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    ‘This is (the industry’s) Alamo,’ says VGM’s John Gallagher
    12/11/2015
    Theresa Flaherty

    WASHINGTON – Industry stakeholders hit the ground running last week with the introduction of a second bill that would lessen the impact of competitive bidding.

    “We just have a few hours left to get this done,” said Jay Witter, senior vice president of public policy at AAHomecare. “We are doing everything politically, legislatively, and at the grassroots level.”

    Introduced Dec. 8 by Reps. Tom Price, R-Ga., and Tammy Duckworth, D-Ill., H.R. 4185 is similar to its Senate companion bill, S. 2312, introduced Nov. 19 by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D.

    The industry’s immediate plan is to get both bills attached to an omnibus bill that lawmakers must pass by Dec. 16 to avoid a government shut down. AAHomecare’s Tom Ryan says he’s as confident as he can be that industry efforts will pay off.

    “(Lawmakers) are bargaining and negotiating,” said Ryan, president and CEO of the association. “All we can do is put ourselves in the best position and hope we’ve got a bipartisan, bicameral bill that’s paid for.” 

    At press time on Friday, H.R. 4185 already had 36 co-sponsors.

    If the bills don’t pass by the end of this year, stakeholders are committed to identifying another legislative vehicle in the first quarter of 2016. Once competitive bid pricing is implemented on Jan. 1, however, it will be harder to drum up support and providers will have tough decisions to make, say stakeholders.

    “They are going to have to take a look at their business models and these rural areas they may no longer (be able to) cover,” said John Gallagher, vice president of government relations for The VGM Group. “This is their Alamo.”

    Among the major provisions in the bills, the House bill has a 30% add-on to single payment amounts in all non-bid areas, while the Senate bill has a 30% add-on to rural SPAs, and a 20% add-on to regional SPAs.

    “(It will) probably fall closer to the Senate provision,” said Ryan.

    Other provisions include a two-year phase-in period; 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.

    The House bill also contains a provision that would implement a demonstration project for a market-pricing program, something that Price has long been a proponent of. The 10-site demo would 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.


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    12/11/2015
    Liz Beaulieu

    YARMOUTH, Maine – The recent transition to ICD-10 codes hasn’t been as bad as they thought, the respondents to a recent HME Newspoll say.

    The keys to what has been mostly a smooth transition for 64% of respondents: a prepared staff and good software.

    “The challenge for us was being certain that our staff was fully trained before Oct. 1,” said John Reed, CEO of Walnut Medical Services in Johnstown, Pa. “We met that goal and hoped that our referral sources were prepared also. So far we are getting paid and encountering few problems.”

    The transition to ICD-10 has meant working with a significantly more specific and expanded code set—68,000 codes vs. the previous 13,000.

    A number of respondents credited software vendors like Brightree and TeamDME! for doing much of the heavy lifting to make sure there were few hiccups.

    “Our software vendor made the transition extremely easy by converting the GEM (general equivalence mapping) codes for us, and automatically adding them to patient records and unprocessed transactions,” said Bruce Brothis, president of Allegient Billing & Consulting in Elizabeth, Colo. “Edits were also added to ensure the right version was transmitted for the affected DOS. There have been virtually no interruptions short of getting the correct ICD-10 codes from the docs for non-GEM translations.”

    One concern about the transition that has played out for a number of respondents: Physicians who aren’t up to speed.

    “The hard part has been getting the physicians to provide the correct codes, or the chart notes so we can code the claim ourselves,” said H.S. Moore, a billing manager at Medicor in Salt Lake City.

    But for some respondents, the transition has helped, not harmed, their efforts to get proper documentation from physicians.

    “The biggest surprise (and benefit) has been that physicians are now sending orders with the ICD-10 codes when previously we could barely get enough information to find the ICD-9 codes ourselves,” said Lori Sears, owner of Active Home Medical Supply in Lapeer, Mich. “I no longer have to fight for the information needed to get things like ‘foot fracture’ or ‘gait instability’ properly coded.”

    Related stories:

    ICD-10: No big deal—yet

    ICD-10: Providers brace for disruptions from physicians, payers

    Expect challenges from ICD-10 transition

     


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    12/11/2015
    HME News Staff

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

    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. 

    Rural residents will have to travel dozens of miles for HME

    WATERLOO, Iowa – Residents in rural states will have to travel further to reach an HME provider when Medicare applies competitive bid pricing nationwide on Jan. 1, according to a new study.

    Residents living in rural areas in Montana, North Dakota, Oregon, Washington state, West Virginia and Wisconsin will all be affected by the change, according to the study from the GeoTree Center at the University of Northern Iowa in Cedar Falls.

    In North Dakota, for example, residents in rural areas will have to travel 53 miles to access an HME provider. The study estimates there will be 6,171 square miles per provider in the state.

    “HME suppliers in rural areas contend with different business challenges, such as the cost of delivery and smaller patient volume, that are not accounted for in this across-the-board cut,” said John Gallagher, vice president-government relations for VGM, in a release. “Businesses will be put in dire situations, forcing coverage reduction or even closures. Naturally, when there are fewer providers, patient access suffers, hospital discharges are delayed, which costs the government more money.”

    The study, commissioned by The VGM Group, is a continuation of an earlier study published in August that showed similar results for five other rural states.

    Since Medicare launched competitive bidding, there has been a 17% decrease in the number of providers throughout the U.S., according to VGM.

    Stakeholders are trying to stave off the expansion of bid pricing to rural areas with bills in both the House of Representatives and Senate.

