MIAMI – A federal judge has ruled that two former Lincare employees failed to prove the provider violated Medicare telemarketing rules.

U.S. District Judge Kathleen Williams on July 10 issued a partial summary judgment that freed Lincare from most of the charges outlined in a whistleblower lawsuit accusing the provider of violating the False Claims Act.

The plaintiffs had argued that Lincare and its subsidiary, Diabetic Experts, violated Medicare rules by using improper sales leads to make unsolicited phone calls to beneficiaries, and by using “purportedly” false assignment of benefits given to Lincare.

The judge ruled that Diabetic Experts is a subsidiary of Lincare, not a separate entity; therefore, because the beneficiaries had received oxygen supplies from Lincare within the 15-month time period before the calls, those calls do not violate the False Claims Act.

The judge also ruled that all of the assignments of benefit in question “contain clear language providing for services to be rendered by ‘Lincare’ or ‘Supplier.’”

The plaintiffs have also charged, however, that other false claims might “lie” with Med4Home, Reliant Pharmacy Services, or other entities related to Lincare.

The judge ruled that both parties must file a joint status report by July 22 indicating what claims, if any, remain and how they want to proceed.

ASP: Up for brand name neb-meds

BALTIMORE – Third-quarter payments for respiratory drugs are up and down. Brand name drugs Brovana (J7605) and Perforomist (J7606) were up 16 cents and nearly 44 cents to $7.20 and $8.48 per dose, respectively. Payments for budesonide (J7626) were down nearly 38 cents to $5.20 per dose and payments for albuterol (J7613) were cut in half to 13.5 cents per dose. Ipratropium (J7644) stayed relatively flat at just under 11 cents per dose.

Hospital group taps former CMS administrator as new leader

WASHINGTON – The board of directors of America’s Health Insurance Plans has elected Marilyn Tavenner, the former administrator of CMS, as its president and CEO. The appointment is raising eyebrows on Capitol Hill, with Tavenner now representing and lobbying on behalf of large health insurers that are regulated by CMS. These insurers are also looking to Medicare Advantage as a key growth area for their businesses. Tavenner replaces Karen Ignagni, who served as AHIP’s top lobbyist for 22 years. Ignani is headed to New York-based insurer EmblemHealth.

ActivStyle secures financing

MINNEAPOLIS – ActivStyle has obtained a credit facility from Garrison Investment Group, it announced July 14. The provider of incontinence products will use the proceeds to refinance debt and provide capital for growth, according to a press release. Terms of the deal, which consists of a term loan and revolving credit facility, were not disclosed. ActivStyle is a portfolio company of The Riverside Group. In addition to incontinence products, the provider offers urological, enteral, ostomy and wound care products.

Lewarski joins Drive-DeVilbiss team

PORT WASHINGTON, N.Y. – Joseph Lewarski has joined DeVilbiss Healthcare as vice president of global respiratory and sleep categories, Drive Medical announced July 14. DeVilbiss is a subsidiary of Drive. In his role, Lewarski will work with the company’s global sales and product management teams to grow the categories. Lewarski has more than 30 years of experience in health care, including seven years with Invacare. “This is an exciting time to be joining the Drive-DeVilbiss team,” said Lewarski. “There is tremendous growth potential for the company in the respiratory and sleep categories.” Drive acquired DeVilbiss earlier this month.

CMS uses data to thwart $820M in fraud

WASHINGTON – CMS’s Fraud Prevention System has identified and prevented $820 million in inappropriate payments in three years of use, the agency announced last week. In 2014 alone, the system identified or prevented $454 million in inappropriate payments, a 10 to 1 return on investment, it says. “We are proving that in a modern health care system you can both fight fraud and avoid creating hassles for the vast majority of physicians who simply want to get paid for services rendered,” said Andy Slavitt, acting administrator of CMS. “The key is data.” The system uses predictive analytics to identify troublesome billing patterns and outlier claims for action similar to systems used by credit card companies. Going forward, CMS plans to expand the system and its algorithms to identify lower levels of non-compliant healthcare providers who would be better served by education or data transparency interventions.

OIG certifies CMS’s fraud savings

WASHINGTON – The Office of Inspector General has certified $133.2 million of actual and projected savings from CMS’s Fraud Prevention System, a return of investment of $2.84 for every dollar spent on the system. The OIG also certified $454 million in unadjusted savings identified by the system. The Small Business Jobs Act of 2010 requires the OIG to certify the actual and projected savings related to the system for each of its first three years. This most recent report fulfills the OIG’s responsibilities for the third year. To help identify and better report savings from the system, the OIG recommends that CMS provide its contractors with improved written instructions on how to attribute savings accurately and better document the contribution of the system toward achieving administrative actions. CMS agreed and has outlined steps for making these improvements. Earlier this month, the agency announced that the system identified and prevented $820 million in inappropriate payments in three years of use.

Study: Vent therapy cuts readmission rates for COPD patients

ANDOVER, Mass. – Readmission rates for COPD patients who were hospitalized two or more times within a year and who were transitioned to a patient management program that included treatment with non-invasive positive pressure ventilation were reduced 97% during the subsequent 12 months, according to new research published in the Journal of Clinical Sleep Medicine. The proportion of COPD patients included in the study who were readmitted on two or more occasions decreased from 100% (397 of 397) in the year prior to initiation of intervention to 2.2% (9 of 397) in the following year. The study, authored by Steven Coughlin, PhD, Wei Liang, PhD, and Sairam Parthasarathy, MD, examined 397 patients who had all been hospitalized at least twice in a single year with an acute COPD exacerbation. Each patient was prescribed a Trilogy ventilator manufactured by Philips Respironics for home use. Continued in home care consisted of medication management, oxygen therapy, patient education and ongoing respiratory therapist care in the home. “This study holds promise in how a multi-faceted intervention could assist health systems in significantly improving the care of the patients with advanced stage COPD in their home,” said Parthasarathy, professor of medicine and director of the Center for Sleep Disorders at Banner University Medical Center in Tucson.

NCPA announces student finalists

ALEXANDRIA, Va. – The National Community Pharmacists Association has named the finalists for the 2015 Good Neighbor Pharmacy NCPA Pruitt-Schutte Student Business Plan Competition. The three teams are from the South Carolina College of Pharmacy, the University of Arkansas for Medical Sciences College of Pharmacy, and the University of Minnesota College of Pharmacy. They will present their business plans in a live competition Oct. 10 at NCPA’s annual convention. The goal of the competition is to motivate pharmacy students to create a business model for buying an existing independent community pharmacy or opening a new pharmacy, according to a press release.

Short takes: Point-of-Rental Software, Univita

Point-of-Rental Software, a Grand Prairie, Texas-based company offering rental and inventory management solutions to thousands of companies worldwide, including HME companies, was one of nine finalists competing for the Cloud Innovator of the Year title at the 2015 Cloud Innovation World Cup Awards on July 8. Held at Google headquarters in New York, the awards identified advancements in cloud computing, with the goal of fostering cutting-edge solutions. Point-of-Rental Cloud was chosen as a finalist out of 312 software products from 59 countries…Univita Health has joined the Florida Association of Health Plans. The provider of post-acute and home healthcare solutions has also signed on as a gold sponsor of the FAHP’s upcoming annual conference in Orlando. The FAHP is the state’s trade association representing Florida’s health plans…The U.S. Small Business Administration will sponsor two Regulatory Enforcement Fairness Roundtable discussions July 21 in Bozeman, Mont., and July 23 in Great Falls, Mont. The VGM Group encourages providers in the area to attend to voice their concerns about CMS’s audit and appeals process, and the agency’s national rollout of competitive bidding pricing…Hollister has consolidated its product line to focus on its VaPro Plus intermittent catheter.

BOZEMAN, Mont. – The impact of audits and competitive bidding on rural providers was on the agenda at a roundtable held by the Small Business Administration yesterday.

