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    11/06/2015
    HME News Staff

    WASHINGTON – Orthotics and vents are among the HME that the Office of Inspector General plans to focus on in fiscal year 2016, according to a work plan published this week.

    The OIG plans to determine the reasonableness of Medicare fee schedule amounts for orthotic braces. The agency will compare Medicare payments made for braces to amounts paid by non-Medicare payers to identify potentially wasteful spending. It will also estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for braces with those of non-Medicare payers.

    Also for orthotics, the OIG plans to review Medicare Part B payments for braces to determine whether the claims of DME providers were medical necessary and were supported in accordance with Medicare requirements. Prior work by the OIG has indicated that some providers were billing for services that were medical unnecessary or were not documented in accordance with Medicare requirements.

    The OIG also plans to describe billing trends for vents, RAD and CPAP devices from 2011-14, as well as examine factors associated with the increase in vent claims. From 2013-14, there has been a 127% increase in allowed amounts for E0464, and during that same period, the number of beneficiaries receiving the devices increased from 8,633 to19,085. The OIG says providers may be inappropriately billing for vents for beneficiaries with non-life threatening conditions, which would not meet the medical necessity criteria for vents and might instead be more appropriately billed to codes for RADs or CPAPs.

    In addition to orthotic braces and vents, the OIG plans to examine provider compliance with payment requirements for power mobility devices, and nebulizer machines and related drugs.

    The agency also plans to examine the effectiveness of system edits to prevent inappropriate payments for blood glucose test strips and lancets to multiple providers, and access to DME in competitive bidding areas.


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    11/12/2015
    HME News Staff

    WASHINGTON – Sen. Heidi Heitkamp, D-N.D., has agreed to be an original co-sponsor, along with Sen. John Thune, R-S.D, on a bill that would soften the blow of the nationwide rollout of competitive bidding pricing on Jan. 1, according to AAHomecare.

    “When the South Dakota providers met with Sen. Thune earlier this year and he agreed to work with Rep. Price, the industry needed a Democratic lead, and Sen. Heitkamp seemed like the logical fit,” said Barb Stockert of Jamestown, N.D.-based Sanford HealthCare Accessories in a bulletin from the association this week.

    Heitkamp was one of 50 co-signers on a letter to CMS last year that asked the agency not to expand competitive bidding until the Office of Inspector General completes an investigation of Round 2 of the program.

    In October, Reps. Tom Price, R-Ga., and Tammy Duckworth, D-Ill., agreed to introduce a bill in the House of Representatives that would provide a 30% increase in reimbursement and phase in cuts over four years. As it stands, CMS intends to phase in the cuts, which will likely be up to 45% to 50% in non-bid areas, over six months.

    Details of the legislation are currently being hammered out, with the goal of having consistent language introduced in both chambers, AAHomecare says.

    Without a legislative solution, providers in rural areas will likely have to reevaluate their product offerings and/or ask beneficiaries to pay out of pocket if they want to stay in business, they say.

     

     


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    11/13/2015
    HME News Staff

    WASHINGTON – Sen. Heidi Heitkamp, D-N.D., has agreed to be an original co-sponsor, along with Sen. John Thune, R-S.D, on a bill that would soften the blow of the nationwide rollout of competitive bidding pricing on Jan. 1, according to AAHomecare.

    “When the South Dakota providers met with Sen. Thune earlier this year and he agreed to work with Rep. Price, the industry needed a Democratic lead, and Sen. Heitkamp seemed like the logical fit,” said Barb Stockert of Jamestown, N.D.-based Sanford HealthCare Accessories in a bulletin from the association this week.

    Heitkamp was one of 50 co-signers on a letter to CMS last year that asked the agency not to expand competitive bidding until the Office of Inspector General completes an investigation of Round 2 of the program.

    In October, Reps. Tom Price, R-Ga., and Tammy Duckworth, D-Ill., agreed to introduce a bill in the House of Representatives that would provide a 30% increase in reimbursement and phase in cuts over four years. As it stands, CMS intends to phase in the cuts, which will likely be up to 45% to 50%in non-bid areas, over six months.

    Details of the legislation are currently being hammered out, with the goal of having consistent language introduced in both chambers, AAHomecare says.

    Without a legislative solution, providers in rural areas will likely have to reevaluate their product offerings and/or ask beneficiaries to pay out of pocket if they want to stay in business, they say.

    MedCare buys Home Health Resource

    GREENSBURG, Pa. – MedCare Equipment Company has added another partnership with a health system.

    The company, part of Excela Health, has acquired Home Health Resource from UPMC Altoona, growing its patient base to 24,000 and its revenue base to $70 million.

    “Working collaboratively with health systems across western Pennsylvania we have been able to achieve cost efficiencies, economies of scale and eliminate duplicative services,” said John Sphon, CEO, in a press release. “Ultimately, the beneficiary of these partnerships is and will remain our patients and customers.”

    MedCare already partners with Conemaugh Home Medical Equipment in Johnstown, part of Conemaugh Health System/Duke Life Point. The company also has partnerships with the Heritage Valley, Butler, Washington and UPMC health systems.

    Home Health Resource expands MedCare’s presence in western Pennsylvania, southern New York, eastern Ohio and northern West Virginia. With Home Health Resource, MedCare now employs 300 people at 14 locations.

    It’s been a good year for MedCare: The company was named first place winner in this year’s HME Excellence Awards by HME News and was named Most Valuable Provider in the enterprise category by Brightree.

    Sunrise hits refresh on its website

    FRESNO, Calif. – Sunrise Medical has revamped its website to make it more user-friendly. Visitors to www.sunrisemedical.com will select their customer group (consumer, clinician, dealer) to view customized homepages with links geared toward their interests. The Sunrise Medical website also features a fresh look and a responsive design, according to a press release. “We are delighted to launch this new website, which provides an easy way to locate information and relevant content, an engaging experience, and is mobile friendly,” said Teresa Adkins, vice president of marketing.

    United Spinal launches directory

    NEW YORK – United Spinal Association is making it easier for consumers to find the products and services they need with its new online directory."We developed the Affiliate Service Provider program to ensure wheelchair users and other consumers living with spinal cord injuries and disorders can take advantage of the very best products and services—discoverable all in one place," said Megan Lee, national sales manager at United Spinal Association, in a release. The association seeks to list businesses that specialize in vehicle and hand controls, therapeutic and bathroom equipment, urological suppliers, scooters, wheelchairs, adaptive devices, contractors, ramp companies and other disability-related products and services. Users of the directory will be able to search the listings by state, keyword and category.