    Sleep therapy devices lead in remote monitoring, study says

    GOTHENBURG, Sweden – Remote monitoring of patients with cardiac rhythm management devices and sleep therapy devices accounted for 81% of all connected home medical monitoring systems in 2015, according to a new study from Berg Insight. Additionally, sleep therapy devices accounted for the majority of the market growth in 2015, the report states. “ResMed was especially successful with its new Air Solutions family of sleep therapy devices that includes a cellular M2M module as standard and is supported by a range of health informatics software that enables healthcare organizations to provide better care more efficiently,” the report states. ResMed has surpassed Medtronic as the world’s largest provider of connected healthcare solutions for remote patient monitoring in 2015, according to the report. Overall, the number of remotely monitored patients grew by 51% to 4.9 million in 2015 as the market entered a growth phase fuelled by rising acceptance in key vertical markets, the report states.

    CareCentrix, Fallon extend contract

    HARTFORD, Conn. ¬– CareCentrix and Fallon Community Health Plan have extended a contract that gives Fallon’s membership continued access to diagnostic testing and therapy adherence programs for sleep-related disorders like obstructive sleep apnea. Since 2009, Fallon and CareCentrix subsidiary Sleep Management Solutions have helped more than 11,000 patients receive testing and therapy in the comfort of their own homes. “In-home sleep tests, coordinated by SMS, typically represent an over 50% cost-savings as compared to a hospital or physician-run sleep clinic,” stated Thomas Gaffney, CareCentrix’s chief customer officer, in a press release. The SMS program helps members get started on the right sleep therapy and then supports their progress by remotely monitoring data from their devices to ensure the therapy is working and to intervene when they’re experiencing difficultly. “Working with SMS has enabled us to offer our members with sleep disorders more choices, so that they can receive the quality, cost-effective care they need in the comfort of their home,” stated Patrick Hughes, Fallon’s president and CEO. CareCentrix and Fallon Health have extended their contract for three years.

    Harbour Group buys SP Industries

    ST. LOUIS – Harbour Group has acquired SP Industries, which, in 2014, bought Bel-Art Products, the parent company of Maddak. Warminster, Pa.-based SP Industries designs and manufactures scientific equipment, biological drug manufacturing solutions and precision labware. It has been part of Graham Partners’ portfolio since March 2011. "SP's brand strength, breadth of product and in-house manufacturing capabilities fit very well with our experience in the manufactured products sector," said Jeff Fox, chairman and CEO of Harbour. "We will accelerate their investment in new product development, geographical expansion and complementary acquisitions, as we have done with our companies for the last 40 years.” Terms of the deal were not disclosed. 

    OMHA publishes updated manual

    WASHINGTON — The Office of Medicare Hearings and Appeals (OMHA) has made several changes to its Case Processing Manual, according to a notice posted in the Federal Register. The updated manual now includes several new chapters, including: Chapter 4 – Parties to an ALJ Hearing; Chapter 5 – Roles and Responsibilities of Parties to an ALJ Hearing; and Chapter 6 – Contractor Roles to an ALJ Hearing. OMHA is asking providers to review the requirements to represent a beneficiary in an ALJ hearing and the roles of providers as representatives, as well as the limitations on DME MACs and QIC participation.  

    Convaid throws support behind complex rehab bills

    TORRANCE, Calif. – Convaid Products has endorsed S. 2196, a bill introduced in October that would prevent CMS from applying competitive bid pricing to accessories for complex rehab wheelchairs. The bill is a companion to H.R. 3229, which was introduced in July. "Convaid has been advocating both bills on an ad hoc basis throughout the year, however, with only a few weeks left to make a difference, we felt it was critical to yield as much visible support to both bills that are critical to the special needs community we serve," said Convaid CEO Chris Braun. The bills have 11 and 74 co-sponsors, respectively.

    Alaska seeks to cover reused DME

    ANCHORAGE, Alaska – The Alaska Department of Health and Social Services and the state legislature want to amend Medicaid regulations to allow reimbursement for reused durable medical equipment, according to a local newspaper article. The reimbursement would be lower than that for new equipment but the equipment would have to meet the same standards for use and have no defects. “(This is) part of bringing the cost down of Medicaid,” said Sen. Peter Micciche, who plans to include the bill on the agenda for the upcoming January session. “Before, in our state, you couldn’t reuse durable medical equipment. If you had a very high-priced wheelchair and the person didn’t need it anymore, they would have to purchase a new one for that client.” A House version of the bill passed in May.

    Griffin Home Health goes state-of-the-art

    CHARLOTTE – Griffin Home Health Care is relocating to a new state-of-the-art showroom in the Greylyn Office Park, four miles from its current location. The provider’s office and warehouse will also be located there. “(The new location) will provide support for all branch locations to better serve patients and customers,” Griffin Home Health stated in a press release. A full-line provider of HME founded in 1983, Griffin Home Health serves the 16-county region in and around the Charlotte metro area. It also has a location in Gastonia.

    Short takes: Lincare, Golden Technologies, Medtrade, AOPA

    Lincare is once again a member of AAHomecare after failing to renew its membership in 2008…Golden Technologies has named Carrie Ernest as its new marketing manager. Previously, she worked in communications for several high-level government agencies, including Veterans Affairs, where she worked as the director of communications for the Wounded Warrior Project…Medtrade Spring attendees who register by midnight on Friday, Dec. 18, can save up to $75 on the expo, and more than $200 on a conference pass. The conference is slated for Feb 29-March 2, at the Mandalay Bay Convention Center in Las Vegas…The American Orthotic & Prosthetic Association has named Jeff Lewis of Mesa, Ariz., the winner of the Mobility Saves Testimonial Contest. Lewis won the grand prize of $500 for his video describing his active life as a quadruple amputee.

     

     


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    12/11/2015
    HME News Staff

    WATERLOO, Iowa – Residents in rural states will have to travel further to reach an HME provider when Medicare applies competitive bid pricing nationwide on Jan. 1, according to a new study.

