims between CMS and hospitals have given stakeholders hope that a settlement with HME providers is also possible.

    As of June 1, CMS has paid $1.3 billion from the Medicare Trust Fund to settle 300,000 pending appealed claims from more than 1,900 hospitals, according to an update.

    Back in August, CMS offered“an administrative agreement to any acute-care hospital or critical access hospital willing to resolve their pending appeals (or waive their right to request an appeal) in exchange for timely partial payment (68% of the net payable amount).”

    CMS made the offer to help break a logjam at the Office of Medicare Hearings and Appeals.

    Stakeholders have been in talks with OMHA on settlement options more geared toward HME providers.

    “The current settlement options offered by OMHA are not appealing to the DMEPOS industry based on strict criteria that OMHA has established to be eligible,” AAHomecare stated in a bulletin this week.

    Stakeholders hope options for HME providers will be a talking point during an OMHA conference call on June 25 to discuss updates on its initiatives. 

    Heritage Valley offers infusion patients more choices

    BEAVER, Pa. – Heritage Valley Health Systems has teamed up with Chartwell Pennsylvania to offer home infusion therapy, according to a story in the Beaver County Times. The partnership will give patients more choices when it comes to care, Bryan Randall, CFO of Heritage Valley, an integrated healthcare delivery network, told the newspaper. “We don’t have to create anything from scratch,” he said. “In some cases, it’s better to partner with an organization that’s already been successful in that field.” Based in Crafton, Pa., Chartwell offers infusion therapy and specialty pharmacy services in Pennsylvania, West Virginia and Ohio.

    Sleep portal seeks users

    WASHINGTON – Web-based community portal MyApnea.org is recruiting patients, caregivers and those at risk for sleep apnea to share information, support and research about the disease. Initially, researchers will focus on questions and results that are most important, practical, and empowering to those impacted by sleep apnea. “By having large amounts of data provided by and for us, we can now drive the research agenda,” said Kathy Page, who has sleep apnea and is a member of MyApnea.org’s Patient Engagement Panel. “This is a way to democratize research—to generate understanding on the part of the researchers and patients together.” MyApnea.org is the public face of the Sleep Apnea Patient Centered Outcomes Network.

    Noridian publishes review results for enteral nutrition, oxygen, test strips

    FARGO, N.D. – Noridian Healthcare Solutions, the Jurisdiction D DME MAC has published the results of prepayment reviews for a number of products from January through April 2015. Parenteral nutrition (B4185 and B4197) had error rates of 92% and 98%, respectively. Oxygen (E0434 and E0439) had error rates of 51% and 63%, respectively. Blood glucose test strips (A4253) had an error rate of 87%.

    NHIA to Boehner: Don’t use ASP for home infusion drugs

    WASHINGTON – The National Home Infusion Association has asked House Speaker John Boehner to drop a provision in H.R. 2570 that would change the payment structure for infusion drugs under the Part B DME benefit to an average sales price methodology. The provision is a “pay-for” in “The VBID for Better Care Act of 2015.” “The payment change for these drugs as set out in H.R. 2570 will make it very difficult, if not impossible, for home infusion providers to provide these drugs and the necessary services to Medicare beneficiaries,” the NHIA stated in a June 15 letter. “Beneficiaries without access to home infusion would most likely need to receive their care in more expensive institutional settings.” Instead, the NHIA asks that Congress pass its “Medicare Home Infusion Site of Care Act,” a bill that would require Medicare to pay for home infusion services and related supplies under Medicare Part B. H.R. 2570 also includes a provision prohibiting Part B DMEPOS drugs from being included in the competitive bidding program. “NHIA does support the prohibition,” the association stated in the letter. “However, it must be noted that while this provision may prevent the drug reimbursement under DMEPOS from being driven even lower, the issue of a service payment for home infusion professional services remains paramount to the industry and the industry cannot support an ASP pricing methodology without home infusion services being reflected.”

    Universal Software Solutions completes expansion

    DAVISON, Mich. – Universal Software Solutions has completed the renovation and expansion of its corporate headquarters to accommodate growth, the company announced June 15. The software company has reconstructed the upper floor of its building into useable office space and a reorganized customer service department. “(This) will provide the necessary space for additional staff members,” the company stated in a press release. Universal Software says it is looking to hire developers, software trainers and sales account executives “at an aggressive rate.” The company provides a fully integrated practice management solution called Healthcare Data Management System for the DME, home infusion, pharmacy and mail-order supplies markets. It offers both premise-based and hosted solutions.

    VMI launches commercial division

    PHOENIX – VMI has launched a new division to provide wheelchair accessible vehicles to commercial customers in North America. “Over the past 18 months, VMI has invested in product quality and manufacturing,” said Doug Eaton, president and CEO, in a release. “We are now well positioned to expand our retail strengths to the commercial market.” Hugh Palmer, director of product management, will head the new division. The launch of VMI’s first commercial wheelchair accessible vehicle is scheduled for July, and full-scale production and delivery is scheduled for August.