    Home infusion costs less, improves outcomes, according to Option Care study

    SAN ANTONIO – Patients treated with immunoglobulin therapy at home with a high level of clinical oversight by Option Care had better outcomes than others receiving the therapy, according to a recent study. “We found that the provision of comprehensive and consistent care in a patient’s own home does indeed lead to better outcomes,” said Jordan Orange, M.D., Ph.D., lead investigator of the study and a professor at Baylor College of Medicine in Houston. “And an added benefit was that it was actually more cost effective.” The study found that costs per year for Option Care patients totaled $112,700 compared to $120,500 for patients from the control group. The findings were presented this week at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting. Formerly Walgreens Infusion Services, Option Care offers home and alternate treatment sites infusion services.

    Brightree honors providers

    ATLANTA – Brightree has announced the winners of its 2015 Customer Excellence Awards. They are: Wright & Filippis, Scholar Award; Advacare Home Services, Ambassador Award; Cape Medical Supply, Leading Edge Award; MDS Medical Device Specialty, Rising Star Award; GSH Home Med Care, Most Valued Provider, 25 users or less; and MedCare Equipment Company, Most Valued Provider, enterprise category. The awards recognize providers who have excelled in their use of Brightree solutions.

    Nonin launches program, partnership

    MINNEAPOLIS, Minn. – Nonin Medical has partnered with Tri-anim Health Services to offer its COPD Seamless Treatment and Exacerbation Prevention (STEP) Plan to hospitals. The STEP Plan, which includes Nonin’s GO2 personal pulse oximeter, has a four-pillar approach: care-team alignment, in-patient hospital care plan, outpatient home care plan, and home-care devices to help hospitals reduce readmissions and costs, while improving patient outcomes and quality of life.

    Arkray snags Medi-Cal contract

    MINNEAPOLIS – Arkray USA has secured a three-year contract with California’s Medicaid program, known as Medi-Cal, to supply recipients with its line of blood glucose meters, test strips and related supplies. About 12.5 million citizens were enrolled in Medi-Cal as of May 2015, or about 32.4% of the state’s population, according to a press release. “We at Arkray place a great deal of emphasis in developing products that are not only easy to use but provide testing results that are highly accurate, providing patients and healthcare professionals with the information they need to effectively manage their diabetes,” said Jonathan Chapman, president, in the release. Arkray USA is a division of Arkray based in Kyoto, Japan.

    MediLogix closes on loan

    DENVER – MediLogix has closed on a $4 million senior term loan from CapX Partners. The provider of rental DME and respiratory equipment to skilled nursing, rehab, long-term acute care facilities and hospice providers, will use the loan to buy additional equipment to fulfill its increased customer demands, according to a release. “With management focused on several key initiatives to support growth—including building and expanding its national geographic footprint, hiring and increasing their brand awareness—they needed to keep up with projected inventory demands,” according to the release from CapX Partners, a specialty finance company that focuses on private equity and venture-backed portfolio companies looking for debt financing in the $2 million to $20 million range.

    Sunovion educates, empowers with videos

    MARLBOROUGH, Mass. – Sunovion Pharmaceuticals and the COPD Foundation have launched a new video series, Reel COPD, to share the first-hand stories of patients and their caregivers as they cope with a chronic, progressive disease. The first three videos in the series are now live on COPDTogether.com, and build on existing tools and resources available to patients and caregivers. Sunovion and the COPD Foundation initiated COPD Together in 2013 to empower and educate caregivers about managing COPD. “Our team is dedicated to providing resources that support patients, their caregivers, and the full COPD ‘shared care’ team, as we advance our ongoing commitment to the respiratory community,” said Michael Gaines, executive director of respiratory marketing at Sunovion, in a press release.

    Short takes: Medtrade, Permobil, D.W. McMillan

    Early bird registration has opened for Medtrade Spring 2016. Those who register early can save $75 on the price of the Expo and more than $200 on the conference sessions. The show is scheduled for Feb. 29-March 2, 2016, at the Mandalay Bay Convention Center in Las Vegas…Permobil has promoted Josh Anderson to vice president of marketing. In this new role, Anderson will lead integration, development and marketing strategies for Permobil, ROHO and TiLite. Most recently, Anderson, a wheelchair user, was vice president of global portfolio management for TiLite…D.W. McMillan Home Medical Equipment in Brewton, Ala., has earned The Joint Commission’s Gold Seal of Approval. The company is a full-service provider of medical equipment and supplies, including oxygen concentrators, CPAP devices, power wheelchairs and diabetes test strips.


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    ‘We are still 50% of the appeals backlog and it would be better for all of us if (the settlement conference) worked better’
    11/13/2015
    Theresa Flaherty

    WASHINGTON – The Office of Medicare Hearings and Appeals has made the settlement process slightly easier, but challenges remain, says AAHomecare’s Kim Brummett.

    The biggest change OMHA has made: Providers can include appeals filed at the Administrative Law Judge level through Sept. 30, 2015. Previously, it was limited to appeals filed in 2013.

    “That’s a much better deal,” said Brummett, senior director of regulatory affairs for AAHomecare. “Providers can settle on a much larger volume of appeals.”

    In an Oct. 18 conference call, OMHA outlined this and other requirements and processes for Phase II of the Settlement Facilitation Conference pilot project.

    Unfortunately, the same strict criteria for participating in a settlement conference remain: Providers must have a minimum of 20 claims or $10,000 at issue, and they must include all pending appeals for like services.

    “It’s still all or nothing for any given category, which is problematic,” said Brummett.

    OMHA is making the logistics easier for providers that do meet the criteria, however. Once a provider submits an “expression of interest” form, OMHA will create a report for CMS containing all eligible appealed claims. Once CMS approves the settlement conference, OMHA will create a spreadsheet with the relevant data and send it to the provider. Previously, providers created the spreadsheets themselves and they were likely to miss certain data, said Brummett.

    Of the 2,400 appeals that were successfully settled in Phase I of the pilot, very few involved HME providers. Even without more substantive changes to the settlement conference, Brummett thinks more HME providers will participate as time goes on—and as the ALJ backlog grows. She knows of one provider that recently settled for about 60 cents on the dollar.

    “For a lot of people, that’s better than four years of nothing,” she said. “But, we are still 50% of the appeals backlog and it would be better for all of us if (the settlement conference) worked better.”


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  • 11/17/15--10:49: CMS provides update on RACs
  • 11/17/2015
    HME News Staff

    BALTIMORE – CMS has released requests for proposals for the next round of the recovery auditor contracts.

    Until new contracts are awarded, CMS has indicated that the RACs may resume auditing activities, including sending additional documentation requests or ADRs, upon signing a contract modification. The modification allows the RACs to conduct these activities through July 31, 2016.

    If a RAC chooses not to sign the modification, providers should note that Oct. 16, 2015, was the last day the RAC could send ADRs, and Dec. 31, 2015, will be the last day the RAC can send an improper payment file to the Medicare Administrative Contractor or MAC for adjustment.