    Residents living in rural areas in Montana, North Dakota, Oregon, Washington state, West Virginia and Wisconsin will all be affected by the change, according to the study from the GeoTree Center at the University of Northern Iowa in Cedar Falls.

    In North Dakota, for example, residents in rural areas will have to travel 53 miles to access an HME provider. The study estimates there will be 6,171 square miles per provider in the state.

    “HME suppliers in rural areas contend with different business challenges, such as the cost of delivery and smaller patient volume, that are not accounted for in this across-the-board cut,” said John Gallagher, vice president-government relations for VGM, in a release. “Businesses will be put in dire situations, forcing coverage reduction or even closures. Naturally, when there are fewer providers, patient access suffers, hospital discharges are delayed, which costs the government more money.”

    The study, commissioned by The VGM Group, is a continuation of an earlier study published in August that showed similar results for five other rural states.

    Since Medicare launched competitive bidding, there has been a 17% decrease in the number of providers throughout the U.S., according to VGM.

    Stakeholders are trying to stave off the expansion of bid pricing to rural areas with bills in both the House of Representatives and Senate.


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    12/16/2015
    HME News Staff

    WASHINGTON – Despite a mammoth push, two pairs of HME-related bills are not included in the omnibus spending package that lawmakers have on the table this week, according to AAHomecare.

    “This result is not a reflection of the amount of effort that our industry has extended at both grassroots and Capitol Hill lobbying levels, and we should all be proud of the way the (industry) has come together to build support for these initiatives,” said the association in its announcement.

    The industry had targeted the spending package as a vehicle for S. 2312 and H.R. 4185, which would soften the blow of the roll out of competitive bid rates in non-bid areas; and S. 2196 and H.R. 3229, which would prevent CMS from applying bid rates to accessories for complex rehab wheelchairs.

    Both changes go into effect Jan. 1.

    All four bills remain active into 2016 and sources on Capitol Hill have indicated there may be other Medicare-related legislation in play early in the year that could serve as a vehicle for the bills.

    “We want to assure the industry that this fight is far from over, and that we will be working with our congressional champions on strategy to move these issues forward,” AAHomecare said.

     


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    ‘We’ll live to fight next year’
    12/18/2015
    Theresa Flaherty

    WASHINGTON – The HME industry took a blow last week when competitive bid legislation was left out of an omnibus spending package, but stakeholders are already regrouping.

    “This hurts,” said Tom Ryan, president and CEO of AAHomecare. “It’s not what we wanted, but we’ve got to get back in the game. It didn’t appear to be any particular person that objected, but at the end of the day, there just were not a lot of Medicare issues that were passed.”

    The industry had targeted the spending package as a vehicle for S. 2312 and H.R. 4185, which would soften the blow of the roll out of competitive bid rates in non-bid areas.

    The industry did score a victory last week, however. A last-minute Senate bill which included a provision to delay the application of bid pricing to accessories for complex rehab wheelchairs, passed on Friday afternoon.

    Stakeholders wasted no time last week reviewing their options. Ryan met with Rep. Tom Price, R-Ga., and the association plans to meet with Senate Finance Committee staff and other stakeholders in January.

    “They’ve already had a discussion about their willingness to get something to happen as soon as we can,” he said. “We’ve been told there will be a Medicare or other large package early in the year.”

    Stakeholders will need to find another pay-for, however—the spending package contained a provision to cap Medicaid at bidding rates starting in 2019.

    “That was tough for our members to agree to in the first place,” said Ryan. “We’ve got to figure out a way to pay for this, but I don’t see a way to pay for it out of our industry.”

    Despite last week’s letdown, stakeholders say there’s a lot of goodwill for getting the bills passed.

    “Our champions are extraordinarily adamant about wanting to get this thing done,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “We’ll live to fight next year.”


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    12/18/2015
    HME News Staff

    ELYRIA, Ohio – Invacare has received observations from the FDA following an inspection of its corporate headquarters and Taylor Street manufacturing facility. “The FDA’s inspection included a review of the company’s compliance with terms of the consent decree, including requirements of the first and second certifications previously reviewed and accepted in 2013,” the company stated in an 8-K Form dated Dec. 9. Invacare is planning a response to the FDA. “The company remains focused on developing a strong enterprise-wide quality culture,” it stated in the form. “It will incorporate the FDA’s observations into its ongoing quality systems improvements.” Invacare is still in the process of trying to complete a third and final audit to comply with FDA regulations. The consent decree with the FDA limits the company’s ability to manufacture and sell custom power wheelchairs and seating systems.

    Liberator ends year with uptick in sales

    STUART, Fla. – Liberator Medical, which is being acquired by manufacturer C.R. Bard, posted a 9.4% increase in net sales for the fiscal year ended Sept. 30, 2015. Net sales were $81.6 million in 2015 vs. $74.6 million in 2014, driven primarily by the company’s continued emphasis on direct response advertising. “In 2015, we expanded the scope and reach of our sales and marketing activities, and strengthened our customer base through our proven direct response advertising efforts,” stated Mark Libratore, president and CEO. Liberator posted a 6% decrease in net income, $7.3 billion in 2015 vs. $7.8 million in 2014. The decrease was driven primarily by lower operating income due to an increase in legal and settlement costs, and advertising and bad debt expenses. It was partially offset by increased gross profits from increased sales volumes, and a reduction in payrolls costs and other general and administrative expenses. C.R. Bard, a manufacturer of medical devices for vascular, urology and surgical specialty fields, announced in November that it has agreed to buy Liberator for $181 million in a move that strengthens its direct-to-consumer platform. Liberator also made headlines in 2015, when it was one of eight companies investigated by the Department of Justice for alleged illegal kickback arrangements with Coloplast.