HME providers and other stakeholders attended the roundtable discussion on Regulatory Enforcement Fairness and hosted by Brian Castro, SBA national ombudsman.

“These unreasonable and excessive audits from CMS are crippling to durable medical equipment providers in Montana,” said Andrew Jeske, CEO of American Seating & Mobility in a VGM bulletin. “Audits are holding up revenue, for multiple years in most cases, that is crucial to the survival of rural providers.”

An appeals backlog at the Administration Law Judge Level put the backlog at more than 870,000.

Providers also spoke out against the national expansion of competitive bid rates, which will disproportionately impact rural providers.

“We face much different obligations than metropolitan areas,” said Mike Calcaterra, Montana Chairman of Big Sky AMES. “Fueling an SUV for an oxygen tank delivery that is 75 miles one-way is unsustainable with the proposed cuts.”

Castro told attendees the SBA understand problems associated with both issues and would be addressing them with key members of Congress.

Another roundtable is scheduled for Thursday, July 23 at the University of Great Falls in Great Falls.

YARMOUTH, Maine – Forty-three percent of respondents to a recent HME NewsPoll say they’re filing fewer appeals due to the massive backlog at the ALJ level.

Of those filing fewer appeals, the majority say they’re now handling denied claims by either asking patients to sign ABNs and pay out of pocket (30%), or picking up their equipment (26%).

“I very carefully review the documentation and situation to determine whether to appeal, pick up the equipment, ‘re-qualify’ the patient and start over, or cut our losses,” wrote Sharon Suchomel, DME billing and compliance for ThedaCare At Home in Appleton, Wis. “Many factors go into this, such as patient circumstance, technical vs. not meeting medical necessary denial, cost of equipment, etc. It depends on whether it is worth the time and effort to advocate for the patient or try to ‘win’/prove a point to Medicare.”

The Office of Medicare Hearings and Appeals recently reported that during the first quarter of 2015 alone, 128,000 appeals were filed at the ALJ level with an average processing time of 588.9 days. 

Respondents say they’re trying their hardest to make appeals unnecessary by doing more on the front end to get claims paid, but this comes at an increased cost.

“As with all providers, we’re struggling with the minutiae (date stamps, signature with date, NPI, legible signature) instead of the ‘meat’ (the actual clinical needs and medical necessity),” wrote Maryanna Hart, AR coordinator for Van’s Medical Equipment of Lakeland in St. Joseph, Mich. “It’s adding to higher administrative costs.”

It is also affecting beneficiary access to products and services, respondents say.

“It’s creating a lot more delays for patients getting their equipment as we are scrutinizing documentation much more closely,” wrote David Chesnut, owner of Pennyrile Home Medical in Cadiz, Ky. 

Some respondents say they’ve gone as far as to refrain from providing products and services that are consistently denied or would warrant an appeal.

“We are losing business because we will not supply over the max allowed for urology supplies,” wrote Donna Barraclough, customer service manager for Apple West Home Medical Supply in Emeryville, Calif. “You can’t really cut down on how much urine you produce without a significant change to your overall health. Our customers who have had over the max in the past are now suffering because they must cut down on use.”

BOZEMAN, Mont. – The impact of audits and competitive bidding on rural providers was on the agenda at a roundtable held by the Small Business Administration last week.

HME providers and other stakeholders attended the roundtable discussion on Regulatory Enforcement Fairness and hosted by Brian Castro, SBA national ombudsman.

“These unreasonable and excessive audits from CMS are crippling to durable medical equipment providers in Montana,” said Andrew Jeske, CEO of American Seating & Mobility in a VGM bulletin. “Audits are holding up revenue, for multiple years in most cases, that is crucial to the survival of rural providers.”

An appeals backlog at the Administration Law Judge level puts the backlog at more than 870,000.

Providers also spoke out against the national expansion of competitive bid rates, which will disproportionately impact rural providers.

“We face much different obligations than metropolitan areas,” said Mike Calcaterra, Montana Chairman of Big Sky AMES. “Fueling an SUV for an oxygen tank delivery that is 75 miles one-way is unsustainable with the proposed cuts.”

Castro told attendees the SBA understand problems associated with both issues and would be addressing them with key members of Congress.

Brady calls hearing on rural health

Rep. Kevin Brady, R-Texas, chairman of the House Ways and Means Health Subcommittee will hold a hearing July 28 to discuss rural health care disparities created by Medicare regulations. Stakeholders maysubmit a written statement for consideration, however only the invited witness will testify. Those who wish to submit written comments may do so here.

SGD bill passes

WASHINGTON – The Steve Gleason Act is headed for the president’s signature. The bill, passed July 15, was signed off by Speaker John Boehner July 21. It protects access to medically necessary speech generating devices by making the devices purchase items instead of capped rental items, and clarify statutory language to ensure coverage of eye-tracking technology for beneficiaries who need it to operate their devices.

AAHomecare initiates grassroots initiative

WASHINGTON – AAHomecare last week launched a new initiative to help stop the nationwide rollout of competitive bid pricing slated for Jan. 1. PowerofHomecare.com allows users to send electronic letters to their representatives asking them to support legislation that seeks to prevent the expansion of rate cuts to non-competitive bid areas, which could cut reimbursement for rural providers by 45%, stakeholders say.

Oncologix increases sales ‘organically’

LAFAYETTE, La. – Oncologix on July 21 reported net revenues of $1.2 million for the three months ended May 31, 2015, compared to $988,000for the same period last year, a 25% increase. The medical holding company reported net revenues of $3.6million for the nine months ended May 31, 2015, compared to $2.7 million for the same period last year, a 34% increase. “We are very pleased with the results of our third quarter fiscal 2015. We increased our division sales revenues by organic growth and we will continue to focus on debt reduction over the next three months," said CEO Wayne Erwin in a release. Oncologix acquired Esteemcare in September 2014.

MK Battery hosts soccer championship

TAMPA, Fla. – Ten teams from around the country participated in the recent MK Battery Power Soccer Premier Cup Championship, the company announced. CNY United was the eventual winner, according to a press release. “The sport of power soccer enhances the lives of those with disabilities and we are extremely proud to be taking such an active role in the program,” said Wayne Merdinger, executive vice president and general manager of MK Battery. MK Battery has been the Title Sponsor and Official Battery of the United States Power Soccer Association and Team USA, which represents the United States in the Power Soccer World Cup.

Short takes

CPAP Store Las Vegas launched last week. The online store caters to customers who have already been diagnosed with sleep apnea and offers CPAP machines, masks, humidifiers, supplies and accessories…The BCP Group, an O&P practice management company,has acquired Raleigh, N.C-based Beacon Prosthetics and Orthotics. The Nashville-based company will provide operational services and practice resources to support Beacon’s growth and Beacon will retain its name…InfuSystem Holdings, a national provider of infusion pumps and related services, has launched InfuSystem EXPRESS at the University of California in San Diego. The patent-pending EMR connectivity solution automates the daily processes associated with treatment logs and pump assignments, and tracks and standardizes data flow at practices with multiple locations…Somnia, a sleep wellness and retail store in Lone Tree, Colo., has published an e-book for people impacted by sleep disorders. The Sleep Disorder Guide: Symptoms, Treatments & Solutions is available for free download here.

A Personal Touch Boutiques has acquired MJ Medical. The La Mesa, Calif.-based MJ Medical provides mastectomy and compression products. ATP is a division of SunMED and plans to launch a National Network Affiliate for boutique owners.

People news

National Seating & Mobility has named William Mixon as its new CEO, the provider announced July 20. Mixon joined the company as president in *July 2014…Stealth Products has tapped Barry Steelman as its director of marketing, the manufacturer announced July 22. Steelman has more than 20 years of experience, most recently at Permobil…Permobil has named Caroline Weaver as its new regional director of marketing and product management. Weaver, who previously worked for Johnson & Johnson Medical Product Division, has more than 20 years of experience in brand management and advertising.