    The new RFPs are posted at the Federal Business Opportunity website, www.fbo.gov.

    CMS's attempts to name new RACs go back almost a year, thanks to disputes over changes to the contracts.

    The disputes could also lead to a new contractor being named as the national RAC for HME, home health and hospice. Connolly was named that contractor in late 2014.


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    11/19/2015
    HME News Staff

    WASHINGTON – A bipartisan bill to “smooth the transition” to competitive bid pricing in rural areas dropped today in the Senate.

    Introduced by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., the DME Access and Stabilization Act seeks to ensure HME providers can still serve Medicare beneficiaries, according to a press release.

    “It is important that people receive quality health care, no matter where they live,” said Thune. “Not only does this legislation ensure that suppliers in rural areas can provide services they need to people in all parts of South Dakota, but it may enable people to return home faster after hospitalization.”

    The text of the bill is not yet available, but AAHomecare has previously said that language for an anticipated bill in the House of Representatives would add 30% to pricing, and phase in the cuts over four years instead of the six months currently planned.

    “Our bipartisan bill would smooth the transition to a new payment formula for businesses supplying and servicing these products, and make sure seniors, particularly those in rural communities, can continue to live independently and with dignity,” said Heitkamp.

    Sens. Pat Roberts, R-Kan.,  Angus King, I-Maine, and Mike Crapo, R-Idaho are co-sponsoring the bill.

    The national roll out of competitive bid pricing will be implemented Jan. 1, 2016.
     


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    Contract modifications for existing RACs allow agency to get buy-in on changes
    11/20/2015
    Liz Beaulieu

    WASHINGTON – It looks like CMS will name a new national RAC for HME by late summer of 2016.

    In a string of updates this month, CMS released requests for proposals for the next round of RACs and asked the existing RACs to sign contract modifications that allow them to continue auditing activities, including sending out additional documentation requests or ADRs, through July 31, 2016.

    “My guess is, if they have extended the contracts to that time period, that’s their intended timeline for having someone announced,” said Wayne van Halem, president of the van Halem Group.

    CMS named Connolly as the first ever national RAC for HME, home health and hospice in December of 2014. But due to controversies surrounding certain planned changes to the RAC contracts, the agency has had to put all contracts back out to bid.

    Asking the existing RACs to sign contract modifications allows CMS to incorporate changes, like requiring contractors to wait until after a discussion period to initiate overpayment proceedings, into the contracts now.

    “CMS is telling the RACs, we have requests for bids out, your contracts don’t go on indefinitely, you have to commit to this extension,” said Andrea Stark, a reimbursement consultant with MiraVista. “That’s where they’re going to get the buy-in to comply with the enhancements not in the original contract.”

    CMS outlined steps if the existing RACs don’t sign the contract modifications but that’s unlikely to happen. 

    “They want to keep the money going,” Stark said.

    The change that caused much of the controversy to begin with, however, is not included in the contract modifications. CMS would also like to prevent the RACs from collecting contingency fees until the second level of appeals is exhausted, but it currently lists that change as “TBD.”

    “I’m surprised it’s still on the docket at all,” Stark said.

    Neither van Halem nor Stark expects much of a ramp up in activity by the RACs until the new contracts are awarded. But that doesn’t mean providers can drop their guards, they say.

    “The claims they’re submitting now will be the claims that the new RAC will be looking at,” van Halem said. “When it’s quiet isn’t the time to be complacent.”


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    11/20/2015
    HME News Staff

    MURRAY HILL, N.J. – C.R. Bard, a manufacturer of medical devices for vascular, urology, oncology and surgical specialty fields, announced last week that it has acquired Liberator Medical for $181 million.

    Liberator is a director-consumer-provider of home medical supplies, including catheters, ostomy, diabetes and mastectomy.

    “As the population ages and more healthcare is expected to occur outside of the hospital setting, we believe that having direct access to the patient in the home is strategically important,” said Timothy Ring, Bard CEO and chairman. “We look forward to adding a strong distribution platform with potential for future growth to our product and technology platforms.”

    Liberator was founded by Mark Libratore, a former Liberty Medical exec, more than a decade ago and has enjoyed steady growth since. In August, the provider 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. Liberator began trading on the New York Stock exchange in 2013 under LBMH.

    The transaction is structured as a merger and is expected to close in the first quarter of 2016.

    OptumRx expands services with buy

    EDEN PRAIRIE, Minn. – OptumRx, the pharmacy care services business owned by Optum, has acquired AxelaCare Health Solutions, a provider of home infusion solutions, the company announced last week.

    “AxelaCare’s at-home services will enable us to more effectively support the growing number of people managing complex conditions, many of whom require infusions that increasingly involve higher-cost specialty medications," said Larry Renfro, Optum CEO, in a release.

    Founded in 2008, Lenexa, Kan.-based AxelaCare treats patients with autoimmune diseases and hemophilia. It was acquired in 2013 by private equity firm Harvest Partners and began actively making buys. AxelaCare serves patients in 44 states through its network of registered nurses and 34 pharmacies.

    OptumRx serves more than 13.5 million people through mail-service pharmacies and a national network of more than 67,000 community pharmacies.

    Terms of the deal were not disclosed.

    ResMed buys distributor in Denmark

    SAN DIEGO – ResMed has acquired Maribo Medical, a distributor of sleep-disordered breathing medical devices and accessories in Denmark. Maribo Medical has been an exclusive distributor of ResMed devices and accessories for more than 15 years. “Maribo and ResMed together will accelerate growth while improving patient quality of life and reducing total healthcare system costs in Denmark,” stated Anne Reiser, president of ResMed, EMEA-APAC. Maribo Medical employees, including CEO Mette Oaxvaerd Larsen, will continue in their current roles.

    HME champion tapped to lead congressional subcommittee

    WASHINGTON – Rep. Pat Tiberi, R-Ohio, has been named chairman of the Subcommittee on Health of the House Ways & Means Committee. “Having (Tiberi) in a leadership role on Capitol Hill will greatly help the prospects for policies that improve patient care, while also creating a fair regulatory climate for HME providers nationwide,” said Tom Ryan, president and CEO of AAHomecare, in a release. Rep. Tiberi introduced H.R. 284, a bill to reform the competitive bidding program, which was signed into law in April.
    http://www.hmenews.com/article/bidding-bill-clears-another-huge-hurdle

    Ways and Means Committee seeks clarifications on accessories plan

    WASHINGTON – Key members of the House Ways & Means Committee last week sent a letter to CMS, asking the agency for additional details on its plans to apply competitive bid pricing to complex rehab wheelchair accessories. In the letter, Chairman Rep. Kevin Brady, R-Texas, and Ranking Member Rep. Sander Levin, D-Mich., also urged CMS to “take the steps necessary to code the CRT-only items separately so that, as dictated by statute, these accessories are exempted from the competitive bidding pricing.” Meanwhile, industry stakeholders are working to build support for two bills, H.R. 3220 and S. 2196, which would prevent the application of competitive bid pricing to complex rehab wheelchair accessories on Jan. 1, 2016.
    NCPA testifies on ‘undue influence’ of PBMs

    WASHINGTON – National Community Pharmacist Association President Bradley Arthur testified at a Nov. 17 hearing on the “disproportionate market power” of pharmacy benefit management corporations. Arthur told members of the House Judiciary Committee Subcommittee on Regulatory Reform, Commercial and Antitrust Law that PBMs have “undue influence” on patients, health plan sponsors and pharmacies.