    FMCSA starts rulemaking process for sleep reg

    WASHINGTON – The Federal Motor Carrier Safety Administration has submitted an advance notice of proposed rulemaking that would regulate testing and treatment of truck drivers with sleep apnea, reports Land Line Magazine, the business newspaper for professional truckers. The FMCSA submitted the notice to the Office of Management and Budget on Dec. 15. The FMCSA lists the proposed rulemaking as not economically significant. President Obama in 2013 signed into law a bill that prevents FMCSA from proceeding with any regulation of sleep apnea without going through a rulemaking process. The FMCSA expects the notice to be published in the Federal Register in January.

    AAH set to take HME Audit Key live

    WASHINGTON – The HME Audit Key goes live in January, AAHomecare has announced. The association is asking providers to register for the tool now and get ready to enter their fourth quarter 2015 audit data into the tool in the second half of January. “The HME community must be able to better demonstrate the burdensome nature of audits, in terms of volumes and overturn rates,” AAHomecare stated. “Your participation will help the industry gather the data we need to make the case for reform, and will also help us identify new trends and developments in the audit space.” To learn more, providers can watch three brief presentations created by the association and its technical support partner, Provider Consulting Solutions. Enrollment opened for the audit key in April.

    Associations throw support behind ‘any willing pharmacy’ bill

    ALEXANDRIA, Va. – The National Federation of Independent Business (NFIB) and National Grocers Association (NGA) have written to Congress endorsing the Ensuring Seniors Access to Local Pharmacies Act. The bills, H.R. 793 and S. 1190, would allow Medicare beneficiaries to use their pharmacy of choice, provided it is located in a medically underserved area and willing to accept the drug plan’s contract terms and conditions. “In many rural and urban communities, independent pharmacies may be the sole option for residents to conveniently fill their prescriptions,” wrote NFIB and NGA, according to a release. “These pharmacies also provide employment opportunities and greatly contribute to their local economies. Yet they are still denied the opportunity to accept ‘preferred’ pharmacy contracts.” Currently Medicare beneficiaries can only use “preferred” pharmacies hand-picked by their drug plan.

    Jurisdiction B finds uptick in error rates for enterals

    INDIANAPOLIS – A claim review of enteral nutrition (B4035) from July 1, 2015, to Sept. 30, 2015, showed a denial rate of 75%. In the previous quarter, the rate was 67%.Of the 148 claims that were reviewed during the third quarter, 112 were denied. Of those, 23 were denied because the documentation was not received in a timely manner. The most common reasons for denial: the refill request documentation was not received; beneficiary's medical records did not demonstrate that the item was reasonable and necessary prior to the initial order; medical necessity of pump not documented; medical necessity for special enteral formulas not shown; and no proof of delivery from the supplier.

    navihealth buys Rightcare Solutions

    DUBLIN, Ohio – naviHealth, a Cardinal Health company, has acquired RightCare Solutions, a healthcare technology company specializing in hospital discharge planning software and readmissions management. RightCare licenses its software to hospitals and health systems to assess patients for post-acute care needs, determine risk of readmission, and coordinate patient discharges to post-acute care providers. The company also licenses its software to post-acute care providers, allowing them to save significant time and money in managing referrals from nearby hospitals through automation. “RightCare has a proven track record of delivering technology solutions to hospitals that translate into real ROI,” said Clay Richards, CEO of naviHealth, in a release.“The combination of our post-acute decision support and clinical analytics with RightCare's integrated discharge planning capabilities will further accelerate our ability to deliver a unique value proposition to health systems.”

    Mediware, Prometheus expand partnership

    LENEXA, Kan. – Mediware Information Systems, a post-acute care software provider, and Prometheus Group, an outcomes-based billing services provider, have signed a collaboration agreement to offer full-service billing solutions. The deal will help Fastrack HME customers make a smooth transition to CareTend and leverage advanced technology to reduce operating costs, improve productivity and enhance patient satisfaction, the companies say. “By expanding our billing and collections service solutions, providers can now have the option to outsource their A/R and focus on their core competencies,” said Paul O’Toole, vice president and general manager of the Home Care Solutions division of Mediware, in a release.

    Nonprofit launches rehab company

    BUFFALO, N.Y. – People Inc., a nonprofit health and human services agency, has launched People First Mobility, to provide DME, including power wheelchairs, scooters and custom seating, to Erie, Niagara and Chautuaqua counties. The provider will operate as a for-profit affiliate, with profits to benefit the People First Foundation, according to a local news report. People Inc. has revenue of more than $145 million and provides programs and services to more than 12,000 people.

    Stock sellers: ResMed, Invacare, Inogen

    James Hollingshead, president of the Americas at ResMed, sold 4,500 shares of company stock on Dec. 15 in a transaction valued at $251,775. He sold the shares at an average price of $55.95. Hollingshead now owns 52,069 shares valued at $2.9 million…Michael Delaney, a member of the board of directors at Invacare, sold 1,000 shares of company stock on Dec. 10 in a transaction valued at $19,050. He sold the shares at an average price of $19.05. Delaney now owns 4,254 shares valued at $81,038…Matt Scribner, executive vice president of operations at Inogen, sold 4,102 shares of company stock on Dec. 14 in a transaction valued at $165,721. He sold the shares at an average price of $40.13. 