WASHINGTON – A businessman at heart, it doesn’t sit well with Tom Ryan that AAHomecare’s membership numbers have been flat for the past three years.

That’s why Ryan, the president and CEO of the association, has enlisted Laboratory Tactical Consulting to help bring in new members and help retain existing members.

“AAHomecare is the umbrella that ties this industry together,” he said. “We have to make sure we’re a healthy, robust national association.”

AAHomecare and Laboratory Tactical Consulting had a one-day meeting in June to review the association’s prospecting and onboarding processes for members.

In such a high-tech and social media-savvy world, one of AAHomecare’s strategies to improve those processes will be personal communication, Ryan says.

“We need to get on a call and tell them what we’re doing and ask them what their biggest issue is, so there’s a feeling of comfort and a sense of understanding,” he said. “Those one-on-one conversations are something we’re working on.”

Technology has its place, though, and AAHomecare plans to use it to target certain providers with certain information, like respiratory providers with information on recent comments submitted to CMS on vents, Ryan says.

“It’s just good member engagement,” he said.

The overarching goal is to make the ROI of being an AAHomecare member clearer, says Anna McDevitt, owner of Laboratory Tactical Consulting.

“What are those value propositions,” she said. “When things are changing like they are, adaptability is really important. So we need to define that value to membership.”

OKLAHOMA CITY, Okla. – O2 Concepts and BOK Financial Capital, a financial services holding company, have closed on a strategic investment.

Proceeds from the investment, the first outside capital that O2 Concepts has raised since launching in 2010, will support international expansion, manufacturing facility enhancements and new product development.

“Our partnership with BOK Financial Capital Corporation allows us to accelerate our already impressive rate of growth,” said Rob Kent, president and CEO of O2 Concepts, in a release. “Over the past year, we have added to our sales and leadership team to significantly expand our market footprint.” 

O2 Concepts recently received CE certification for its Oxlife Independence, paving the way for expansion into international markets.

The investment from BOK will also help position the company for future acquisitions.

“This will ensure we are positioned to capitalize on compelling opportunities that come our way,” Kent said.

BOK calls O2 Concepts “a great long-term investment.”

“We believe the demographics will remain extremely favorable for medical device manufacturers, in both domestic and global markets,” said Mark Hall, senior vice president of BOK, in the release. “Additionally, the regulatory pressures along with changing technology will create a divergence among market participants.” 

Growth in healthcare spending slows

BALTIMORE – Total healthcare spending is expected to grow, on average, 5.8% over 2014-2024, according to a new report from the CMS Office of the Actuary. That rate is lower than the, on average, 9% growth in healthcare spending in the three decades before 2008. “The task ahead for all of us is to keep people healthier while spending smarter across all categories of care delivery so that we can sustain these results,” said CMS Acting Administrator Andy Slavitt. Healthcare spending in 2014 is projected to have hit $3.1 trillion, or $9,695 per person, and to have increased 5.5% from the previous year. Driving growth: millions gained health insurance coverage and new expensive specialty drugs hit the market.

Inogen to join S&P SmallCap 600

NEW YORK, N.Y. – Inogen will be added to the S&P SmallCap 600 stock market index after trading closes on Aug. 3. A company’s market capitalization must range from $400 million to $1.8 billion to be included in the S&P SmallCap 600 Index. Inogen will be replacing Micrel, an IC solutions manufacturer.

Executive changes at VGM

WATERLOO, Iowa – The VGM Group has named Jeremy Kauten CIO and senior vice president of information technology. Previously, Kauten was president of VGM Forbin. He has been with the company since 1999, when VGM acquired Forbin. Rob Duryea is now president of VGM Forbin.

Community pharmacies join forces

WITCHITA, Kan. – Hart Pharmacy and Durable Medical Equipment is partnering with Family Prescription Shop to expand its business. The companies will remain as separate entities but operate under the Hart name. “We’ve kind of combined forces, I guess you could say,” Jason Schmitz, director of pharmacy operations told a local newspaper. The 75-year-old Hart offers a full line of DME in addition to prescriptions and compounding. Family Prescription Shop has two pharmacies and focuses on prescriptions.

Prism Medical reports second quarter results

TORONTO – Prism Medical on July 28 reported sales of $14.1 million for the three months ended May 31, 2015, compared to $10.3 million for the same period last year. Net income was $430,000 vs. $21.3 million. The Canadian DME manufacturer and provider reported net sales of $26.3 million for the six months ended May 31, 2015, compared to $20.3 million for the same period last year. Net income was $832,000 vs. $22.1 million. The company intends to increase shareholder value through organic growth and strategic acquisitions in the North American market, according to President and CEO Andy McIntyre.

Pharmacy, Therafirm sponsor Kenyan runner

AUBURN, Maine, and HAMLET, N.C. – Bedard Pharmacy and Medical Supplies and Therafirm are sponsoring Moninda Marube on his quest to run 3,700 miles across county to raise awareness of human trafficking. His four-month journey started in Auburn, Maine, and includes an approximately 30-mile run six days a week. Along the way, Marube will speak at Police Athletic/Activities League centers to spread the word on his Moninda Movement. Once he reaches Santa Barbara, Calif., he will compete in the Santa Barbara International Marathon. The co-sponsorship includes a cargo van that his crew will use, Therafirm-brand compression socks and sleeves, and athletic apparel. In addition, Bedard and Therafirm will donate a significant portion of proceeds from the retail sales of CoreSport, CoreSpun and Therafirm’s new sports compression line, launching Sept. 1, 2015, to the Moninda Movement. Sales through Bedard’s store and website, bedarddirect.com, between July 27, 2015, and March 31, 2016, will also benefit the movement.

Tech challenge winners announced

NEW YORK – The Kinesic Mouse, a software solution that allows users to operate their PCs hands-free using a 3D camera to detect facial expressions and head rotations, was awarded the $25,000 grand prize in the Connect Ability Challenge, sponsored by RESNA, AT&T, and New York University’s ABILITY lab. The People’s Choice award went to the Laugh Out Loud Aid, whichsends social and living skills reminders, such as saying "please" and "thank you,” to users. More than 60 software, wearable and other technology solutions were submitted during the three-month challenge, which was designed to spur innovation for people with physical, social, emotional and cognitive disabilities.

Short takes: Allina Health, Cardinal Health and more

Staff at Allina Health Home Oxygen and Medical Equipment has earned the Aids to Daily Living Specialist credential through Accessible Home Improvement of America. The certification is designed to assist professionals dealing in the retail environment of ADLs. Staff will be required to renew this certification every two years…Cardinal Health has named the winners of its annual Independent Pharmacy Best Practices award: Medicine Shoppe Pharmacy in Whiting, N.J., (Wellness Advantage category); Katterman’s Pharmacy in Seattle (Retail Advantage category); and El Dorado TrueCare Pharmacy in El Dorado, Kan., (Business Advantage category). The pharmacies were selected for implementing exceptional programs that demonstrate how independent pharmacies can improve patient outcomes, drive business results in their community and be better “positioned to win”…Franciscan Companies has donated nearly $3,000 worth of medical equipment to Operation Walk Syracuse, a nonprofit that helps arthritic patients in developing countries receive total-joint replacements at no cost. Franciscan Companies is an affiliate of St. Joseph’s Health and provides HME, respiratory therapy and sleep disorder treatments in New York and Pennsylvania…inSleep Health has received 510(K) clearance from the FDA for its Cloud9 Anti-Snoring System. Designed for home use, the prescription device uses continuous low positive airway pressure to treat simple snoring.

WASHINGTON – The deadline has been extended until Aug. 10 for senators to sign on to a letter asking CMS to continue paying for accessories for complex rehab wheelchairs at the fee schedule, not the competitive bidding, rate.