    Arthur, a pharmacist, is co-owner of Black Rock Pharmacy and Brighton-Eggert Pharmacy in Buffalo, N.Y. “I can tell you that as a small business owner and health care provider, the current situation and overall business climate that exists in which market power is increasingly concentrated in an ever-shrinking number of corporations makes me apprehensive about what is around the bend,” he testified. Three corporations, Express Scripts, CVS Health and OptumRx, cover approximately 78% of patients managed by PBMs.

    Philips celebrates COPD Day with song, website

    NEW YORK – The Philips Breathless Choir made its debut last week at the famous Apollo Theater in Harlem, N.Y, in honor of World COPD Day, Nov. 18. The group was made up of 18 people living with chronic respiratory conditions. Each member of the choir was provided with the SimplyGo Mini, a portable oxygen concentrator from Philips Respironics. Philips Respironics has also launched a new resource for patients with COPD. The website aims to increase awareness and support for patients by providing tips for living with COPD.

    J&J increases interconnectivity for diabetes management

    CHESTERBOOK, Pa. – The Johnson & Johnson Diabetes Solutions Companies has announced that people using LifeScan’s OneTouch Reveal mobile app for managing their diabetes can now view their blood sugar readings directly in the Apple Health app on their iPhones. They can also choose to privately and securely share that data with their healthcare team. “We’re thrilled to offer this new connectivity and ultimately help people have access to the information they need using the tools of their choice to better manage their diabetes,” stated Dr. Brian Levy, chief medical officer at LifeScan. Users of the OneTouch Verio Sync meter can wirelessly sync their data to the OneTouch Reveal mobile app for access across multiple devices. With this announcement, this information can now be synced with the Apple Health app, providing a comprehensive view of the overall health of users for themselves and, if they choose, their healthcare providers. While Johnson & Johnson Diabetes Solutions Companies champion interconnected diabetes management, they also realize that tens of thousands don’t have access to fundamental supplies. As such, they have also announced that LifeScan will donate 1.3 million blood glucose monitoring test strips in support of the Life for a Child program, an ongoing effort by the International Diabetes Federation to provide urgently needed diabetes supplies to children worldwide.

    Short takes: Medical Service Co. and Aeroflow

    Medical Service Companyhas opened a new location in Crestview Hills, Ky., to provide respiratory services and sleep services. The 65-year-old Cleveland, Ohio-based provider has 23 locations in Ohio, Pennsylvania, New York and West Virginia…Aeroflow Healthcare held a grand opening Nov. 20 to  celebrate its new office in North Wilkesboro, N.C. The Ashville-based provider hopes to better serve a regional medical center.


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    11/20/2015
    Liz Beaulieu

    WASHINGTON – Stakeholders say the HME industry’s “work has just begun” now that a bill aimed at softening the blow of competitive bidding has finally been introduced in the Senate.

    The provisions in S. 2312, introduced by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., on Nov. 19, include a 30% increase to rural single payment amounts for providers in rural areas, and a 20% increase to regional SPAs for providers in all other non-bid areas.

    “It’s time to start running,” said Tom Ryan, president and CEO of AAHomecare.

    Other provisions in the bill include a two-year phase-in period starting Jan. 1, 2016 (a 50/50 blend of fee schedule and adjusted pricing in 2016 and 100% adjusted pricing in 2017); and a limit on the federal portion of Medicaid allowables to match the new SPAs in an area starting Jan. 1, 2020.

    Stakeholders had to compromise on a number of provisions to get the bill introduced as budget neutral, the only way they say it will move by the end of this year. Originally, they had sought a 30% increase across the board in non-bid areas and a four-year phase-in period. The new provision adjusting Medicaid reimbursement to reflect the new pricing was also added as a “pay for.”

    “The reality is there are two options,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Continuing with life as it is now, which is CMS’s plan, or embracing this package deal. In balance, is the package deal better or worse than today? I think most would say it’s better than today.”

    Ryan agreed: “The numbers are much better than what we’re facing if this does not become law.”

    Other provisions in the bill: a ceiling for future rounds of competitive bidding set at the unadjusted fee schedule rates as of Jan. 1, 2015; and a requirement that CMS revisit adjusting pricing for non-bid areas that takes into account travel distance, clearing price and other associated costs for furnishing equipment that will be in effect Jan. 1, 2019.

    “The bid ceiling fix is significant,” Ryan said. “We negotiated hard for that and the other provisions in this bill.”

    Following a congressional recess for Thanksgiving, stakeholders expect an identical bill, with the addition of a market-pricing demonstration project, to be introduced in the House of Representatives in early December. Then the plan is to attach both bills to an omnibus bill that must pass Congress by Dec. 10 to prevent a government shut down.

    On the likelihood of all of these dominoes falling into place, Ryan said, “Absolutely, this has been part of the discussion all along. Everyone is aware of the timeline. Getting a bill out of the Senate is not easy and it’s finally been accomplished. But our work has just begun.”


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  • 11/23/15--12:51: He's no Inspector Gasget
  • Bob Weir takes stock after 15 years as an accreditation inspector
    11/23/2015
    Liz Beaulieu