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    12/22/2015
    HME News Staff

    SAN JOSE, Calif. – A&D Company has entered into a definitive agreement to buy the necessary business assets of Toronto-based Auto Control Medical. The deal allows A&D to expand its product range and application experience across the Americas. A&D provides a full line of advanced biometric monitoring solutions, including blood pressure monitors, weight scales, activity monitors and other health monitoring devices for consumer and professional use. Auto Control Medical distributes hypertension, diabetes and respiratory products in Canada. Per the deal, Auto Control Medical will initially operate as a division of A&D Canada. Its current executive team, as well as its sales team and support staff, will continue to manage the company. The deal is scheduled to close in January.

    PharMerica closes year with two buys

    LOUISVILLE, Ky. – Amerita, a subsidiary of PharMerica, a national provider of institutional and specialty pharmacy services, has acquired Alternacare Infusion Pharmacy, an Olathe, Kan.-based specialty home infusion provider. PharMerica also announced that it has completed its acquisition of Integrated Pharmacy Network, a Midland, Mich.-based long-term care pharmacy. With these deals, PharMerica has achieved its goal of completing acquisitions that generate at least $100 million of annualized sales, in aggregate, in 2015, according to a press release from The Braff Group, which served as the M&A adviser to Alternacare. “2015 is shaping up to be a strong year in infusion therapy mergers and acquisitions,” said Reg Blackburn, managing director of pharmacy services for The Braff Group. “Through the third quarter of this year, infusion deal volume is up more than 80% vs. the same period in 2014. Moreover, 2015 has already produced two new private equity sponsored platform deals, clearly signaling that after a sustained period of M&A activity, the sector still has legs.”

    Liberator to finalize settlement agreement

    STUART, Fla. – Liberator Medical Holdings has entered a definitive agreement to settle all allegations related to a complaint that it had violated the False Claims Act, it announced Dec. 22. Liberator previously announced it had reached an agreement in principle to settle the allegations in a civil qui tam complaint. The mail order provider will pay $500,000, along with its share of the plaintiffs’ legal expenses, according to a press release. Liberator was accused of engaging in illegal kickback arrangements with Coloplast. Other defendants included 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 in November announced that it would be sold to C.R. Bard, a manufacturer of medical devices for vascular, urology, oncology and surgical specialty supplies for $181 million. The deal is expected to close in the first quarter of 2016.

    Med sync programs work, according to NCPA survey

    ALEXANDRIA, Va. – Medication synchronization programs can benefit pharmacists and patients, according to a survey of pharmacies that are using the Simplify My Meds program created by the National Community Pharmacists Association. Pharmacies reported that SMM increased their efficiency and balanced their workflow, and increased patient satisfaction. “Med sync programs, such as Simplify My Meds, are critical to achieving greater patient adherence,” said NCPA CEO Douglas Hoey, RPh. “Non-adherence to medication is estimated to cost the healthcare system as much as $290 billion annually through necessitating costly procedures or hospitalizations that could otherwise have been prevented.” SMM is used by more than 2,600 independent pharmacies nationwide. 


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    12/22/2015
    Tracy Orzel

    DES MOINES, Iowa – Stakeholders in Iowa say they have a number of concerns about the upcoming transition to IA Health Link, a new Medicaid managed care program, slated for Jan. 1, 2016.  

    Iowa’s Department of Human Services in October finalized contracts to administer the plan with four managed care organizations (MCOs): Amerigroup Iowa, AmeriHealth Caritas Iowa, WellCare of Iowa, and UnitedHealthcare Plan of the River Valley.

    While the MCOs are required to work with existing Medicaid providers, whether they are in-network with them or not, Rose Schafhauser says providers are still worried about getting locked out.

    “Obviously, everybody’s nervous,” said Schafhauser, executive director of MAMES. “We’ve heard stories in other states where contracts weren’t being offered to everyone.”

    There’s also concern among providers who have received contracts. Although the fee schedule is locked in at the current Medicaid reimbursement rate, the rates are only guaranteed until June 30, 2016.

    “They’re sending us contracts that are a minimum of one year with renewal access, but we don’t have the fee schedule after July 1,” said Leila Wilkerson, director of Heritage Medical Equipment and Supply in Burlington. “We only know what we’re getting paid the first six months.”

    Also at the forefront of providers’ minds: Univita, which in August filed for Chapter 7 bankruptcy a year after 10 of the 14 MCOs charged with running managed care plans in Florida contracted with the provider to administer DME, leaving providers scrambling to get paid.

    “The (four MCOs) have done business with other state Medicaid programs in the past, so I feel like they have more experience than others,” said Wilkerson. “But there’s always a concern (that it could happen here).”


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  • 12/22/15--10:28: Go beyond products
  • Use evidence-based medicine to boost your role as educator
    12/22/2015
    Theresa Flaherty

    HME providers that focus on education, rather than products, can build a marketing strategy that sets them apart from their competitors, says Cheryl Needham.

    “You need to know what a product is, what it does, and what that means,” said Needham, senior clinical marketing manager for Philips Respironics. “Disease management is not just about the product any more.”

    Physicians and other clinicians use evidence-based evidence to make treatment and product decisions for patients; payers use it to look for areas of cost effectiveness; and patients use it to find therapies that will make their lives better, Needham said.

    “As the Internet grows, more and more patients are out there looking for (solutions),” she said.

    Providers can capitalize on evidence-based medicine by building an education-based marketing program. For example, using a copy of a published clinical study can give providers the evidence they need to support product claims, Needham said.

    “Work together with the clinicians as a team on what’s best for that patient,” she said. “You could have a series of supporting clinical facts.”

    It’s also important to keep marketing fresh. Don’t keep using the same clinical information, Needham said.

    “Where can you get fresh ideas? Customer inquiries,” she said. “What are people asking about? Address skepticism and controversy with clear, well-though out information.”

    And make sure you know your target, Needham said.

    “Identify the target and make sure that target is the right target,” she said. “Not every physician is going to (be interested). Understand their needs.”