At press time, 14 senators had signed on to the letter.

Sens. Thad Cochran, R-Miss., and Charles Schumer, D-N.Y., have taken the lead on the letter.

“Congress specifically excluded complex rehabilitative wheelchairs and related accessories from the Medicare DME competitive bidding program when it approved the Medicare Improvements for Patients and Providers Act of 2008,” they write. “It is our view that applying competitive bidding pricing to complex rehabilitative wheelchair accessories is inconsistent with the intent of MIPPA 2008 and contrary to CMS policies.”

Cochran and Schumer, like stakeholders, argue that the change in pricing could reduce access to complex rehab wheelchairs and accessories for a small population of Medicare beneficiaries with significant disabilities.

The change in pricing, scheduled to go into effect Jan. 1, could mean a 20% to 50% reduction in reimbursement for accessories for complex rehab wheelchairs.

“We encourage CMS to issue written clarification that accessories used with complex rehabilitative wheelchairs will continue to be paid at Medicare established fee schedule amounts,” Cochran and Schumer write.

A similar letter has already circulated in the House of Representatives and attracted more than 100 signatures.

Additionally, Rep. Lee Zeldin, R-N.Y., has introduced a bill that would provide a technical correction to prevent CMS from applying competitive bid pricing to accessories for complex rehab wheelchairs.

Sunrise adds ‘complementary’ business

FRESNO, Calif. – Sunrise Medical has acquired Handicare’s mobility business. The acquisition is limited to mobility products such as wheelchairs, scooters and rollators, according to a press release. The Helmond, Netherlands-based Handicare has divisions in several countries, including Norway, Sweden, Denmark, Germany, France and Canada. "Sunrise Medical has seen very strong growth over the past five years, organically and by way of strategically important and successful acquisitions,” said Thomas Rossnagel, president and CEO of Sunrise Medical. “This business is highly complementary to Sunrise Medical's, geographically as well as from a product perspective.” Sunrise Medical was acquired by Nordic Capital in June.

ResMed grows presence in China

SAN DIEGO – ResMed has signed a definitive agreement to acquire Curative Medical, a manufacturer of non-invasive ventilation and sleep disordered breathing medical devices and accessories in China. The deal will expand ResMed’s presence in China’s significant and fast-growing respiratory medical device market and boost its global product platform, according to a press release. When the deal is complete, ResMed China and Curative Medical will retain their operational independence and continue to invest in R&D, manufacturing, marketing and sales teams in China. Curative Medical will maintain its name, brands and offerings. Its employees, including founder and CEO Jason Sun, will continue as members of the combined ResMed and Curative Medical team. Financial terms of the deal were not disclosed.

OIG: CMS could have saved $7.6M on diabetic test strips

WASHINGTON – The Office of Inspector General (OIG) has found that CGS Administrators made Medicare payments for diabetic test strips when beneficiaries had not exhausted previously dispensed supplies. Based on sample results, the OIG estimates that $7.6 million or 74% of the $10.3 million that CGS paid to suppliers may have been unallowable for Medicare reimbursement. “These potential overpayments occurred because CGS’s system edit was not designed to identify for review claims submitted by multiple suppliers with overlapping service dates for test strips dispensed to the same beneficiary,” the OIG states. “Rather, the system was designed to identify claims with a quantity of test strips that exceeded the utilization guidelines.” The OIG sampled 100 line items and found that 12 were allowable; 17 were non-errors because the suppliers were no longer in business and the supporting documentation could not be obtained for review; and 71 may not have been allowable because the suppliers dispensed test strips sooner than 10 calendar days before the expected end of usage for the current product. For almost half of the 71 line items that may not have been allowable, the suppliers dispensed test strips when there were more than 60 days remaining in the beneficiaries’ existing supplies. The OIG recommends that CGS implement a system edit to identify for review claims submitted by multiple suppliers with overlapping service dates for test strips dispensed to the same beneficiary.

O&P groups push back on LCDs

ALEXANDRIA, Va. – The National Association for the Advancement of Orthotics and Prosthetics has launched a petition asking the White House to rescind new draft LCDs for O&P. The petition states: “We petition the Obama Administration to rescind the Medicare proposal restricting access to prosthetic limbs and returning amputees to 1970s standards of care.” In July, the four DME MACS released draft LCDs with a number of proposed changes, including requiring a face-to-face visit, and requiring patients to complete rehab programs before they can obtain prosthetic devices. The LCDs also seek to consolidate many O&P codes into one code.

The petition must gather 100,000 signatures within 30 days to receive a response from White House staff. It currently has 31,563. The petition is one of several new efforts from the O&P community to fight the proposed changes. The American Orthotics and Prosthetics Association announced on Twitter today that it plans a protest on Aug. 26 at the Department of Health and Human Services building.

Familiar face takes helm at NHIA

ALEXANDRIA, Va. – Tyler Wilson has been named president and CEO of the National Home Infusion Association. He succeeds Russell Bodoff, who retired Aug. 7 after eight years at the helm of the association. Wilson is best known in the HME industry for his tenure at the American Association for Homecare, where he served as president and CEO from 2006 to 2013. Most recently, he was executive director of the National Association for Proton Therapy. He also served as executive director of the American Orthotic & Prosthetic Association for six years.

BOC group examines exams

OWINGS MILLS, Md. – The Board of Certification/Accreditation recently convened a group of experts to review and update content for its exams. The group was comprised of experts from the two national orthotic and prosthetics credentialing organizations, educators and other medical professionals, according to a press release. “The dynamic nature of the O&P and Durable Medical Equipment (DME) fields necessitates periodic reviews of our examinations,” said Wendy Miller, BOC’s chief credentialing officer, who organized and participated in the meeting.

Invacare supports senior veterans

ELYRIA, Ohio – Invacare will sponsor the National Veterans Golden Age Games in Omaha Aug. 8-12. In its 29th year, the games are the only national multi-event sports and recreational competition program designed to improve the quality of life for senior veterans, according to a press release. “Seeing these veterans compete and be active is really living the Invacare brand promise—‘Making Life’s Experiences Possible,’” said Dean Childers, senior vice president and general manager, North America, in the release. Senior veterans will travel from across the country to compete in sports like swimming, cycling, horseshoes, bowling and air rifles.

iPush, At Home Medical donate wheelchair

CUMMING, Ga. – The iPush Foundation has named the winner of its “Wheelin’ for the Holidays” contest: 9-year-old Alexis Taylor of Plant City, Fla. As part of the online contest, iPush asked wheelchair users what they pushed for and why they needed new wheels. Alexis, who was born with Spina Bifida and has gone through 26 surgeries, told iPush she wanted a purple wheelchair that went fast. She received just that: a custom-fit Eagle wheelchair built by Eagle Sportschairs and donated by At Home Medical. At Home Medical financially supports the iPush Foundation.

Convaid reps get certified

TORRANCE, Calif. – Several business development representatives throughout Convaid’s 11 regional territories in North America have earned certification as Child Passenger Safety Technicians by the National Child Passenger Safety Board. The certification qualifies the reps to assess and evaluate car seat configurations for children. The National Child Passenger Safety Board was established to provide program direction and technical guidance to states, communities and organizations as a means to maintain a credible, standardized child passenger training and certification program. The certification is part of an ongoing push by Convaid to keep its workforce highly trained and on top of latest industry regulations, standards and practices.

People in the news from NSM, Handicare

Nashville-based National Seating & Mobility has appointed Steve Penny as CIO. Penny comes to NSM from Nashville-based Ardent Health Services, where he served as chief technology officer. The appointment allows Bill Noelting, who has held the dual positions of CIO and vice president of marketing, to focus solely on marketing. Penny will focus on IT infrastructure services and architecture, including operations and security, network management and voice communications…Handicare US has named Tom Rolick, formerly of Permobil, as CEO. During his more than 20 years at Permobil, Rolick built one of the industry’s most respected and successful sales teams, according to a press release. Hans Sigvardsson will remain with Handicare and will focus on key accounts.