    When Bob Weir first started as an inspector, the word accreditation would cause the hairs on an HME provider’s neck to stand up. “They would get very defensive,” he said. Now, it’s part of a provider’s daily operations. After 15 years, Weir is no longer contracted with an accreditation organization to conduct inspections (Most recently, he was contracted with HQAA, and before that ACHC). Here’s what he had to say about what he’s seen over the years when providers opened their doors to him and his checklist, and what’s in store for him next.
    HME News: What’s the biggest shift in business you’ve seen?
    Bob Weir: When I started, most providers were 75% Medicare. That was their reimbursement stream. Now they’re 25% to 30% Medicare. They’re also doing Medicaid and third-party insurance and cash. For cash, it has taken awhile for baby boomers to take out their Amex cards, but they’re doing it now.
    HME: What about when the accreditation requirement went into effect in 2009—how did that, specifically, shift business?
    Weir: I think providers have made leaps and bounds. In 2009, when you’d go in, you pretty much looked at what they were saying they were going to do because they had nothing. By 2015, it was all pretty much integrated into their operations.
    HME: Have you found that providers are thankful that they’ve had to go through the process?
    Weir: I don’t know if they were kissing up to me or what, but yes. It’s like, in 2009, people didn’t like Brightree; in 2012, they were OK with it; in 2015, they love it. Change is hard. Still, I’m sure when I left, people said, “Thank God he’s out of here.”
    HME: Why are accreditation organizations downsizing their roster of surveyors?
    Weir: I think if Medicare’s plan was to put small independent providers out of business, they’re doing a great job. There’s a slow down in the number of inspections needed because of that. It’s almost ridiculous when you talk about capitalism and then you throw something like competitive bidding out there.
    HME: What’s next for you?
    Weir: I started working in this industry when I was 12—my older brother had a respiratory homecare business—so I’ve being doing this for 47 years. I’m a musician and I play in bands, so I have that. But I’d still like to find an organization that I can do spotinspections for. It’s the longest thing I’ve ever done. I’m an inspector. That’s what I do for a living.


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  • 11/23/15--12:50: ICD-10: No big deal—yet
  • 11/23/2015
    Theresa Flaherty

    ATLANTA – ICD-10 went live Oct. 1 and, while so far it has gone better than expected, industry consultant Mary Ellen Conway thinks that’s about to change.
    “I think the fan’s going to hit in November,” said Conway, president of Capital Healthcare Group, during a session at Medtrade. That’s because many healthcare providers and systems often take 30 days to bill.
    As with most CMS changes, attendees said they did what they could to prepare for the transition—for themselves and for their referral sources.
    “We made sure we got out and did the education and training,” said one attendee. “It’s been a big help.”
    Still, there have been early hiccups, attendees said.
    “We have a lot coming in with ICD-10, but the documentation doesn’t match,” said one attendee.
    One note Conway made: ICD-10 codes are billing codes. There’s no need for providers to collect new orders or documentation for patients already on service.
    “As long as you can support the original claim, (it’s good),” she said.


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    11/24/2015
    HME News Staff

    WASHINGTON – CMS has released revised fee schedule amounts for 11 product categories as part of its national roll out competitive bidding on Jan. 1.

    CMS has based pricing in rural areas on the national weighted average plus 10%.

    For oxygen concentrators, for example, that means a 22% reduction in reimbursement, on average, in rural areas from 2015 to 2016.

    CMS plans to phase-in new pricing over six months. Starting Jan. 1, pricing will be based on a 50/50 blend of the current and adjusted rates. On July 1, it will be based only on the adjusted rates.

    Using oxygen concentrators as an example again, providers are paid $1,086, on average, for six months under the current rates. Starting Jan. 1, they will be paid $850 in rural areas.

    Last month, CMS released a preliminary list of zip codes that it considers rural.

    AAHomecare late on Monday said it was analyzing the data and would provide additional information shortly.


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    11/25/2015
    HME News Staff

    WASHINGTON – CMS last week released revised fee schedule amounts for 11 product categories in non-bid areas as part of its upcoming national roll out of competitive bid pricing on Jan. 1, 2016.

    CMS has developed fee schedule amounts for non-bid areas in two ways: the average pricing in the competitive bidding areas in the region for regional areas; and the national weighted average plus 10% for rural areas.

    For oxygen concentrators, for example, that means a 24% reduction in reimbursement, on average, for regional areas and a 22% reduction in reimbursement, on average, for rural areas.

    CMS plans to phase-in new pricing over six months. Starting Jan. 1, pricing will be based on a 50/50 blend of the current and adjusted rates. On July 1, it will be based only on the adjusted rates.

    Using oxygen concentrators as an example again, providers are paid $1,086, on average, for six months under the current rates. Starting Jan. 1, they will be paid $822 for six months in regional areas and $850 in rural areas.

    Last month, CMS released a preliminary list of zip codes that it considers rural to distinguish those areas that will receive the 10% bump in reimbursement.

    Average reductions from 2015 to 2016 for other popular HME are:

    ·      CPAP, 27% in regional areas; 25% in rural areas

    ·      Hospital bed, 24% in regional areas; 21% in rural areas

    ·      Power wheelchair, 25% in regional areas; 23% in rural areas

    In a bulletin to its members following the announcement, AAHomecare stated: “(We) will full analyze the 2016 rates and will provide additional information shortly.”

    In a bulletin to its members, The VGM Group included a link to a presentation it has prepared explaining and outlining the new pricing.

    In a bulletin to its members, NCART confirmed that the new pricing includes reductions in reimbursement to accessories for complex power wheelchairs. Executive Director Don Clayback urged stakeholders to use the new pricing as a talking point with legislators to drum up support for bills in the House of Representatives and the Senate that would provide a technical correction preventing CMS from applying competitive bidding pricing to these accessories on Jan. 1.

    The industry has also succeeded in getting a bill introduced in the Senate recently that would soften the blow of competitive bidding by, among other things, providing a 30% increase in reimbursement in rural areas and a 20% increase in regional areas. It expects a similar bill to be introduced in the House this week.

     

     


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    11/25/2015
    HME News Staff

    INDIANAPOLIS – The Office of Inspector General is not satisfied with National Government Services’ progress in preventing overpayments for diabetic test strips.

    The OIG found that NGS, the DME MAC for Jurisdiction B, made payments to suppliers for dispensed strips when the beneficiaries had not nearly exhausted previously dispensed strips by different suppliers, resulting in overpayments of about $3.2 million in 2013.

    “NGS stated (in response to a previous review in 2007) that it was in the process of developing a system edit that would address the problem of overlapping dates of service on claims for individual beneficiaries,” the OIG stated in a report published last week. “We conducted this follow-up review to determine whether this system edit had been implemented and was effective in preventing overpayments.”

    The OIG based its findings on a sample of 100 claims. It found 17 were allowable, 13 were non-errors because the suppliers were no longer in business and the supporting documentation could not be obtained, and 70 may have not been allowable because the suppliers dispensed strips before the beneficiaries’ existing supplies were nearly exhausted. For more than half of the 70 claims, the suppliers dispensed strips when there were more than 60 days remaining in the beneficiaries’ existing supplies.

    On the basis of the sample, the OIG estimates about $3.2 million, or 74%, of the $4.4 million that NGS paid to suppliers may have been unallowable for Medicare reimbursement.

    The OIG recommends that the NSG implement a system edit to identify claims submitted by multiple suppliers with overlapping service dates for strips dispensed to the same beneficiary. It argues that the contractor’s current system was designed only to identify claims with a quantity of strips that exceeds the utilization guidelines.