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  • 12/22/15--10:26: Pay-for causes concern
  • 12/22/2015
    Tracy Orzel

    WASHINGTON – A provision that would limit the federal portion of Medicaid allowables to match the new payment amounts in a given area starting in 2020 raises concerns, but stakeholders say it’s worth the risk. 

    The provision was included in a bill in the Senate as a pay-for for other provisions that would increase payment amounts in rural areas by 30% and in regional areas by 20%, and phase in the changes over two years.

    “It’s not ideal, but there must be a pay-for and is the only option that we have,” said Karyn Estrella, president and CEO of Home Medical Equipment and Services Association of New England.

    Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., introduced the bill, S. 2313, on Nov. 19 (see story page 1). 

    The trouble with analyzing the impact of the provision is, stakeholders have no way of knowing what payments will be in 2020. 

    The legislation would require CMS to revisit pricing adjustments for non-bid areas, taking into account travel distance, clearing price and other associated costs for prices in effect Jan. 1, 2019.

    “The rates will be re-evaluated in 2019,” said Estrella. “Whatever happens in 2020 will not be based on the rates that are currently in existence. That’s what makes it even more complicated.”

    Still, stakeholders are optimistic that they will be able to reverse the provision before it kicks in.

    “With the pay-for not going into effect until 2020, this gives the industry time to push back and work with our members of Congress and state Medicaids to prevent that from happening,” said Estrella.


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    12/22/2015
    Liz Beaulieu

    WASHINGTON – An “impatient” CMS has sent a strong message to hospitals that they must take post-acute care providers more seriously.

    The agency in November published extensive proposed regulations that seek to make the discharge planning process more comprehensive and open the door for more back-and-forth between acute and post-acute care providers. One regulation would require regular re-evaluation of a patient’s condition to identify changes that require modification of discharge plans.

    “What CMS wants is collaboration, not a one-time referral,” said healthcare attorney Elizabeth Hogue.

    The proposed regulations also, among many other things, expand the discharge planning process to include all inpatients; all outpatients receiving observation services or undergoing surgery or other same-day procedures; and ER department patients.

    Hogue says the only way hospitals will be able to meet these regulations is if they tighten their relationships with all types of homecare providers—home health, private duty nursing, hospice, and yes HME.

    “There’s no way to do it without that,” she said.

    Hogue recommends HME providers use the proposed regulations as a talking point with discharge planners about how they can make compliance easier.

    “I’d say to them, ‘Here’s what’s coming. You need us. Let’s start talking about how we can help you meet these requirements and meet the needs of patients,’” she said.

    Though the regulations are just proposals at this point, Hogue expects them to stick.

    “CMS has been talking about this for some time,” she said.

    Hogue added: “I’ve been saying that home care is the future of health care in this country, and I was wondering for awhile, but darned if I’m right.”


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    12/29/2015
    HME News Staff

    BALTIMORE – CMS today issued a final rule that would establish a prior authorization process for certain durable medical equipment.

    The agency, which issued a proposed rule in May 2014, had originally said a final rule would not be forthcoming until 2017.

    CMS says prior authorizations will reduce overutilization of certain high cost DME without impeding beneficiary access. The agency has a “master list” of 135 codes that meet that criteria and will be potentially subject to prior authorizations.

    Specifically, that means items with an average purchase fee of $1,000 or greater, or an average rental fee of $100 or greater, (adjusted annually for inflation) and are the subject of:

    • HHS Office of the Inspector General (OIG) or U.S. Government Accountability Office (GAO) reports that are national in scope and published since 2007, or

    • Comprehensive Error Rate Testing Annual Medicare Fee-for-Service Improper Payment Report Durable Medical Equipment (DME and/or) Report’s DMEPOS Service Specific Reports.

    CMS will publish the Required Prior Authorization List in the Federal Register with a 60-day notice before implementing prior authorization for those items.

    The industry is generally in favor of prior authorizations, as long as they are done correctly. A chief concern is that approvals are done quickly.

    In its announcement, CMS says either the agency or the review contractor will “make a reasonable effort to render an initial prior authorization determination within 10 business days and will make a reasonable effort to render a resubmission prior authorization determination within 20 business days. “ 

    In May 2015, Rep. Marsha Blackburn, R-Tenn., introduced a bill that would require prior auths for certain high-cost DME, including oxygen. In September 2015, CMS extended a demo for power mobility devices. The demo kicked off in seven states in 2012.

     


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  • 12/30/15--07:51: More MA audits on the way?
  • 12/30/2015
    HME News Staff

    WASHINGTON – CMS is considering expanding its RAC program for Medicare Advantage, according to a draft scope of work published by the agency.

    Currently, CMS audits 30 MA contracts per payment year, about 5% of the total number of contracts. Now it is considering increasing the number of contracts that are subject to some type of risk adjustment data validation audit, which validates the accuracy of diagnosis data submitted by MA organizations.

    “Our ultimate goal is to have all MA contracts subject to either a comprehensive or condition-specific RADV audit for each payment year,” the agency states in the draft.

    Errors and omissions in diagnosis data submitted by MA organizations are the drivers of the 9.5% improper payment rate in Medicare Part C, according to CMS.

    The Patient Protection and Affordable Care Act of 2010 requires expansion of the RAC program to Medicare Part C and Part D, the agency states.

    CMS is accepting comments on the draft until Feb. 1.


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    12/31/2015
    Theresa Flaherty

    BALTIMORE – CMS is moving forward with its plans to implement a prior authorization process for certain DME and stakeholders say it should make life easier for providers.

    “The fact of the matter is, the items that are going to be subject to prior auths are already under prepay review in one form or another,” said Andrea Stark, a reimbursement consultant with MiraVista. “Anything that mitigates supplier risk and financial liability is, in my book, a positive thing.”