WASHINGTON – The Office of Inspector General (OIG) has found that CGS Administrators made Medicare payments for diabetic test strips when beneficiaries had not exhausted previously dispensed supplies.

Based on sample results, the OIG estimates that $7.6 million or 74% of the $10.3 million that CGS paid to suppliers may have been unallowable for Medicare reimbursement.

“These potential overpayments occurred because CGS’s system edit was not designed to identify for review claims submitted by multiple suppliers with overlapping service dates for test strips dispensed to the same beneficiary,” the OIG states. “Rather, the system was designed to identify claims with a quantity of test strips that exceeded the utilization guidelines.”

The OIG sampled 100 line items and found that 12 were allowable; 17 were non-errors because the suppliers were no longer in business and the supporting documentation could not be obtained for review; and 71 may not have been allowable because the suppliers dispensed test strips sooner than 10 calendar days before the expected end of usage for the current product. For almost half of the 71 line items that may not have been allowable, the suppliers dispensed test strips when there were more than 60 days remaining in the beneficiaries’ existing supplies.

The OIG recommends that CGS implement a system edit to identify for review claims submitted by multiple suppliers with overlapping service dates for test strips dispensed to the same beneficiary.

BALTIMORE – Registration for Round 1 2017 opens Aug. 25, and the bid window opens Oct. 15, CMS announced yesterday.

“CMS is achieving additional savings as part of the Affordable Care Act’s expansion of the competitive bidding program,” stated CMS Deputy Administrator Sean Cavanaugh in a press release. “Data used to monitor the effectiveness of the overall competitive bidding program show that implementation is going smoothly, with few inquiries or complaints and no adverse changes to beneficiary health outcomes.”  

Due to lower payments and decreased utilization, the Round 1 recompete has saved Medicare more than $580 million over three years (January 2011-December 2013), according to CMS. Round 2, which spanned 91 cities, and the national mail-order program have saved Medicare $2 billion in the first year, the agency says.

The complete Round 1 2017 timeline:

Aug. 25
Registration for user IDs and passwords begins

Sept. 14
Authorized Officials are strongly encouraged to register no later than this date

Oct. 5
Backup Authorized Officials are strongly encouraged to register no later than this date

Oct. 15
CMS opens bid window for Round 1 2017

Oct. 23
Registration closes

Nov. 16
Covered document review date for bidders to submit financial documents

Dec. 16
Bid window closes

Winter 2016
Preliminary bid evaluation notification

Summer 2016
CMS announces single payment amounts, begins contracting process

Fall 2016
CMS announces contract suppliers, begins contract supplier education campaign and begins beneficiary, referral agent and supplier education program

Jan. 1, 2017 
Implementation of Round 1 2017 contracts and prices

The seven product categories included in the Round 1 2017 are: enteral nutrients and equipment; general home equipment; nebulizers; negative pressure wound therapy pumps; respiratory equipment; standard mobility equipment; and transcutaneous electrical nerve stimulation devices.

BALTIMORE – CMS announced the timeline for Round 1 2017 last week, with one noticeable difference from previous rounds: The contract period is two years instead of three.

Stakeholders say CMS most likely reduced the contract period to two years so that Rounds 1 and 2 would both end Dec. 31, 2018.

“There’s a good chance CMS could scrap the bid program in its entirety and do something to update the fee schedule or do some kind of national bid program,” said Seth Johnson, vice president of government affairs for Pride Mobility Products. “I’m not sure what their rationale is in bringing these two bid programs into sequence. We’ll find out as we get closer to that date."

By law, CMS is required to recompete competitive bidding contracts at least once every three years.

The change in contract length could impact the number of providers who submit bids, says Kim Brummett,vice president of regulatory affairs at AAHomecare.

“It’s a lot of work for a shorter contract,” she said. “We may see less bidders because of this.”

However, Johnson says the two-year contract could be a blessing for some providers.

“If the rates are lower and/or a supplier did not win a contract then that could be viewed as a good thing,” he said. “It’s all about where the single payment amounts come in and whether the supplier was offered or not offered a contract.”

As for what those rates will be, stakeholders say it’s hard to predict what will happen. In the Round 1 re-compete, the average reduction in reimbursement was 37%. In the original Round 1, it was 32%.

“With the bid prices being where they are right now, it’s difficult to even fathom that they would be lower,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

STUART, Fla. – Liberator Medical Holdings has reported net revenues of $20.4 million for its fiscal third quarter ended June 30, 2015, a 9.7% increase compared to the same period last year.

It reported a net income of $1.7 million vs. $2 million, a 15.8% decrease.

The increase in revenues was due primarily to Liberator Medical’s continued emphasis on its direct response advertising campaign to acquire new customers.

The decrease in income was due to a one-time expense of $600,000 associated with an agreement to settle a civil qui tam lawsuit in which the company, among others, was charged with violating the False Claims Act for engaging in illegal kickback arrangements with Coloplast. The other defendants named in the lawsuit are Hollister, 180 Medical, A-Med Health Care Center, Byram Healthcare Centers, CCS Medical, RGH Enterprises, d/b/a Edgepark Medical Supplies, and Shield California Health Care Center.

Liberator Medical has reported net revenues of $60.3 million for the first six months of 2015, a 9.9% increase over the same period last year. It reported a net income of $5.8 million vs. $5.7 million, a 1.2% increase.

Senators ask CMS to backpedal on accessories

WASHINGTON – A bi-partisan group of 23 senators sent a letter to CMS last week asking the agency to rescind its plan to apply competitive bidding pricing to accessories for complex rehab wheelchairs. The letter was lead by Sens. Thad Cochran, R-Miss., and Chuck Schumer, D-N.Y. “The conversations with these offices over the past week, and with those who were not able to sign on at this time, have created an important increase in Senate awareness and support on this issue,” said Don Clayback in a bulletin to members. “We will need that as we move ahead.” In the House of Representatives, Rep. Lee Zeldin, R-N.Y., has introduced a bill that would provide technical correction to prevent CMS from applying competitive bidding pricing to accessories for complex rehab.

NHIA seeks feedback on outcomes elements

ALEXANDRIA, Va. – The National Home Infusion Association is accepting stakeholder comments on newly revised Definitions for Patient Outcomes Data Elements to be used in the collection of data to assess the safety, effectiveness and efficiency of home and specialty infusion care. Providers, nurses, physicians, pharmacists, payers, accreditors and other healthcare professionals can submit feedback on NHIA’s website. The revised definitions are part of the association’s ongoing efforts to establish field-specific demographic, operational and clinical quality benchmarks. The latest iteration of definitions builds upon and updates previous definition established in 2012. Revised definitions include adverse drug reaction, ER use, unscheduled hospitalization, access device events, medication error and therapy complete.

ACHC gets accepted by Highmark Health

CARY, N.C. – The Accreditation Commission for Health Care’s sleep accreditation program has received acceptance by Highmark Health, an independent licensee of the Blue Cross Blue Shield Association. Effective this month, the approval allows ACHC-accredited sleep providers in Pennsylvania, Delaware and West Virginia to access Highmark Health’s network. Highmark Health and its diversified businesses and affiliates operate health insurance plans serving 53 million members in those states.

RESNA revises position on tilt and recline

ARLINGTON, Va. – RESNA has released an updated position paper on tilt, recline and elevating legrests. “Since the original publication in 2010, there’s been additional scientific evidence for various functional uses for tilt, recline and elevating legrests,” said lead author Brad Dicianno, medical director at the University of Pittsburgh. RESNA states that these features are often medically necessary, allowing users to realign posture, improve respiration, bowel and bladder function, redistribute and relieve pressure, and manage edema. To keep up with changing technology, research and clinical best practice, RESNA’s position papers are reviewed every five years.