    Short takes: Stratice Healthcare, Breathe Technologies and more

    Stratice Healthcare has appointed Carmen Davies executive vice president and chief compliance officer. In this role, Davies will lead all aspects of the electronic order generation from the EHR/physician. Davies will also work with a number of industry stakeholders toward order standardization measures for CMS and other payers. Previously, Davies served as regional vice president of respiratory operations at Walgreens Infusion and Respiratory Services…Breathe Technologies has received 510(k) clearance from the Food and Drug Administration for its Life2000 ventilation system. The system is for adult patients who require positive pressure ventilation delivered invasively or non-invasively. It’s suitable for use in the home and institutional settings…101 Mobility of Boston now offers Philips Lifeline, which enables seniors and others to call for help in the event of a fall or other emergency. Offering the product makes 101 Mobility a one-stop shop for customers, the company says…Community Medical Products now offers the Melio Self-Emptying Leg Bag System. The Prairie du Sac, Wis.-based provider has a self-pay option for the product…American Medical Sales and Chart Industries have partnered to donate a new SeQual eQuinox portable oxygen concentrator to 6-year-old Cooper Anglemyer after Medicaid refused to pay for it. Anglemyer suffers from chronic lung disease and requires constant oxygen and a full-time nurse to monitor his oxygen levels…Invacare will be a national host sponsor and the official wheelchair of the 35th National Veterans Wheelchair Games. Presented by Paralyzed Veterans of America and the Department of Veterans Affairs, more than 600 veterans are expected to compete in the games, scheduled for June 21-26 in Dallas. 


    0 0

    06/19/2015
    HME News Staff

    WASHINGTON – A nationwide sweep led by the Medicare Fraud Strike Force has resulted in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals.

    The individuals have been charged for their alleged participation in Medicare fraud schemes involving about $712 million in false billings, the Department of Health and Human Services announced this week.

    “This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement,” said Attorney General Loretta Lynch. “The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”  

    The defendants are charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of anti-kickback statutes, money laundering and aggravated identify theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, DME and pharmacy fraud.

    In one case in Los Angeles, for example, a doctor is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for DME, including more than 1,000 expensive power wheelchairs and home health services that were not medically necessary and often not provided.

    Including this week’s enforcement actions, nearly 900 individuals have been charged in national takedown operations, involving more than $2.5 billion in fraudulent billings.

    The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion.


    0 0

    06/19/2015
    Theresa Flaherty

    WASHINGTON – Industry stakeholders are pushing hard on multiple fronts with a nearly five-week summer recess looming in August.

    The top priority: drafting language that would delay the Jan. 1 expansion of competitive bid pricing nationwide, something AAHomecare has been working on with Rep. Tom Price, R-Ga.

    “The key is what it’s going to cost and how do we pay for that?” said Tom Ryan, president and CEO of the association. “From a grassroots standpoint, providers need to let (lawmakers) know, if they are in a rural area, what this means for their business.”

    To that end, AAHomecare is partnering with The VGM Group on a study of the impact of competitive bidding so providers have hard data to back up their arguments.

    The study focuses on access to oxygen in the original Round 1 bidding areas and will be conducted by an academic research group that recently did a similar study for diabetes supplies, says VGM’s John Gallagher.

    “We already know the data shows, similar to diabetic supplies, that competitive bidding is causing problems and CMS is misleading Congress,” said Gallagher, vice president of government relations. “Because this is (an outside group) and peer-reviewed, CMS can’t say it’s just our industry numbers.”

    Other priorities include attaching to the 21st Century Cures Act language to require prior authorizations for DME and to address payment reductions for accessories for complex rehab wheelchairs.

    “There’s been positive reception to the PA language, and there’s sympathy on the accessories issue,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

    Rep. Marsha Blackburn, R-Tenn., introduced a bill in May that would require prior authorizations for high-dollar DME.

    Even if the industry gets its language into the Cures Act, the bill, which was originally expected to move to the House floor last week, is unlikely to make it further than that, says Bachenheimer.

    Still, “if you can get it into one package, it’s an easier lift down the line to attach it to another moving package,” she said.

    Stakeholders have also gotten wind that CMS expects to publish a final rule before July 4.

    “We don’t know if it has more meat on the bundling stuff, or a rethinking of how they want to calculate the pricing in the non-bid areas,” said Ryan. “We’re crossing our fingers that maybe this other rule is going to address the pricing.”


    0 0

    06/23/2015
    HME News Staff

    WASHINGTON – A bill to repeal the medical device tax passed in the House of Representatives last week.

    H.R. 160, the Protect Medical Innovation Act, passed with a bi-partisan vote of 280-140. The bill now heads to the Senate, where repealing the tax also has bi-partisan support, according to a press release from Rep. Erik Paulsen, R-Minn.

    “As a country, we take great pride in our ability to create, invent and innovate—especially when it comes to products that improve people’s lives,” stated Paulsen, who authored the bill. “The medical device tax stands in direct contract to this ideal, which is why you’ve seen members of Congress from across the political spectrum support its repeal. It’s time to push this legislation across the finish line and support American jobs and innovation.”

    The 2.3% medical device tax was included in the Affordable Care Act and went into effect Jan. 1, 2013. Most, but not all, home medical equipment was excluded from the tax.

    As an example of the impact of the tax, Paulsen noted one small business in his district is paying an effective tax rate of 79% because the tax is based on sales, not profit.

    Paulsen serves on the House Ways and Means Committee and the bicameral Joint Economic Committee, and is co-chairman of the Congressional Medical Technology Caucus.


    0 0

    06/25/2015
    HME News Staff

    WASHINGTON – CMS is proposing new codes for miscellaneous DME to reflect more accurate payment of Medicare claims.

    HCPCS codes E1399 and K0108 are currently used to bill for inexpensive items; however, the agency proposes to replace them with new codes effective Jan. 1, 2016.

    The public is invited to submit electronic comments on the proposal until July 9, 2015.

    The proposed codes are:

    ·      KXXX1: Durable medical equipment, miscellaneous, the purchase price does not exceed $150. Based on the average reasonable charges for items that could be included in this code, CMS calculates that the 2015 fee schedule amount would be $97.94; this amount will be updated by the 2016 covered item update.

    ·      KXXX2: Durable medical equipment, miscellaneous, the purchase price exceeds $150. Based on the average reasonable charges for all items covered by this code, CMS determines that the 2015 capped rental fee schedule amounts would be $80.60 for rental months 1 thru 3 and $60.45 for months 4 thru 13; these amounts will be updated by the 2016 covered item update.