    MedCare adds two health systems in one month

    GREENSBURG, Pa. – MedCare Equipment Company has signed on Indiana Regional Medical Center as its latest health system partner, in a move that adds about 1,000 patients and $2 million in revenues to its books. “This is an excellent example of how strong community health systems can collaborate,” said Stephen Wolfe, president and CEO of Indiana Regional Medical Center. “We can improve care to patients and reduce costs to employers while remaining independent and focused on our local community.” MedCare, which provides respiratory and HME to patients in western Pennsylvania and neighboring states, already has partnerships with a number of health systems, including UPMC Altoona. It acquired Home Health Resource from UPMC Altoona in early November. With the addition of Indiana Regional Medical Center, MedCare will serve 25,000 patients annually, with a revenue base of $72 million. It employs 320 people in 14 locations.

    Medical Service Company announces location, promotion

    CLEVELAND, Ohio – Medical Service Company has opened its second new location this month, this time in Rochester, N.Y. The location will offer oxygen, respiratory and sleep equipment and services. Earlier this month, the provider opened a location in Crestview Hills, Ky. Medical Service Company has also promoted Judy Bunn to director of revenue cycle and compliance. Bunn also serves on several industry boards and councils, including as chairwoman of AAHomecare’s regulatory council.

    Invacare adds diabetes expert to board

    ELYRIA, Ohio – Invacare has appointed Marc Gibeley to its board of directors. Gibeley is the head of diabetes care, North America, for Roche Holding AG and is responsible for all aspects of the company’s blood glucose monitoring and insulin pump business, including sales, marketing, finance, customer support and product launches. “He has a keen understanding of the population that we serve, the ongoing healthcare reform changes that impact our business, and the rise of consumerism in the medical device space,” Invacare stated in a press release. Gibeley is the third new independent director to join Invacare’s board over the past year and a half. He joins the board after a search by a nationally recognized firm.

    ResMed Halifax gets rebate deal

    HALIFAX, Nova Scotia – ResMed Halifax will earn a rebate of up to $787,500 over five years from the province of Halifax if it creates 40 new jobs, according to Nova Scotia Business. ResMed acquired the Halifax-based Umbian in 2012 and renamed it ResMed Halifax. Umbian is the developer of U-Sleep, a web-based software solution to track CPAP usage by long haul truckers.

    Reid Health opens retail location

    GREENVILLE, Ohio – Reid Health is opening a 1,500-square-foot retail location for home health supplies here, according to the Dayton (Ohio) Business Journal. Reid Health Medical Equipment & Uniforms opens its doors Nov. 30, offering home safety aids, oxygen units, hospital equipment, and diabetes and mastectomy supplies. Three employees will man the location, with support from the company’s Richmond, Ind., headquarters, according to the newspaper. Reid Health includes a 217-bed hospital and numerous satellite locations in Eastern Indiana and Western Ohio, serving about 280,000 people.


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    12/02/2015
    HME News Staff

    BALTIMORE – CMS will revise its recently released 2016 DMEPOS fee schedule after finding errors, the agency has announced.

    The agency released the revised fee schedule Nov. 23. It includes adjusted payment amounts for 11 product categories as part of its national roll out of competitive bid pricing on Jan. 1.

    “CMS identified errors in the fee schedule amounts for some items and will therefore be releasing revised fee schedule files within the next week,” the agency stated on Dec. 1. “A list of the items affected by the revisions will be included in a separate public use file along with the revised 2016 fee schedule public use files.”

    The fee schedule for non-bid areas was developed in two ways: the average pricing in the competitive bidding areas in the region for regional areas; and the national weighted average plus 10% for rural areas.

    Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., have introduced a bill that seeks to soften the blow of the rollout of the adjusted payment amounts. S. 2312 would increase rural single payment amounts by 30%, and increase regional SPAs by 20% in all other non-bid areas.

     


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    But growth is still lower than most prior years
    12/03/2015
    HME News Staff

    WASHINGTON – Overall national health expenditures grew by 5.3% in 2014, as millions of uninsured Americans gained health coverage through the Affordable Care Act, the CMS Office of the Actuary reported Dec. 2.

    The report also credits rapidly rising prescription drug costs for the growth.

    “Still, the rate of growth remains below the level in most years prior to the coverage expansion, while out-of-pocket costs grew at the fifth lowest level on record,” said CMS Acting Administrator Andy Slavitt in a release.

    Overall, health care spending grew 1.2% faster than the overall economy in 2014, resulting in an increase in the health spending share of gross domestic product from 17.3% in 2013 to 17.5% in 2014, the report states. In the decade before the ACA, healthcare spending grew 6.9% annually, 2.8% faster than the overall economy. 

    Medicare spending grew 5.5% in 2014 compared to 3% in 2013. Total Medicare spending per enrollee grew by 2.4% in 2014, the report states.

    Total Medicaid spending grew 11% in 2014, compared to 5.9% in 2013, due to the coverage expansion under the ACA, the report states.

    “Today’s report reminds us that we must remain vigilant in focusing on delivering better health care outcomes, which leads to smarter spending, particularly as costs increase in key care areas, like prescription drugs costs,” said Slavitt.


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    12/04/2015
    HME News Staff

    YARMOUTH, Maine – Medicare allowed charges for DME bounced back a bit in 2014 compared to 2013, according to the 2015 State of the Industry Report.

    Allowed charges for DME-related BETOS “buckets”* were $5.8 billion in 2014 compared to $5.3 billion in 2013.

    Still, that’s a far cry from the $8.1 billion in allowed charges in 2012, $7.8 billion in 2011 and $8.5 billion in 2010, when Medicare first launched competitive bidding.

    Allowed charges for the majority of individual DME saw decreases in 2014 compared to 2013. Allowed charges for oxygen concentrators, for example, were $1.19 billion, a decrease of about 15.5%. Charges for CPAP devices were $181.69 million, a decrease of about 20.5%.

    Some products did see increases in allowed charges in 2014. Allowed charges for vents (E0463), for example, were $63.4 million, an increase of about 12%.

    The number of providers supplying the most popular DME products continues to drop. For oxygen concentrators, for example, there were 6,862 providers in 2014 vs. 7,491 in 2013. For CPAP devices, there were 6,628 vs. 7,239.

    The State of the Industry Report also includes a list of 100 top Medicare providers (Lincare comes out on top again in 2014), and a breakdown of the number of providers by how much they billed Medicare (there were decreases across the board in 2014). 

    *BETOS is a coding system developed to analyze the growth in Medicare expenditures. It covers all HCPCS codes; assigns a HCPCS code to only one BETOS bucket; consists of readily understood clinical categories that permit objective assignment; is stable over time; and is relatively immune to minor changes in technology or practice patterns.