MedForce, Universal Software integrate

SUFFERN, N.Y., and DAVISON, Mich. – MedForce Technologies and Universal Software Solutions have developed an interface that enables automated transfer of patient demographics, documentation and other information. The integration streamlines workflows, eliminates duplicate data entry and ensures instant access to information at all times, according to the companies. “In health care, it is critically important that software systems work together for providers to realize the improvement in productivity they’ve been promised,” said Nathan Apter, chief technology officer at MedForce, in a press release. MedForce provides document and process management solutions; Universal Software provides a practice management solution known as Healthcare Data Management System or HDMS.

Attendance at AZMESA event tops charts

PHOENIX – The Arizona Medical Equipment Suppliers Association saw record attendance at its annual conference held Aug. 6 in Phoenix, according to a press release. The association has also seen its ranks grow for the fifth consecutive year. It now represents 44 companies in the state with 80 member contacts. “We are still a small association, but we are seeing more and more interest and recognition here,” said Rose Schafhauser, executive director of the association. “We are aggressively moving to attract a larger number of providers in the state.” More than 65 people attended the conference to hear sessions from VGM’s John Gallagher, AAHomecare’s Jay Witter and others.

HME industry leaves imprint on Inc. 500 list

Brightreehas ranked on the Inc. 5000 list of fastest growing private companies in the U.S. for the sixth year in a row. “This achievement recognizes the talent, dedication and passion of our employees in creating innovative solutions for the post-acute healthcare market,” said Dave Cormack, president and CEO, in a release. The list ranks companies according to percentage revenue growth between 2011 and 2014. In that timeframe, Brightree has grown 128%, reporting a revenue of $96.6 million in 2014…Carolina’s Home Medical Equipment also made the list for the fourth consecutive year. The company ranked in the top 15 healthcare companies in North Carolina. “Having experienced a 50% reimbursement cut from most payers over the last three to four years, it is clear to me that the relationships we have with our customers and referral sources made this possible,” said Frank Trammell, president and CEO, in a press release. “This could not have happened without an extremely proficient staff that is dedicated to the notion of extreme customer service.”…Cape Medical Supply also made the list for the sixth time. Claiming No. 4,003 this year, the company has experienced 73% revenue growth over the past three years, has added 25 new jobs and has continued to expand its geographic reach.

Inogen gets new board member

GOLETA, Calif. – R. Scott Greer has been appointed an independent director to Inogen’s board of directors. Greer has also been appointed to the company’s Audit Committee. He will serve as a Class I director, with a term expiring at the annual meeting of stockholders on Oct. 14, 2015. Greer, who is a director of Sientra and numerous biopharmaceutical companies, replaces Timothy Petersen, who served on the board since 2010. Previously, Greer was chairman of Inogen’s board of directors from 2005 to 2007.

YARMOUTH, Maine – Template has long been a dirty word in the HME industry, but as health care shifts toward paperless, HME providers are now playing catch up.

“Virtually all physicians are using electronic templates for everyday exams, surgeries, etc.,” said one respondent to a recent HME NewsPoll. “They get frustrated with the lack of HME capabilities in their systems.”

Forty-five percent of respondents to the poll say they use electronic templates vs. 55% who don’t.

One of the biggest obstacles to more widespread use of templates: Many providers believe they’re a no-no. In 2013, however, CMS issued a clarification to its Program Integrity Manual that stated, “CMS does not prohibit use of templates to facilitate recordkeeping,” as long as they are not what it calls “limited space templates.”
Still, the misperception remains.

“Do we use templates? No,” said one respondent. “Do we use one or more of the various electronic medical record systems that facilitate ordering? Yes.”

But with increasingly complex requirements, coupled with an onslaught of audits, templates can make it easier to document need.

“The templates walk the doctor through each question making sure they address all the notes that are needed,” said one respondent. “We don’t need to go back to the physician two or three times. It’s more efficient.”

Of the poll respondents that do use electronic templates, 70% cite increased efficiency as the biggest benefit. Other benefits include improved patient care (18%) and decreased denials (12%).

Templates are only as good as the people using them, however.

“We are finding that templates are not the answer because humans are not willing to update and understand the importance of this process,” said Starla Barlie, billing coordinator at Center Home Health Care in Enterprise, Ala.

LAKE FOREST, Calif. – Apria Healthcare has expanded an agreement to offer PERS devices.

Apria has worked with Tunstall Americans for nearly six years, but under an expanded agreement, the provider will make the company’s products available to the general public under its Apria Medical Alert brand.

“This expanded relationship demonstrates our commitment to providing enhanced services, such as Tunstall’s cellular base unit and automatic fall detection, combined with 24/7 personal support, to help individuals continue to recover and live safely in their own homes," said Chris Gorciak, senior director of marketing & e-commerce for Apria.

Tunstall will support order intake and fulfillment, and design custom branded products and materials for Apria.

“Our two companies share a passion for improving patient outcomes, safety, and quality of life through innovative healthcare technology and high-touch personal health monitoring services,” said Casey Pittock, president and CEO of Tunstall Americas.

Drive Medical buys HurryCane

PORT WASHINGTON, N.Y. – Drive Medical has entered into an agreement to buy HurryCane from the Marketing Architects portfolio of companies.

Drive Medical believes HurryCane’s brand recognition means a “huge market” for its products.

“With Drive’s extensive manufacturing and distribution capabilities, these products will soon be sold all over the world, as will the many new HurryCane products soon to be introduced,” said Harvey Diamond, CEO Of Drive Medical, in a press release.

The HurryCane cane employs a patented design that allows for maximum mobility on all terrains, along with continuous balance and stability, according to the release. It is sold direct-to-consumer, but last year, HurryCane relaunched a retailer program to also sell through HME providers.

Kirsten Newquist, vice president of channel development at Drive Medical, will oversee the marketing, sale and promotion of all HurryCane products, under the leadership of Jeffrey Schwartz, co-founder and executive vice president of Drive Medical.

The deal is scheduled to close by Aug. 25.

HurryCane is only the latest in a string of acquisitions for Drive Medical. Most recently the manufacturer bought DeVilbiss Healthcare.

AOPA pulls out all the stops

Ads, meeting, protest and petition all part of efforts

WASHINGTON – The American Orthotic and Prosthetic Association is organizing stakeholders to fight proposed changes to coverage requirements to prostheses.

AOPA has commissioned print and TV advertising in the Washington, D.C., area; it’s arranging for top officials and a Boston Marathon survivor to attend, and hopefully speak at, a DME MAC open meeting on Aug. 26; and it’s organizing more than 100 amputees to converge at CMS headquarters for a protest later that same day.

Also part of the fray: a petition organized by the National Association for the Advancement of Orthotics and Prosthetics asking the White House to rescind the proposed changes. The petition has more than 100,000 signatures.

All of these activities lead up to an Aug. 31 deadline to submit comments to CMS on the proposed changes.

InfuSystem says it’s ‘well positioned’

MADISON HEIGHTS, Mich. – InfuSystem Holdings on Aug. 13 reported net revenues of $17.2 million for the second quarter ended June 30, 2015, compared to $16.4 million for the same quarter in 2014, a 5% increase.

It reported a net income of $800,000, an 11% decrease.

"This was an important quarter for InfuSystem as we made substantial progress in integrating the acquired Ciscura assets, gained traction in the expansion of our EMR initiatives, continued expanding our base of payer contracts, decreasing bad debt by 21% compared to last year's second quarter, and we operated profitably for the 11th out of the last 12 quarters, said CEO Eric Steen, in a release. “InfuSystem is well positioned to generate solid financial results for the second half of 2015 and beyond."