    ·      KXXX3: Wheelchair component or accessory, miscellaneous, the purchase price does not exceed $150. The 2015 fee schedule amount generated based on CMS calculations would be $72.56; this amount will be updated by the 2016 covered item update.

    ·      KXXX4: Wheelchair component or accessory, miscellaneous, the purchase price exceeds $150. CMS calculates that the 2015 fee schedule amounts for items in this code would be $53.41 for months 1 thru 3 and $40.06 for months 4 thru 13; these amounts will be updated by the 2016 covered item update.

    ·      KXXX5: Repair part for use with beneficiary owned durable medical equipment, other than wheelchair, not covered under supplier or manufacturer warranty, not otherwise specified.  Payment will be made on a lump sum purchase basis, per the contractor's individual consideration of the item.

    ·      KXXX6: Repair part for use with beneficiary owned wheelchair, not covered under supplier or manufacturer warranty, not otherwise specified. Payment will be made on a lump sum purchase basis, per the contractor's individual consideration of the item.


    0 0

    06/26/2015
    Theresa Flaherty

    WASHINGTON – Industry stakeholders say, despite slow progress, the reintroduction of an audit reform bill is still a “high priority.”

    They had hoped to see Rep. Renee Ellmers, R-N.C., drop the bill this spring.

    “Obviously, we wanted it sooner than this,” said Beth Bowen, executive director of the North Carolina Association of Medical Equipment Services, who’s been working with Ellmers on the bill. “It’s still in the works, still a high priority.”

    The hold up? At least one member of the House Ways and Means Committee has issues with a provision in the bill reinstating clinical inference. This would allow audit contractors to make common sense judgments on whether claims should be paid, rather than denying them just because of technical issues.

    “If the bill is introduced without clinical inference it won’t make any sense,” said Tom Ryan, president and CEO of AAHomecare. “I think some of the pushback from the committee is probably coming from lobbyists for the Recovery Audit Contractors.” 

    Since the elimination of clinical interference in 2009, error rates for HME have soared, from less than 10% of claims to more than 60% of claims denied for technical reasons, stakeholders say. 

    Ellmers’ previous audit reform bill, introduced in July 2014, included a provision to reinstate clinical inference.

    Meanwhile, the backlog of appealed claims at the Administrative Law Judge level continues to grow, said Chief ALJ Nancy Griswold during a forum on June 25. During the first quarter of 2015, 128,000 appeals were filed, with an average processing time of 588.9 days, she said.

    “We are seeing sustained growth in appeals due to a number of factors,” she said. “We’ve seen across-the-board increases not only from RACs, but also from other post-pay audit programs, more active state Medicaid agencies, and more beneficiaries aging into the program.”

    OMHA is working with CMS to resolve issues surrounding the appeals workload, Griswold said, including trying to resolve cases earlier in the process.

    Michael Crochunis, deputy director for the Medicare Enrollment and Appeals Group, offered one bright spot on the call. Beginning Aug. 1, if a claim gets denied on post-pay review and is then corrected, it can’t be denied for any other reason.

    “This only applies to post-pay claims because they have already been through all our systems edits and subjected to medical review,” he said.


    0 0
  • 06/26/15--11:06: Bid lawsuit inches forward
  • One year after Cardiosom ruling, litigation and mediation still in play
    06/26/2015
    Liz Beaulieu

    WASHINGTON – The federal government on June 25 had its last chance to weigh in on whether or not a court ruling in favor of Cardiosom should be applied to other providers whose contracts were rescinded as part of the original Round 1 of competitive bidding. 

    Following the filing of this fourth brief, Jerry Stouck, a shareholder with Greenberg Traurig, the law firm representing Cardiosom and three other providers, believes the judge will make a decision in a few months time.

    “We’ll see,” he said. “The plaintiffs believe the cases are essentially identical and that the judge should apply the Cardiosom ruling.”

    A U.S. Court of Federal Claims judge ruled in Cardiosom’s favor a year ago, saying the provider is entitled to damages for being awarded contracts and then having them rescinded as part of an 18-month delay to the program in 2008. There are now nine lawsuits, representing 15 providers.

    In the Cardiosom case, the judge struck down the government’s argument that the contracts were subject to any changes in Medicare regulations. But the government has a new argument: When the contracts were terminated, the providers “were returned to the status quo,” meaning they were still able to do business with Medicare and at better reimbursement rates at that. 

    “The government is saying, ‘What’s the problem? We did you a favor by terminating the contracts,’” Stouck said. “We’ve responded that the whole purpose of the contracts was to significantly reduce the number of suppliers, so that, while the reimbursement was lower, they’d get higher volumes of business.”

    While litigation inches forward, the providers and the government are still pursuing mediation, as well. But it’s slow going, Stouck says, with the providers still waiting for sales volume data from CMS so they can put together damages claims.

    “By fall, we hope we’ll have a much better idea of whether the cases can be settled, or whether they need to be litigated,” he said.


    0 0

    06/26/2015
    HME News Staff

    WASHINGTON – CMS is proposing new codes for miscellaneous DME to reflect more accurate payment of Medicare claims.

    HCPCS codes E1399 and K0108 are currently used to bill for inexpensive items; however, the agency proposes to replace them with new codes effective Jan. 1, 2016.

    The public is invited to submit electronic comments on the proposal until July 9, 2015.

    The proposed codes are:

    KXXX1: Durable medical equipment, miscellaneous, the purchase price does not exceed $150. Based on the average reasonable charges for items that could be included in this code, CMS calculates that the 2015 fee schedule amount would be $97.94; this amount will be updated by the 2016 covered item update.