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    12/04/2015
    HME News Staff

    WASHINGTON – The Office of Inspector General (OIG) wants Hoveround to pay back the federal government $27 million for power mobility devices that it says do not meet Medicare reimbursement requirements.

    The OIG audited claims for 200 randomly selected beneficiaries who received PMDs from the direct-to-consumer manufacturer in 2010 and found 154 did not meet Medicare requirements. Of those, 144 did not meet medical necessity requirements and 10 had incomplete documentation, according to the agency’s report.

    On the basis of its sample, the OIG estimates that Medicare paid Hoveround more than $27 million for PMDs that did not meet requirements in 2010. In all, Hoveround received nearly $50 million for PMDs that year, the second-largest reimbursement for these claims.

    In addition to the refund, the OIG recommends that Hoveround implement internal controls to ensure that beneficiaries meet requirements before providing equipment.

    In a written response to the report, Hoveround disagreed with the findings, saying the OIG applied incorrect standards, and the agency influenced the medical review and biased the results. Furthermore, Hoveround claims the OIG never revealed it was conducting a medical necessity review and therefore the company was unable to submit supporting evidence.

    The OIG denies Hoveround’s allegations and stands by the review’s findings.

    CMS to revise revised fee schedule

    BALTIMORE – CMS will revise its recently released 2016 DMEPOS fee schedule after finding errors, the agency has announced.

    The agency released the revised fee schedule Nov. 23. It includes adjusted payment amounts for 11 product categories as part of its national roll out of competitive bid pricing on Jan. 1.

    “CMS identified errors in the fee schedule amounts for some items and will therefore be releasing revised fee schedule files within the next week,” the agency stated on Dec. 1. “A list of the items affected by the revisions will be included in a separate public use file along with the revised 2016 fee schedule public use files.”

    The fee schedule for non-bid areas was developed in two ways: the average pricing in the competitive bidding areas in the region for regional areas; and the national weighted average plus 10% for rural areas.

    Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., have introduced a bill that seeks to soften the blow of the rollout of the adjusted payment amounts. S. 2312 would increase rural single payment amounts by 30%, and increase regional SPAs by 20% in all other non-bid areas.

    Inogen faces fears head-on

    GOLETA, Calif. – Inogen last week provided additional full-year guidance for next year, perhaps in a move to quell fears surrounding the national rollout of competitive bidding pricing on Jan. 1, 2016.

    The company, which manufactures and provides portable oxygen concentrators, expects adjusted EBITDA for 2016 to be in the range of $35 million to $37 million, representing 14.8% to 21.3% growth compared to its mid-point guidance of $30.5 million for 2015. It expects net income for 2016 to be between $11 million to $13 million, representing 18.9% to 40.5% growth.

    “INGN shares have fallen in recent weeks and we think that the primary factor driving the decline was concern about the impact of the expansion of Medicare’s competitive bidding program during 2016,” wrote Mike Matson, an analyst for Needham & Co., in a report following the announcement. “While we expect the additional reimbursement cuts to create a modest headwind for revenue growth and margins, we still expect INGN to see strong revenue and earnings growth next year.”

    Inogen shares dropped from $43.86 per share on Nov. 16 to $38.76 per share on Nov. 19, an 11.6% decrease. Currently, they’re trading at $38.27 per share.

    Inogen also confirmed revenue guidance for 2016 of $177 million to $183 million, representing 16.8% growth compared to mid-point guidance of $151.5 million for 2015.

    “We remain confident in our ability to continue to grow the top line, while at the same time leveraging operating efficiencies for continued strong profitability despite the reimbursement headwinds from the national rollout of competitive bidding pricing we anticipate in 2016,” stated Ray Huggenberger, president and CEO of Inogen.

    CMS recently released revised fee schedule amounts for oxygen equipment and 10 other products categories in non-bid areas as part of the national rollout.

    In its most recent earnings report, Inogen detailed its plans to offset the expected hit to rental sales with strong growth in direct-to-consumer sales.

    CMS: ACA spurs growth in health spending

    WASHINGTON – Overall national health expenditures grew by 5.3% in 2014, as millions of uninsured Americans gained health coverage through the Affordable Care Act, the CMS Office of the Actuary reported Dec. 2.

    The report also credits rapidly rising prescription drug costs for the growth.

    “Still, the rate of growth remains below the level in most years prior to the coverage expansion, while out-of-pocket costs grew at the fifth lowest level on record,” said CMS Acting Administrator Andy Slavitt in a release.

    Overall, health care spending grew 1.2% faster than the overall economy in 2014, resulting in an increase in the health spending share of gross domestic product from 17.3% in 2013 to 17.5% in 2014, the report states. In the decade before the ACA, healthcare spending grew 6.9% annually, 2.8% faster than the overall economy. 

    Medicare spending grew 5.5% in 2014 compared to 3% in 2013. Total Medicare spending per enrollee grew by 2.4% in 2014, the report states.

    Total Medicaid spending grew 11% in 2014, compared to 5.9% in 2013, due to the coverage expansion under the ACA, the report states.

    “Today’s report reminds us that we must remain vigilant in focusing on delivering better health care outcomes, which leads to smarter spending, particularly as costs increase in key care areas, like prescription drugs costs,” said Slavitt.

    Industry revs up lobbying engine

    WASHINGTON – Industry stakeholders have logged on to the VGM Action Center and sent more than 1,100 messages in one week to drum up support for a new bill to soften the blow of the national rollout of competitive bidding pricing, according to The VGM Group. S. 2312, introduced Nov. 19, would, among other things, increase reimbursement by 30% in rural areas and 20% in regional areas, and phase in the new pricing over two years instead of six months. AAHomecare has also been encouraging stakeholders to reach out to their senators to support the bill. The association expects a similar bill to be introduced in the House of Representatives this week. The end goal: attach the bills to an omnibus bill that Congress must pass by Dec. 10 to prevent a government shutdown.

    Virtual sleep center keeps patients at home

    MOUNT PLEASANT, S.C. – A new online service is allowing sleep apnea patients and individuals with sleep disorders to get diagnosed and receive treatment from the comfort of their own living rooms. Singular Sleep offers online consultations with a board certified sleep physician, home sleep testing in 13 states and sleep health products.“We established Singular Sleep to help empower people to take control of their health by getting better sleep,” said founder Dr. Joseph Krainin in a release.

    LifeMap Solutions launches COPD apps

    SAN JOSE, Calif. – LifeMap Solutions’ COPD Navigator app, which helps patients better manage their condition, is now available for free download from the App Store. The company, a digital-health subsidiary of BioTime, a biotechnology company, has also announced that an enhanced version of the app called SuperCare iBreathe will be used by SuperCare Health, a respiratory disease management company. This app is customized with data collection points that allow SuperCare Health’s clinical care team to track data in real time and respond immediately to patients enrolled in its Healthcare at Home program. Both versions of the app will provide real-time local weather and air quality alerts, medication reminders, and tools to help patients track their symptoms.