The infusion pump and services provider has completed the acquisition of all the assets of Alpharetta, Ga.-based Ciscura, including 1,600 infusion pumps in 100 facilities throughout the Southeast. The acquisition will open up InfuSystem’s full portfolio of infusion products, including its InfuSystem EXPRESS EMR software, to its newly acquired customers.

Brightree, VGM Fulfillment remove fees

ATLANTA – Brightree and VGM Fulfillment, a consignment-based CPAP resupply service, have made available a no-fee integrated interface. “This new agreement allows providers to realize additional reductions in operating costs by removing any transaction fees,” stated Rob Boeye, executive vice president of Brightree, in a press release. The interface allows Brightree customers to reduce inventory cost and speed up the billing process with direct shipments of CPAP supplies to patients. Brightree and VGM have been partners since 2008.

VGM creates cost calculator as part of bid fight

WATERLOO, Iowa – The VGM Group has created a delivery cost calculator to help show Congress and CMS that rural areas will take a significant hit in 2016 if competitive bidding pricing is applied nationwide. VGM is asking HME providers to fill out and submit delivery cost calculator forms. The group will file the data it receives by state and send it to the appropriate members of Congress. Questions that VGM hopes to answer with the data include: Does CMS realize how much it costs to deliver medical equipment and service patients? Is it considering the cost of gas, and the wear and tear on your vehicle? How about the time it costs to send a delivery person 50-100 miles away round trip?

PRO2 bets on POC

LUBBOCK, Texas – PRO2 Medical Supplies has started carrying the LifeChoice ActiVox Portable Oxygen Concentrator. The provider says it has added the product in response to “customers wanting an overnight, portable oxygen concentrator that reduces cylinder deliveries and eliminates the trouble of changing and carrying multiple oxygen bottles,” according to a press release. The POC comes complete with AC/DC power supplies, carrying bag and cannula. PRO2 has stores in Lubbock and Big Spring. It also carries urological equipment, incontinence briefs, knee scooters, walkers, CPAP masks, wheelchairs, catheters and other health and medical necessities.

Wanted: Individuals making an impact on HME

WASHINGTON – AAHomecare seeks nominations for its “Homecare Champion Award.” The annual award represents an opportunity to honor and thank someone in the HME industry for his or her hard work and dedication. Last year’s recipients: Cara Bachenheimer, senior vice president of government relations for Invacare, and Joe Mills, chief executive officer of Advanced Homecare. The recipients of this year’s award will be announced at AAHomecare’s “Stand up for Homecare” reception at Medtrade. The reception will take place from 5:30 to 7 p.m. on Oct. 27 on the rooftop deck at the Metro Atlanta Chamber of Commerce. The reception is also a fundraiser for consumer-related initiatives and groups, like the National Council on Independent Living.

Video commemorates ADA

EAST AMHERST, N.Y. – NCART has released a seven-minute video honoring National CRT Awareness Week and commemorating the 25th anniversary of the ADA. “Complex Rehab Technology: 25 Years after the Americans with Disabilities Act” includes historical footage, as well as commentary from former Sen. Tom Harkin, D-Iowa, highlighting the importance of preserving access to complex rehab products. “While the passage of the ADA was a great achievement, if people with disabilities can’t access the CRT they require, the ADA can be a big unfulfilled promise,” wrote Don Clayback, executive director of NCART, in an email to stakeholders. To view the video, click *here.

Move over Movember, here comes Sleeptember

WASHINGTON – The American Sleep Apnea Association and numerous partners will launch Sleeptember next month. The year-long, patient-led, patient-supported campaign will create online and community events to raise awareness of the public health impact of sleep loss, and will raise funds for medical research and advocacy efforts, according to Sleep Review. The campaign will center around the soon-to-go-live website www.sleeptember.org. The association modeled the campaign after Movember, a campaign where men grow moustaches during November to raise awareness of men’s health issues.

Missouri providers meet senator

PERRYVILLE, Mo. – Provider Patrick Naeger hosted a meeting with Sen. Roy Blunt, R-Mo., Aug. 12. Naeger is executive vice president of Healthcare Equipment & Supply Co., and president of the Midwest Association of Medical Equipment Services. "This was a great opportunity to meet with Senator Blunt and to share with him industry concerns,” said Naeger in a release. “In particular, we asked for support of our efforts to curb the competitive bid national price roll-out, which is slated to take place Jan. 1, 2016.” Also in attendance: Justin Decker, CRTS and ATP with Alliance Rehab and Medical Equipment; and Tom Powers from The VGM Group.

Paralympian partners with Melio maker

LIVERPOOL, England – Albert Medical Devices has partnered with Paralympian Bert Burns to create a new educational video. Earlier this year, Albert Medical Devices launched Melio, a self-emptying leg bag system for catheters. The video features Burns demonstrating the system and the positive impact it can have on wheelchair users. “Melio answers one of the biggest inconveniences of using the restroom when you’re away from home,” said Burns in a release. “It never fails—every time you visit a public restroom, the handicap stall is occupied by someone who is not a wheelchair user.”

Drive, DeVilbiss hammer away at integration

PORT WASHINGTON, N.Y. –Drive Medical has completed a significant portion of its restructuring plan to integrate DeVilbiss Healthcare, the company announced August 14. “Over the next few months, we will be focused on the operational aspects of the integration plan with a renewed focus on innovation and the development of new products,” said Harvey Diamond, CEO of Drive, in a release. The two companies will operate independently in the Americas until the integration is competed, which is expected to happen by the end of October. At that time, customers will be able to order Drive and DeVilbiss products together on one purchase order, through a centralized customer service support center. Drive DeVilbiss Healthcare will have more than 2,000 employees and distribute in more than 80 countries.

More list makers: Aeroflow, PlayMaker CRM

Aeroflow Healthcarehas landed at 3089 on the Inc. 5000 list list of fastest growing companies. “We are extremely proud to receive this recognition, but we are even more excited about the future of the company and our employees,” said Casey Hite, CEO and founder, in a press release. It’s the provider’s first time on the list…PlayMaker CRM, a cloud-based customer relationship management software provider for the post-acute care industry, has ranked 722 on this year’s list. It’s the third year in a row that PlayMaker has made the list: It ranked 956 in 2014 and 451 in 2013. “Our continued growth is a testament to the tremendous amount of work our team puts in to deliver a purpose-built sales acceleration platform to the post-acute healthcare industry,” stated John Griscavage, CEO, in a press release. “I am delighted to see clients of all sizes embracing our innovative technology.” 

NEW YORK – There is little or no competition in the Medicare Advantage market in 97% of U.S. counties, according to a new study from the Commonwealth Fund.

Among the nation’s 2,933 counties, only one—Riverside, Calif.—qualified as a competitive market and only 80 qualified as moderately competitive.

“Allowing private health insurers to play a larger role in Medicare is often suggested as a way to control Medicare costs and improve quality of care,” said Stuart Guterman, senior scholar in residence at AcademyHealth and coauthor of the study, in a press release. “The idea is if there are more insurers, they’ll fight for customers by lowering premiums and improving quality. For that to happen, however, we need to have enough insurers in a given market—and this study shows that, overwhelmingly, that isn’t the case.”

The Commonwealth Fund found that six insurers dominate the markets in the 100 counties with the most Medicare beneficiaries. United Health had the greatest number of Medicare Advantage enrollees in 38 counties, while Blue Cross affiliates had the greatest enrollment in 13 counties and Humana in 12 counties.

While both urban and rural markets lack competition, rural markets are the least competitive, the Commonwealth Fund found.

The Commonwealth Fund is a private foundation that aims to promote a high-performing healthcare system that achieves better access, improved quality and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children and elderly adults.

AUSTIN, Texas – Texas Medicaid is deactivating some DME providers for not having a current surety bond on file, even though, technically, they do.