    KXXX2: Durable medical equipment, miscellaneous, the purchase price exceeds $150. Based on the average reasonable charges for all items covered by this code, CMS determines that the 2015 capped rental fee schedule amounts would be $80.60 for rental months 1 thru 3 and $60.45 for months 4 thru 13; these amounts will be updated by the 2016 covered item update.

    KXXX3: Wheelchair component or accessory, miscellaneous, the purchase price does not exceed $150. The 2015 fee schedule amount generated based on CMS calculations would be $72.56; this amount will be updated by the 2016 covered item update.

    KXXX4: Wheelchair component or accessory, miscellaneous, the purchase price exceeds $150. CMS calculates that the 2015 fee schedule amounts for items in this code would be $53.41 for months 1 thru 3 and $40.06 for months 4 thru 13; these amounts will be updated by the 2016 covered item update.

    KXXX5: Repair part for use with beneficiary owned durable medical equipment, other than wheelchair, not covered under supplier or manufacturer warranty, not otherwise specified.  Payment will be made on a lump sum purchase basis, per the contractor's individual consideration of the item.

    KXXX6: Repair part for use with beneficiary owned wheelchair, not covered under supplier or manufacturer warranty, not otherwise specified. Payment will be made on a lump sum purchase basis, per the contractor's individual consideration of the item.

    Congress looks to repeal medical device tax

    WASHINGTON – A bill to repeal the medical device tax has passed in the House of Representatives. H.R. 160, the Protect Medical Innovation Act, passed with a bi-partisan vote of 280-140. The bill now heads to the Senate, where repealing the tax also has bi-partisan support, according to a press release from Rep. Erik Paulsen, R-Minn. “As a country, we take great pride in our ability to create, invent and innovate—especially when it comes to products that improve people’s lives,” stated Paulsen, who authored the bill. “The medical device tax stands in direct contract to this ideal, which is why you’ve seen members of Congress from across the political spectrum support its repeal. It’s time to push this legislation across the finish line and support American jobs and innovation.” The 2.3% medical device tax was included in the Affordable Care Act and went into effect Jan. 1, 2013. Most, but not all, home medical equipment was excluded from the tax.

    Contract providers receive termination letters

    WASHINGTON – “Secret shopper” calls have lead to dozens of termination letters for contract providers, The VGM Group reports. Providers are receiving the letters after failing to respond to the calls. “Regional liaisons of the Competitive Bidding Implementation Contractor cited numerous complaints about out-of-state suppliers not honoring their contracts and in-state providers not offering all product codes within a category,” VGM says. If they receive a termination letter, providers have an opportunity to submit a “corrective action plan” and/or appeal the termination. “By taking the necessary steps, some providers have enacted plans and their contracts have not been terminated,” VGM says. For more information, read Mark Higley’s blog.

    BMC Medical wins case

    BEIJING – BMC Medical has announced that it has won an overseas patent infringement case against ResMed. ResMed previously filed a preliminary injunction against the Chinese manufacturer for a CPAP respiratory system machine with a detachable water talk. During an Oct. 23, 2014, hearing, the Court of Munich I lifted the preliminary injunction against BMC Medical “based on the considerably uncertain patentability of ResMed’s patent.” ResMed filed an appeal, but the decision was upheld.

    Quantum Rehab turns feedback into solutions

    EXETER, Pa. – Quantum Rehab has implemented a cloud-based application that allows its field staff to collect real-time feedback from consumers, clinicians and providers, and provide it to corporate departments via smartphone, tablet or computer. The Quantum Rapid Response System then allows the applicable departments, including R&D, quality, production, sales and customer service, to address any needs. “We wanted a way to convey consumer and market feedback throughout our entire organizations as quickly as possible for prompt solutions and results,” said Megan Kutch, director of marketing for Quantum Rehab, in a release. “With the cutting-edge technology of QSSR, we have the ability to distribute consumer needs from the field among our team almost instantaneously, and deliver solutions remarkably fast.” QSSR was recently used to enhance Quantum Rehab’s iLevel seat elevation technology. After feedback from the field, the company increased iLevel’s driving speed to 3.5 mph and updated existing units in the field in less than four days.

    Univita opens second pharmacy

    MIRAMAR, Fla. – Univita Health is opening a second state-of-the-art infusion pharmacy in Orlando, Fla. The pharmacy, which will feature a sterile cleanroom specifically designed for compounding intravenous medications, will offer a wide range of infusion therapies, including IV antibiotics, total parenteral nutrition, pain management and enteral nutrition therapy. It will be located in Univita’s distribution center and will serve a 100-mile radius. The company already has such a pharmacy in Miramar, Fla. Together the two pharmacies encompass 11,500 square feet of space and employ 11 full-time pharmacists. “Last year alone, we filled more than 145,000 prescriptions,” stated Michael Muchnicki, CEO, in a press release. “Many patients prefer the convenience of getting their infusions in the comfort of their own homes instead of having to spend hours at an infusion center or other facility.” The pharmacy is slated to open this summer.

    Advanced Health Care buys PDG

    MONTREAL – Advanced Health Care Products has acquired PDG Product Design Group, a Vancouver, British Columbia-based manufacturer of tilt-in-space, bariatric and high performance wheelchairs. Advanced Health Care is a distributor of home health care, long-term care and rehab products with a portfolio of 15 brands. It will keep PDG’s administration, engineering, manufacturing plant and customer service teams in Vancouver. Advanced Health Care plans to help PDG with an integrated presence across Canada, the U.S. and existing international markets.