    Scott’s Home Health expands footprint

    WASHINGTON, Mo. – Scott’s Home Health Medical Supply has doubled in size, according to a local newspaper. The new 2,000-square-foot facility offers liftchairs, oxygen supplies, nebulizers, bath safety and mobility products, as well as home modification products. “We’ve always wanted to expand the retail store so we can offer more of a variety of product,” co-owner Cary Goldsmith told the newspaper. After the business next door moved, Goldsmith purchased the space and knocked down the wall. Founded more than 30 years ago, Scott’s Home Health has locations in Washington and Troy, Mo.

    OIG spotlights home infusion payments in report to Congress

    WASHINGTON – Medicare could have reduced payments for home infusion drugs by $251 million over an18-month period if it used an average sales price methodology, the Office of Inspector General said in its Semiannual Report to Congress. The OIG, which has recommended that Medicare switch from an average wholesale price to an ASP model, found that “at least 42% of DME infusion drugs had Medicare payment amounts that were more than twice their estimated acquisition costs.” The OIG reported the same findings in April but noted it had not factored in the cost of services for providing home infusion therapy.

    Aeroflow employees host canned food drive

    ASHEVILLE, N.C. – Aeroflow Healthcare donated more than 1,000 pounds of food to the Manna FoodBank, the provider announced recently. The provider’s employees held a canned food drive to collect the food, according to a press release. “Patient care is always our number one priority at Aeroflow,” said CEO Casey Hite. “It doesn’t matter if they are current patients of ours, or members of the community who may be in need; we want to do whatever we can to help improve their lives.” The food bank serves Western North Carolina. Aeroflow employees are also collecting Toys for Tots and donating their time at a local senior center. In September, the provider raised money to support a local children’s hospital.

    Invacare inventor has passed away

    ELYRIA, Ohio – Joseph B. Richey, who founded Invacare with Mal Mixon, died of cancer on Nov. 23, according to the Chronicle-Telegram. He was 79. Richey was president of Invacare’s Technologies Division and senior vice president of electronic and design engineering when he retired from the company about a year ago. Richey, an inventor and innovator, was instrumental in the development of the HomeFill Oxygen System. He also helped develop gearless-brushless motors and digital controls for power wheelchairs. He held numerous patents.

    Lincare gets bigger in N.C.

    WILMINGTON, N.C. – Lincare plans to double its footprint here, according to the Greater Wilmington Business Journal. The Clearwater, Fla.-based national provider plans to move into a 4,300-square-feet location in January, twice the size of its current location. “We continue to grow internally and externally across the area,” Wes Todd, local center manager, told the newspaper. “There’s very strong demand for our level of service and clinical expertise.”

    Nunn’s HME acquires Rothschild’s Home Health

    ROME, N.Y. – Nunn’s Home Medical Equipment has acquired Rothschild’s Home Health Care of Syracuse, N.Y., allowing the company to open its first additional location. Nunn’s has been operating out of Rome, serving 15 counties, for 73 years. Nunn’s will continue to offer the same products and services in the 6,000-square-foot location in Syracuse, but it will add new products and a respiratory therapist. “Acquiring Rothschild’s was a natural next step for Nunn’s as we expand and grow in our region,” said Shawn Weiman, vice president.

    Short takes: United States Medical, Oaklawn HME & more

    Yvonne Blackstone, shipping director at United States Medical Supply, has been inducted into the National Association of Professional Women’s VIP Woman of the Year Circle for 2015-16. She has been recognized for leadership in health care…Marshall, Mich.-based Oaklawn Home Medical Equipment has relocated from a downtown storefront to the first floor of Oaklawn Hospital. “The driving force behind the move was convenience for the patients,” Bill DeSmet, the company’s executive director of support services, told a local newspaper…Lebanon, Tenn.-based Permobil has donated a custom wheelchair to former Wilson County Sheriff’s Deputy Court Officer Earl Dyer, who is paralyzed after a stroke. Dyer, 49, now lives on a disability income of $1,200 each month and he mush pay $1,600 for insurance, leaving nothing for expenses. “I cannot tell you how thankful I am,” he told a local newspaper…OxyGo now offers a five-year warranty plan on its portable oxygen concentrators. One-, two- and three-year limited warranties are the industry standard, despite a five-year rental cycle, the manufacturer points out.


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  • 12/08/15--13:32: House bid bill drops
  • 12/08/2015
    HME News Staff

    WASHINGTON – A House bill that would lessen the impact of competitive bid pricing in non-bid areas was introduced today.

    Led by Reps. Tom Price, R-Ga., and Tammy Duckworth, D-Ill., H.R. 4185 contains several provisions. Chief among those provisions: it would apply a 30% increase to single payment amounts for providers in non-bid areas; and phase in the pricing over a two-year period, compared to the current six months.

    Other provisions include setting a ceiling for future rounds of competitive bidding at the unadjusted fee schedule rates in effect Jan. 1, 2015; and instructing CMS to revisit pricing adjustments for non-bid areas to take into account travel distance, clearing price and other associated costs for prices that will be in effect Jan. 1, 2019.

    "This bill is a life line for rural providers adn the patients they serve," said John Gallagher, vice president of government relations for The VGM Group in a release. "It's a common sense approach to stop the devastation of rural health care by a poorly devised and thought out bureaucratic program."

    The provisions are similar to those included in a Senate version of the bill, S. 2312, which was introduced Nov. 19 by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D.

    One big difference between the two bills: the House bill contains a provision that would implement a market pricing program demonstration project. The 10-site demo will include the same DME items as the competitive bidding program, require binding bids, weigh historic capacity of the bidders, and determine the price based on the clearing price.

    A separate auction will take place in two states for diabetes testing supplies.


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    12/10/2015
    HME News Staff

    WASHINGTON – After finding several errors in its revised 2016 DMEPOS fee schedule, CMS has posted an updated version to its website, AAHomecare has announced.

    The fee schedule maps out adjusted payment amounts for 11 product categories as part of the national roll out of competitive bid pricing on Jan. 1.

    The first version of the revised fee schedule was released on Nov. 23.

    CMS has developed payment amounts for non-bid areas by using the average pricing in the competitive bidding areas in the region for regional areas, and the national weighted average plus 10% for rural areas.

    The agency plans to phase-in the new pricing over six months. Starting Jan. 1, pricing will be based on a 50/50 blend of the current and adjusted payment amounts. On July 1, it will be based only on the adjusted amounts.

    AAHomecare says it’s currently reviewing the updated fee schedule and will inform members of any major changes.


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