    The rule, published Dec. 30 in the Federal Register, will be implemented Feb. 29. CMS has a “master list” of 135 codes that could be subject to prior auths. Specifically, that means items with an average purchase fee of $1,000 or greater, or an average rental fee of $100 or greater, (adjusted annually for inflation) and are considered high utilization.

    The list includes CPAP (E0601), semi-electric hospital beds (E0260), manual wheelchairs (K0004) and—a new addition—oxygen concentrators (E1390).

    Inclusion on the master list doesn’t mean the code will automatically be subject to prior auths, says Stark, who “guesstimates” CMS will move forward with about 25% of the codes to start.

    “The list is there to give them flexibility,” she said. “I think they will start small because they’ve got to ramp up resources and phase in the categories. They are vested in making sure this process works.”

    CMS will publish the final list of codes in the Federal Register.

    CMS first tested the waters with prior auths with a seven-state demonstration project for power mobility devices. While the success of the demo, which was expanded to 12 additional states in 2014 and then extended in August 2015, underlines the value of the prior auth process, there has been concern that other product categories, like oxygen, could require quicker approvals.

    In its announcement, CMS says either the agency or the review contractor will “make a reasonable effort” to issue a determination within 10 business days, which it states is a “maximum timeframe” that can be adjusted downward. CMS says there will also be an “expedited” review process for cases where the standard timeframe is harmful to the beneficiary.

    CMS is aware of the need for faster turnaround times in certain cases, says Stark.

    “CMS will monitor this very closely and if modifications are required, they will make them,” she said.

    .   

     

     


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    Association set to launch companion to HME Audit Key in second quarter
    12/31/2015
    Liz Beaulieu

    WASHINGTON – AAHomecare went live with its HME Audit Key on Jan. 1, ready to harness the power of numbers in the industry’s fight against out-of-control audits.

    Forty-four HME companies have registered to use the tool so far, but AAHomecare believes the official launch and support from industry allies like Brightree, The VGM Group and The MED Group, and Medrade will prompt more companies to do the same.

    “I think we’ll definitely have an uptick in participation,” said Kim Brummett, vice president of regulatory affairs for the association.

    In the ramp up to the live launch, 14 companies—one national company, with a mix of regional and smaller companies—imported their data into the tool successfully.

    To further increase participation, in the second quarter AAHomecare plans to launch a companion tool, the Audit and Appeal Mapping System, to help HME companies collect the data needed for the HME Audit Key, like how many audits they have at the different levels of appeals and how many appeals they have won.

    “We have found that most companies are tracking the data in some form or fashion, but what we’re trying to do is create a standard,” Brummett said.

    Preliminary findings from the 14 companies that have successfully used the tool include an 80% appeal rate and a corresponding 92% overturn rate for MAC prepayment denials for respiratory products.

    “This data will be unbelievable to CMS,” said Laura Williard, senior director of regulatory affairs and contracting for Greensboro, N.C.-based Advanced Homecare, one of the 14 companies. “It will send a powerful message that we’re committed to working with them to resolve issues around audits.”

     


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    2015 brought rollups and buyouts, but most noticeably, one big flameout
    12/31/2015
    Theresa Flaherty

    YARMOUTH, Maine – While familiar topics once again made the list of most read stories for 2015, it’s likely a bit of schadenfreude that drove one story to the top.

    That’s because Univita, the provider at the center of the story (“‘Chaos’ erupts as Univita loses contracts”), didn’t win many fans among providers when it gained control of the Florida Medicaid market and served as both a provider and program administrator for the majority of the managed care organizations running the program. A follow-up story on Univita’s resulting bankruptcy also made the list (“Univita files Chapter 7 with long list of creditors”).

    Otherwise, it was business as usual with competitive bidding dominating provider concerns. Early in the year, the industry scored a victory when lawmakers passed a bill that would reform the competitive bidding program by requiring binding bids (“Bidding bill clears another huge hurdle”).

    Unfortunately, CMS continued prepping for its expansion of the program into non-bid areas throughout 2015, with the release of payment amounts (“Industry now has full view of bid pricing”) and affected zip codes (“Nat’l roll out starts to take shape”).

    With all of this talk of competitive bidding, it’s hardly surprising that many smaller providers are, sadly, looking for a way out, as evidenced by one story about a roll-up gaining momentum (“Company seeks to offer ‘exit strategy’”).

    Speaking of acquisitions, big deals are always big news and the end of the year saw one of the biggest, with news that Lincare planned to buy American HomePatient (“Possible Lincare, AHP marriage not surprising”). AHP had been rumored to be up for sale since late 2014.

    Noticeably absent from this year’s most read list: any stories about audits, but stay tuned for the year ahead. 

    Most read stories of 2015

    # 1 ‘Chaos’ erupts as Univita loses contracts

    http://www.hmenews.com/article/chaos-erupts-univita-loses-contracts

    # 2 Bidding bill clears another huge hurdle

    http://www.hmenews.com/article/bidding-bill-clears-another-huge-hurdle

    # 3 Industry now has full view of bid pricing

    http://www.hmenews.com/article/industry-now-has-full-view-bid-pricing

    # 4 Company seeks to offer ‘exit strategy’

    http://www.hmenews.com/article/company-seeks-offer-exit-strategy

    # 5 Possible Lincare, AHP marriage not surprising

    http://www.hmenews.com/article/possible-lincare-ahp-marriage-not-surprising

    # 6 Lincare joins Rotech, AeroCare on M&A trail

    http://www.hmenews.com/article/lincare-joins-rotech-aerocare-ma-trail?to...