    PHS, Reliable Medical make grade

    MINNEAPOLIS – Pediatric Home Service and Reliable Medical Supply have each been named a Top Workplace by the Minneapolis Star Tribune. The award ranks companies based on confidential employee surveys that measure their leadership, benefits and strategic direction, according to a press release. It’s the fifth year in a row that PHS has made the list, and its first garnering the No. 1 spot for midsized workplaces. “We are incredibly fortunate to employ people who are just as passionate about our business as we are,” said Mark Hamman, president of PHS. Reliable Medical also earned first place in the HME Excellence Awards last year. “We have amazing employees and their dedication to our customers and community makes Reliable a top home medical equipment supplier,” said Jeff Hall, president and CEO of Reliable Medical.

    Ottobock makes prosthetics stylish

    AUSTIN, Texas – Ottobock will partner with UNYQ to provide stylish prosthetics for lower limb amputees. UNYQ uses 3D printing to customize prosthetic fairings, according to a press release. The deal will allow Ottobock to expand its product portfolio. “Through our partnership with UNYQ, we are excited to offer products that enable our customers to combine their own identity with the technology we provide,’” said Dr. Falk Berster, business unit director for Ottobock.

    Wheel:Life publishes travel guide

    ATLANTA – Wheel:Life, an online community for wheelchair users worldwide, has published “Discovering: An Accessible US Travel Guide for Wheelchair Users” as an e-book on amazon.com. These accessible travel suggestions were gathered as part of the annual “Get Out & Enjoy Life” program, a joint educational initiative between Wheel:Life and Sports ‘n Spokes Magazine. The book culminates a month-long education program and photo contest launched June 1. “We are thrilled to provide practical advice and encouragement by offering this resource filled with handy travel tips, family-friendly destinations and travel pictures shared by wheelchairs users,” says author Lisa Wells. Wheel:Life was able to publish the book thanks to generous financial support from sponsors like ABC Medical, a provider of urology and incontinence supplies.

    Short takes: Medtrade, Convaid, Performance Health

    Early registration for Medtrade opened last week. The show will be held at the Georgia World Congress Center in Atlanta from Oct. 26-29… Convaid Products is presenting the First Annual South Bay Kidsfest June 27. The event, in collaboration with Pediatric Therapy Network and United Cerebral Palsy of Los Angeles, features a short-film festival for kids, carnival games, food and other activities, alongside an educational program for caregivers, parents and PT/OTs…Performance Health has relaunched PerformanceHealthAcademy.com, formerly TheraBandAcademy.com. In addition to focusing on the TheraBand, the academy will now begin to offer resources for the company’s growing portfolio of interconnected products. The site will serve as a resource that connects healthcare professionals and consumers to an ever-growing body of knowledge on exercise and techniques related to Performance Health products.

    People news: Mixon, Greatorex, Plauché

    Invacare Founder Mal Mixon will retire from the company’s board of directors effective June 30. “After much consideration, I have made the decision to retire from the Invacare board of directors to deal with recent health challenges,” Mixon stated in a press release. “I am very pleased with the transition of leadership to Matt Monaghan. I am confident in the future of the organization.” Monaghan* became Invacare’s chairman, president and CEO earlier this year…Jim Greatorex has joined VGM’s Retail Services Group. Greatorex, who has more than 20 years of HME retail experience, has been tasked with finding new products to help VGM members increase sales and build profitable retail businesses. Greatorex founded Portland, Maine-based Black Bear Medical supply in 1988 and is a former president of NEMED…AAHomecare has named Ashley Plauché to the newly created role of manager of government affairs. She will manage three association councils and provide support on government relations initiatives. Plauché was the director of communications and public relations for her family’s business, Lambert’s Health Care in Knoxville, Tenn. She is also co-founder, vice president and executive director of the Association for Tennessee Home Oxygen & Medical Equipment Services and a former board member of the Tennessee Association for Home Care.


    0 0

    07/02/2015
    HME News Staff

    ELYRIA, Ohio – Invacare has sold its device rentals business for long-term care facilities.

    The business, comprised of Invacare Outcomes Management and Dynamic Medical Systems, sold for $15.5 million in cash. The buyer was not disclosed.

    The deal will allow Invacare, which has struggled under the weight of a consent decree with the Food and Drug Administration, to refocus on its core businesses, says Matthew Monaghan, president and CEO.

    ''The sale of our United States rentals businesses allows us to narrow our focus on improving profitability in our core business, including the design, manufacture and distribution of medical devices,” he said in a press release.

    Monaghan took the reins April 1, and announced a 90- to 100-day plan to begin a turnaround of the North America HME business.

    The rentals businesses had net sales of approximately $7.2 million for the first quarter of 2015.

    Expo spotlights complex rehab

    WASHINGTON – NCART will host a “Congressional CRT Exposition” on Capitol Hill on July 20 to educate lawmakers and their staffs on complex rehab.

    The expo will feature hands-on displays of manual wheelchairs, power wheelchairs, seating and positioning products, and other equipment highlighting how complex rehab is different than DME. Consumers, clinicians, providers, manufacturers and other advocates will attend to provide demos and answer questions.

    “This will be a great opportunity to further demonstrate what CRT is all about,” said Don Clayback, executive director of NCART, in a bulletin to members. “We will be able to communicate in person what the technology looks like, who uses it, the benefits it provides, how it is configured to meet a person’s individual needs, and other important parts of the CRT message.”

    Complex rehab stakeholders are lobbying lawmakers to help them on a number initiatives, including creating a separate benefit for complex rehab, and reversing CMS’s decision to apply competitive bidding pricing to accessories for complex power wheelchairs.

    The expo is being hosted in conjunction with the United Spinal Association and the National MS Society.

    In other news, NCART has also pegged Aug. 17-21 as National CRT Awareness Week.

    Firm picks up fourth community pharmacy

    DALLAS – Ascendant Solutions, an investment firm, and its healthcare subsidiary, Dougherty’s Holdings, have acquired The Medicine Shoppe pharmacy in McAlester, Okla.