Provider Alicia Correa, owner of San Antonio-based Bexar Care Home Medical, lost $100,000 in Medicaid business over three weeks because the agency couldn’t locate her original bond. At press time, Correa’s provider number was on hold, even though the agency has since acknowledged that it does indeed have her bond. 

“It’s a huge problem for many customers,” said LeAnn Kelly, surety bond portfolio manager at VGM Insurance Services. “Some people called Medicaid, verified that their bond was in place and they still got deactivated.” 

Texas Medicaid started requiring providers to purchase $50,000 surety bonds for each enrolled location in 2013, but the agency hasn’t enforced the policy until recently, Kelly says. Providers without a 2015 surety bond on file were deactivated June 1, even if their 2014 surety bond didn’t expire until later in the month.

That’s what happened to Spearhead Home Medical in Amarillo, Texas. Beth Depew, manager, called Texas Medicaid after a claim was denied and was told the provider was “placed inactive.”

“I told them, ‘Our bond is good until June 6,’” she said. “You can’t just deactivate us early unless you’re going to refund us some money.”

After speaking with a supervisor, who escalated the issue, Depew was able to get the number reactivated.

Other reasons providers have been deactivated: They’ve submitted Texas Medicaid surety bonds without a signature, and the bonds they’ve submitted have suffixes on their provider numbers that aren’t properly linked in the state’s system.

WASHINGTON – CMS’s proposal to revise HCPCS codes for miscellaneous DME, many used for wheelchairs, has stakeholders concerned over reimbursement. 

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

The agency says the changes will reflect a more accurate payment of Medicare claims. 

“The way CMS has it set up is there would be certain codes for miscellaneous items based on their dollar amount and previous billing history,” said Martin Szmal, founder of The Mobility Consultants. “Some of the reimbursements are based on 1986 and 1987 levels, when some of the items weren’t even around at that time.”

Under the current system, miscellaneous codes are individually considered based on supplier charges.

While stakeholders support CMS’s goal to further segregate miscellaneous codes, they say the way CMS is going about it is problematic.

“This really came out of the blue,”said Don Clayback, executive director of NCART. “It was posted just to the CMS website and then we had a very small time frame to respond.”

Industry consultant Sarah Hanna has noticed a big difference in the types of calls she has received from HME providers in 2015 compared to 2014.

Hanna, president of ECS Billing & Consulting North, says last year providers were looking for training to improve their operations; this year they’re looking for benchmarks to improve their operations.

“We’re really using more data analysis with our clients than we have in the past,” Hanna said. “They’re moving into the next realm.”

While providers are interested in benchmarks for traditional areas like AR over 120 days and DSO, they’re also interested in holding revenue (revenue that’s on hold because a provider is waiting on, say, medical documentation) and bad debt (from both patients and payers).

With competitive bidding less of an unknown, Hanna says providers may be back to the business of analyzing their businesses.

“They don’t feel the panic they used to,” she said. 

Coach, don’t condemn

While data analysis is the foundation of any good business, consultant Kelly Franko says leadership skills matter, too.

“With the negative air in the industry, employees are having a hard time staying connected,” said Franko, vice president of training and development at Advantage Training & Coaching Solutions. 

Attitude is the key to employee engagement, says Franko, and that involves coaching not condemning.

Franko offers the following scenario: “You have two different managers: one is a coach-oriented manager with a team filled with naysayers. That manager can turn that team around into high performers. One has an I’m-the-manager attitude. That manager can send high performers looking for lifeboats.” 

There’s a big push toward coaching across all industries right now, Franko says, because our world has become so focused on communication, whether it’s in person, by email or through various social media outlets.

“It all comes down to how something is said versus what is said,” she said.

Rick Hibben says the Health Care Compliance Association, a nonprofit which offers resources for compliance professionals, needs to provide DME providers more guidance when it comes to creating compliance programs. Here’s what Hibben, a privacy and compliance adviser at VGM Homelink, had to say about the hurdles providers face.

HME News: Are providers having difficulty meeting compliance requirements?

Rick Hibben: My problem with the compliance plan is there’s no guidance. In 2013, I attended a Compliance Academy in Chicago, presented by the Health Care Compliance Association. While informative, it was really geared more toward hospitals and practitioners and offered little or no information for the typical DME provider. In this age of overwhelming regulation in all aspects of the DME industry, there needs to be more information that is focused toward our industry, instead of us having to try to interpret everything as it relates to us.

HME News: What are HME providers required to do in terms of compliance?

Hibben: The seven elements of an effective compliance program are: conducting internal monitoring and auditing, implementing compliance and practice standards, designating a compliance officer; conducting training and education; responding appropriately to fraud and developing corrective action; developing open lines of communication; and enforcing disciplinary standards through well publicized guidelines.

HME: When it comes to compliance, where are providers strong?

Hibben: Policy and procedures, simply because of mandatory accreditation. 

HME: What do providers need to work on?

Hibben: Doing quality reporting (under compliance and practice standards) to make their business better. That’s something we focus on at VGM Homelink—staff satisfaction, payer satisfaction, patient satisfaction—trying to see where we’re at and what our weaknesses are. A small company doesn’t have an opportunity necessarily to track and trend these kinds of things. hme

WASHINGTON – The wait time for DME appeals at the administrative law judge level has increased by nearly 25% during the first half of 2015, according to an analysis released by AAHomecare.

“It is painfully obvious that this system is broken, but no measures are being taken to fix the root of the problem,” said Kim Brummett, vice president of regulatory affairs at AAHomecare, in a release.

Despite reports from the Office of Medicare Hearings and Appeals indicating improvement, the average processing time at the ALJ level was 725 days in June, according to data that AAHomecare analyzed from the OMHA website.

By law, providers who file an appeal at the ALJ level must receive a decision within 90 days. However, due to the sheer number of appeals received, OMHA has suspended the assignment of hearings for appeals.

The result: the number of claims held at the ALJ level has gone from 38,506 in 2006 to 364,634 in 2015, a 947% increase.

The number of appeals for DME at the ALJ level has skyrocketed from 6,305 in 2006 to 133,839 in 2014, a whopping 2122% increase.

That’s in part due to the specific nature of providing DME products and services, Brummett says.

“Home medical equipment providers are dealing with the same patient and same service/item on an ongoing basis over a period of time,” she said.  “When the first claim is denied, all of the subsequent claims for the same patient and service are denied. However, when the previous claim is overturned, it does not mean that any other claims for the same patient and same service will be paid/overturned at any level. This cycle traps a large volume of claims in a system that cannot handle them properly.”

If this trend continues, OMHA will have 3 million appeals by the end of 2016, AAHomecare says.

YARMOUTH, Maine – A tug of war between CMS and the RACs over planned changes to contingency fees could lead to a new national RAC for HME, says Andrea Stark.

As part of its latest requests for proposals, CMS announced plans to implement a number of changes to its RAC program and one, in particular, has driven two contractors to file protests: The agency wants to prevent the RACs from collecting contingency fees until the second level of appeals is exhausted.

“CMS has paid out beaucoup dollars,” said Stark, a reimbursement consultant with MiraVista, during a webcast last week.

In the wake of the controversy, CMS announced this summer that it will update its statement of work for the contracts and release new RFPs “shortly.”

Stark believes that CMS will also rescind the contract for Connolly, which was named as the national RAC for HME, home health and hospice late last year. 

“If you redo one, you should redo them all,” she said.

Until CMS releases additional guidance, the agency has instructed the current RACs—Performant Recovery, CGI Federal, Connolly and Health Data Insight—to keep doing what they’re doing.

“They’re sitting back and riding the tide,” Stark said.

As to what the new statement of work will look like: Stark says she doesn’t know whether or not the changes to contingency fees will survive.

“There has to be a balance between protecting providers and allowing the RACs to do their jobs,” she said. “That’s the balance CMS is trying to figure out.”