    It’s the fourth recent acquisition for Ascendant, which trades on Pink Sheets and is focused on acquiring, managing and growing community-based pharmacies in the Southwest region under Doughtery’s Holdings.

    “Given its excellent reputation as the premier independent pharmacy in McAlester, we intend to continue to operate this pharmacy under The Medicine Shoppe name,” stated Mark Heil, president and CFO of Ascendant, in a press release.

    The Medicine Shoppe is expected to add about $3 million in revenues to Ascendant’s results for 2015 and $6 million to its annual revenues on a full-year basis.

    Together, the four recent acquisitions should boost sales for Dougherty’s Holdings 45% to more than $42 million in 2015 compared to $29 million in 2014.

    The Medicine Shoppe provides retail prescriptions, non-sterile compounded prescriptions and home health products.

    Medline, Brightree pilot new supply interface

    MUNDELEIN, Ill. – Medline and Brightree have expanded an existing partnership to bring a new supply interface to the market for licensed home health and hospice dealers. Using the interface, these dealers will only have to enter patient data once rather than each time they order products. “Through this new interface expansion, we aim to help address common patient data entry challenges by making sure patients receive the right products when and where they need them,” stated Mike Lee, president, homecare sales division, Medline, in a press release. To test the interface, Medline and Brightree have coordinated a pilot program among home healthcare agencies and hospices nationwide. One of the trail participants: Natick Visiting Nurse Association. “This collaboration highlights two major forces in the post-acute industry: working together to become more integrated so that clients like us can provide better and more cost effective care to our patients,” stated Wendy Cofran, the association’s CIO.

    PMDRX gets representation

    GLENDALE, Ariz. – PMDRX has signed an exclusive territorial marketing agreement with MSL Associates in Tampa, Fla. MSL, a marketing, sales and logistics company, has representation in 21 states and Puerto Rico. Its staff includes ATPs, PTs, personal trainers and other healthcare professionals. PMDRX is a web-based mobility exam and documentation solution used by prescribing medical practitioners that integrates with mobility providers to ensure compliance. “Thousands of practitioners, including military physicians and facilities have been successfully using PMDRX for more than 4 years,” stated Gary Cox, CEO of PMDRX, in a press release. “Practitioners and suppliers utilizing PMDRX report virtually 100% documentation compliance evidenced by pre- and post-payment reviews, prior authorization affirmations and audits.”

    Apria Healthcare hires heroes

    LAKE FOREST, Calif. – Apria Healthcare has renewed its commitment to “Hiring our Heroes” by partnering with Direct Employers Group to launch a Military Occupation Code translator on its career page. The translator will allow transitioning service members to match their military skills and experience with available positions within the company. “At Apria Healthcare, we want to honor our veterans each and every day,” stated John Figueroa, chairman of Apria’s board of directors and a veteran, in a press release. “We are proud to welcome veterans to Apria where they can bring their unique skills and experience to serve our patients and strengthen our company.” “Hiring Our Heroes” was launched in 2014 to offer veterans the opportunity to make a successful transition to civilian life through employment with Apria.

    Medela’s staff gets certified

    MCHENRY, Ill. – Medela has partnered with the Wound Care Education Institute to provide industry certification to its professional wound care staff. The institute’s Certified Wound Care Market Specialist program educates professionals on evidence-based current standards of care in wound management. The institute has trained and certified nearly 1,000 wound care sales and marketing professionals in both the healthcare and manufacturing industries. "This partnership ensures Medela sales and marketing personnel continue to have the skills and competency in the evolving field of wound care to support clinicians nationwide," stated Nancy Morgan, president and co-founder of Wound Care Education Institute, in a press release. "This type of very focused training in wound care represents a growing opportunity to improve the overall clinical outcomes for wound care patients." Medela has been providing negative pressure wound therapy since 2008.

    Marble City Pharmacy wins top award from McKesson

    SAN DIEGO – Marble City Health Mart Pharmacy in Sylacauga, Ala., has been named the 2014 Pharmacy of the Year by McKesson. The award recognizes independent pharmacies that are best-in-class in a range of areas, including innovative approaches to their business and outstanding service to their community. McKesson recognized three additional pharmacies as regional winners: The Prescription Shop Health Mart Pharmacy in Montebello, Calif., Towncrest Health Mart Pharmacy in Iowa City, Iowa, and First State Health Mart Pharmacy in Wilmington, Del.

    People news: Insulet, Brightree and more

    Patrick Ryan, former COO of Insulet, has resigned to “pursue other interests.” Other changes: Mark Licari has been promoted to vice president of global manufacturing and operations; and David Colleran, who joined Insulet June 29, will succeed Anthony Diehl as vice president and general counsel. Diehl also resigned. Licari and Colleran will report directly to Patrick Sullivan, president and CEO…Brightree has appointed two new executives to support growth at the company: Lori Jones as executive vice president and general manager of home health, hospice and private duty; and Shaw Rietkerk as executive vice president and general manager of revenue cycle management…Jodi Clarkhas been named assistant director at Johnstown, Pa.-based Walnut Medical. Clark will assist in managing the day-to-day operations of the provider’s four locations…Bob Fary, vice president of strategic alliances at Inogen, has been selected to join AAHomecare’s board of directors. “Bob brings years of industry experience and knowledge to the board and has served diligently for years on our Regulatory Council working on industry issues,” stated AAH President and CEO Tom Ryan in a press release.

    Short takes: Therafirm, ACHC and more

    Therafirm’snew Ease brand of compression legwear was named Most Innovative Retail Product of 2015 as part of the “Retail Idol” competition at The VGM Group’s recent Heartland Conference. During the competition, manufacturers demonstrated their products and answered questions from a judging panel and audience members…The Accreditation Commission for Health Care’s sleep accreditation program has been accepted by PacificSource Health Plans. This allows ACHC-accredited sleep providers in Oregon, Idaho, Washington and Montana to access PacificSource’s network of 275,000 covered lives…The National Home Infusion Association will hold its 2016 Annual Conference & Exposition March 21-24 in New Orleans. The event features networking and education.


    0 0

    By Theresa Flaherty, Managing Editor
    07/10/2015
    Theresa Flaherty

    WASHINGTON – A bright spot in the high-profile 21st Century Cures Act that the House of Representatives passed on Friday: a provision that would extend CMS’s PMD demo.

    The provision would extend the demo, which requires prior authorizations for certain PMDs, through at least Aug. 31, 2018.

    “It’s a really big step forward in terms of expanding the demo nationwide,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “This was language that the industry strongly supported.”

    The demo, which kicked off in seven states in September 2012 and was expanded to an additional 12 states in 2014, is set to expire this Aug. 31.

    The provision also gives CMS the authority to expand the demo beyond the current 19 states and expand it to include all PMDs, options and accessories. 

    “We’re hopeful CMS will move forward on its own,” said Bachenheimer.

    Although the PMD demo has proven popular with providers and has the support of CMS, until now, there were no plans to extend it.

    “Stopping the demo is in no one’s best interest,” said Seth Johnson, vice president of government affairs for Pride Mobility.

    Another bright spot in the bill: a provision that would limit audits of claims that have already had an advance determination of medical necessity.

    Other HME-related provisions in the bill aren’t as popular, including a pay-for that seeks to reduce Medicaid rates to Medicare rates for certain HME included in the competitive bidding program starting in 2020, and a proposal to pay for Part B infusion drugs using an average sales price model.


    0 0

    07/10/2015
    HME News Staff

    WASHINGTON – President Barack Obama last week nominated Andrew Slavitt as CMS administrator, according to news reports.

    Slavitt has been acting administrator for CMS since Marilyn Tavenner stepped down in February.

    “Since taking the role in February, Slavitt’s focus as acting administrator is on strengthening CMS’s role in helping the healthcare delivery system meet the evolving needs of consumer by transforming the way care is paid for providing the tools to make the system thrive and by fostering simplicity and transparency,” according to his profile on the CMS web site.

    Slavitt originally joined the agency in July 2014 as principal deputy administrator.

    Reaction to the news of the appointment was mixed, according to reports. Some, like Senate Majority Leader Mitch McConnell said, “No one can successfully manage a law as unworkable as Obamacare,” while others, like American Hospital Association CEO Rich Umbdenstock said, Slavitt has a “deep understanding of the US healthcare system and a commitment to improving patient care.”

    Previously, Slavitt served as group executive vice president for Optum, where he oversaw the delivery of clinical, technology and operational solutions to healthcare clients and consumers. He was also CEO of OptumInsight.

    Additionally, Slavitt was the founder and CEO of HealthAllies, a consumer healthcare service company focused on serving people who are uninsured or underinsured by contracting affordable care on their behalf nationwide.

    Circadiance enters global pediatric market

    EXPORT, Pa. – Circadiance has acquired the SmartMonitor and NeoPAP product lines, including the infant apnea monitoring and PAP technologies associated with those lines, from Philips Respironics. The move allows Circadiance, manufacturer of the SleepWeaver soft cloth CPAP masks, to enter the global pediatric respiratory market. “Home infant cardiorespiratory monitoring is an established market dominated by SmartMonitor’s proven technology, which offers at-risk infants a smooth transition from hospital to home,” said David Groll, CEO of Circadiance, in a release. “NeoPAP represents the future of respiratory care in neonatal patients with respiratory distress syndrome. It’s an exciting combination that we intend to leverage with future innovation.”

    Rotech continues momentum

    ORLANDO, Fla. – Rotech has purchased the respiratory equipment assets of Alert Medical in Fort Myers and Naples, Fla. “The momentum continues,” said CEO Tim Pigg in a release. “We are thrilled to be expanding our footprint in these service areas.” Rotech has made three acquisitions since December, including assets from Specialized Medical Services in Cody, Wyo., and unnamed companies in Natchitoches, La., and the Gulfport, Miss., area. Rotech currently operates in 23 markets in Florida. Duckridge Advisors served as the exclusive M&A adviser to Alert Medical.

    Universal Software partners with Prometheus Group

    DAVISON, Mich. – Universal Software Solutions has partnered with Prometheus Group, an outcomes-based billing services provider, to help its HME provider customers to better leverage its Healthcare Data Management System. “Prometheus Group has a proven track record of helping DMEs improve efficiencies and overcome industry challenges,” said Christopher Dobiesz, CEO of Universal Software Solutions, in a press release. “We feel their services will help our clients maximize revenues in a constantly changing industry.” Prometheus specializes in delivering staff augmentation, operations consulting and full-service billing in a “new era of value-based care,” according to the release. HDMS is a fully integrated practice management solution that manages critical functions ranging from customer service and inventory to A/R and compliance.

    Noridian publishes review results

    FARGO, N.D. – Noridian Healthcare Solutions, the Jurisdiction D DME MAC, has published the results of prepayment reviews for a number of products. Oxygen (E1390) had a potential improper payment rate of 31% from March 2015 through May 2015. Group 2 pressure reducing support surfaces (E0277) had a potential improper payment rate of 62% from February 2015 though May 2015, while Group 1 pressure reducing support surfaces (E0181 and E0185) had improper rates of 52% and 63%, respectively, during that same timeframe. Vacuum erection devices (L7900) had a potential improper payment rate of 97% from February 2015 through May 2015. Diabetes testing supplies (A4253 and A4253KX) had improper rates of 50% and 64%, respectively, from March 2015 through May 2015.

    Patterson Medical secures exclusive rights

    WARRENVILLE, Ill. – Patterson Medical has entered into an exclusive distribution agreement with DJO Global to distribute the Chattanooga Fluidotherapy line of products. Effective July 1, Patterson Medical now serves as the sole supplier of the Fluidotherapy models for single extremity and double extremity use. Fluidotherapy is a dry heat therapy that transfers energy to soft tissues through suspended particles. In other news, Patterson Medical has announced that it was recently awarded the Supplier Legacy Award from Premier, Inc., a healthcare performance improvement company that serves an alliance of U.S. hospitals and other providers. Patterson Medical was recognized for its long-standing support of Premier members through customer service and engagement, value creation and commitment to lower costs.

    Short takes: VMI, Golden Technologies, Medtrade

    VMI honored long-time employee Tiger Desmarais with a Lifetime Achievement award for 20 years of service. Along with a key to the company, Tiger received a new silver 2015 Toyota Sienna…Timothy Robinson has been hired as the new director of digital media at Golden Technologies. Robinson is tasked with producing product sales and training videos, dealer TV commercials and technical repair videos… This year’s Medtrade will mark Shelly Prial’s last appearance at the conference. The 88-year-old Medtrade ambassador has been to all but one event since its inception. 


    0 0

    07/10/2015
    HME News Staff

    WASHINGTON – President Barack Obama on Thursday nominated Andrew Slavitt as CMS administrator, according to news reports.

    Slavitt has been acting administrator for CMS since Marilyn Tavenner stepped down in February.

    “Since taking the role in February, Slavitt’s focus as acting administrator is on strengthening CMS’s role in helping the healthcare delivery system meet the evolving needs of consumer by transforming the way care is paid for providing the tools to make the system thrive and by fostering simplicity and transparency,” according to his profile on the CMS web site.

    Slavitt originally joined the agency in July 2014 as principal deputy administrator.

    Reaction to the news of the appointment was mixed, according to reports. Some, like Senate Majority Leader Mitch McConnell said, “No one can successfully manage a law as unworkable as Obamacare,” while others, like American Hospital Association CEO Rich Umbdenstock said, Slavitt has a “deep understanding of the US healthcare system and a commitment to improving patient care.”

    Previously, Slavitt served as group executive vice president for Optum, where he oversaw the delivery of clinical, technology and operational solutions to healthcare clients and consumers. He was also CEO of OptumInsight.

    Additionally, Slavitt was the founder and CEO of HealthAllies, a consumer healthcare service company focused on serving people who are uninsured or underinsured by contracting affordable care on their behalf nationwide.


    0 0

    Association launches campaign to ‘stop the cuts’
    07/16/2015
    HME News Staff

    WASHINGTON – Rep. Tom Price, R-Ga., is finalizing legislative language to soften the blow of the national roll out of competitive bidding slated for Jan. 1, according to AAHomecare.

    The legislation would “provide a 30% increase in reimbursement over the bidding-derived prices and a four-year phase-in period for these rates, and include a provision that would reinstate the bid cap at the unadjusted fee schedule,” the association says.

    “AAHomecare is in a full court press to support this forthcoming legislation,” it says.

    AAHomecare has launched a new website to build awareness and drive grassroots action among HME providers for the forthcoming legislation: action.aahomecare.org/stopthecuts. The association encourages providers to visit the website and send an email to Congress.

    With a month-long congressional recess starting Aug. 3, AAHomecare also encourages providers to discuss their concerns with lawmakers face-to-face.

    “It’s time for members of Congress to hear firsthand how these cuts will kill small business in rural areas,” the association says.


    0 0

    ‘It’s not as dramatic a cut so quickly,’ Bachenheimer says
    07/17/2015
    Theresa Flaherty

    WASHINGTON – With legislation to modify the national rollout of competitive bidding in the works, industry stakeholders are setting the stage for a full court press. 

    But there’s only so much they can do until they have a “score” from the Congressional Budget Office, they say.

    “We’ll begin a full grassroots push, which we’ve lined up,” said Tom Ryan, president and CEO of AAHomecare. “We can work the committees and we can work the grassroots angle, but we’ve got to get a score.”

    The legislation, drafted by industry champion Tom Price, R-Ga., would provide a 30% increase in reimbursement over the bidding-derived prices and a four-year phase-in period, and include a provision that would reinstate the bid cap at the unadjusted fee schedule.

    As the current plan stands, CMS wants to apply bid pricing in two phases: 50% of the cut Jan. 1 and the full cut on July 1.

    “It’s not as dramatic a cut so quickly, so it gives providers the ability to make plans and to adjust over a longer period of time, which is really critical for business,” said Cara Bachenheimer, senior vice president of government relations for Invacare. 

    Asked whether a 30% reimbursement adjustment could be too big of an ask, Bachenheimer says stakeholders have their work cut out for them, but she says it is “a reasonable and proper request.” 

    “It’s understood in health care that the cost to serve is higher in rural areas,” she said. “There are plenty of reasons to have a bump-up in pricing. CMS is blindly applying bid prices, which makes no sense.”

    It certainly makes no sense to Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services, which represents seven states, including the “100% rural” Dakotas. MAMES will host a virtual fly-in on Wednesday to start greasing the wheels for the legislation.

    “Providers, if they even survive, say there will be a vast difference of what they are going to be capable of doing (compared to what they do now),” she said. “We have some members who are the only provider within a 150-mile radius. They are not going to be able to cover that any more.”


older | 1 | .... | 23 | 24 | (Page 25) | 26 | 27 | .... | 61 | newer