    # 7 Submit a bid in the Round 2 re-compete? ‘Why bother?’

    http://www.hmenews.com/article/submit-bid-round-2-re-compete-why-bother

    # 8 National pricing for Medicare looms large

    http://www.hmenews.com/article/national-pricing-medicare-looms-large

    # 9 Univita files Chapter 7 with long list of creditors

    http://www.hmenews.com/article/univita-files-chapter-7-long-list-creditors

    # 10 Nat’l roll out starts to take shape

    http://www.hmenews.com/article/nat-l-roll-out-starts-take-shape


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    12/31/2015
    HME News Staff

    WASHINGTON – CMS is considering expanding its RAC program for Medicare Advantage, according to a draft scope of work published by the agency.

    Currently, CMS audits 30 MA contracts per payment year, about 5% of the total number of contracts. Now it is considering increasing the number of contracts that are subject to some type of risk adjustment data validation audit, which validates the accuracy of diagnosis data submitted by MA organizations.

    “Our ultimate goal is to have all MA contracts subject to either a comprehensive or condition-specific RADV audit for each payment year,” the agency states in the draft.

    Errors and omissions in diagnosis data submitted by MA organizations are the drivers of the 9.5% improper payment rate in Medicare Part C, according to CMS.

    The Patient Protection and Affordable Care Act of 2010 requires expansion of the RAC program to Medicare Part C and Part D, the agency states.

    CMS is accepting comments on the draft until Feb. 1.

    Sutter Home Care expands footprint in California

    FAIRFIELD, Calif. – Sutter Home Care, whose offerings include HME, respiratory therapy and home infusion, has acquired Alliance Home Health. Fairfield, Calif.-based Sutter Home Care delivers care to more than 150,000 patients in 24 counties in Northern California. Alliance Home Health offers skilled nursing, OT and PT, speech therapy, and home health aide and medical social services to patients in Monterey County. “Our partnership with Alliance Home Health will expand Sutter Care at Home’s capacity to provide timely, affordable and high-quality home health services in Monterey County,” stated Marcia Reissig, CEO of Sutter at Home. “Our mutual goal is to further expand and strengthen home health services in the community.”

    Tubeless CPAP mask draws $500K in funding

    BURLINGTON, Mass. – Startup Airing has received $500,000 in funding to commercialize its disposable, tubeless CPAP mask, according to Boston Business Journal. The funding follows a successful crowdfunding campaign in July that raised $100,000 in three hours and has netted more than $1.1 million to date by offering vouchers to buy the mask at a steep discount when (and if) it becomes available. Airing plans to retail the masks for $3. The recent funding, from a single investor, is part of a larger goal to raise $2.5 million, according to the journal.

    Z1 Auto CPAP gets upgrade

    CHARLOTTESVILLE, Va. – Human Design Capital has released a firmware upgrade for its Z1 Auto CPAP machine and Nitelog App for Android devices. The upgrade delivers a new Z-Breathe algorithm with settings that offer more breathing comfort, improved battery life and quieter operation, according to a press release. The upgrade also allows users to sync the Nitelog App with the latest Android software version 5.1.1. The app syncs with the Z1 via Bluetooth to display sleep therapy results, including apnea/hypopnea index, apnea count, usage hours and pressure levels in day-week-month presentations. HDM is owned by Charlottesville, Va.-based PBM Capital.

    President signs complex rehab bill into law

    WASHINGTON – President Obama signed the Patient Access and Medicare Protection Act into law last week, delaying the application of competitive bid pricing to accessories used on Group 3 complex power wheelchairs for one year. “Our recommendation is to hold off on billing any claims for Group 3 power wheelchair accessories with dates of service on or after Jan. 1, 2016, until this CMS guidance is received,” wrote Don Clayback, executive director of NCART, in an email to members. Unfortunately, the one-year delay does not apply to accessories used with complex rehab manual wheelchairs, which will be paid at competitive bid rates starting Jan. 1. “We will be working on solutions to this issue as part of our activities in early 2016,” added Clayback.

    Infusion scholarship deadline approaching

    ALEXANDRIA, Va. – The National Home Infusion Association is accepting applications for two scholarships. The Lynn Giglione Memorial NHIF Scholarship Award for Home and Specialty Infusion Nursing and the inaugural Scholarship for Excellence in Home and Specialty Infusion Pharmacy Practice are open to nurses and pharmacists who have demonstrated a commitment to advancing patient care, says NHIA in a release. Each scholarship offers complimentary registration to the association’s 2016 annual conference, scheduled for March 21-24, 2016, in New Orleans, and an allowance of $1,500 for travel, hotel, and incidentals. Scholarship applications are due Jan. 15.

     


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    01/08/2016
    HME News Staff

    WASHINGTON – HME providers can breath a little easier when it comes to CMS’s proposed time frame for responding to prior authorization requests, says AAHomecare. Originally, the agency said responses to prior authorization request would be issued within 10 business days, or two days for expedited requests. AAHomecare argued that the responses need to be completed within 24 hours, or two hours for expedited requests, to meet patient needs.Fortunately, CMS has now said it will not finalize its original time frame for responding to prior authorization requests, according to the association.

    VGM acquires women’s group

    WATERLOO, Iowa – The VGM Group has acquired Essentially Women, it announced Dec. 31. The 20-year-old member service organization, which has more than 500 members with 1,000 locations, will operate as a standalone company and will retain its name, brand and values, according to a press release. The deal will give Essentially Women members access to additional VGM products and services. VGM’s Christa Miehe will serve as the new president of Essentially Women. “Both companies were founded on the principle of providing business solutions to independent providers so that they can focus on what’s most important, taking care of their patients,” said Miehe. Cindy Ciardo, manager of vendor relations, and Melinda Smith, manager of membership services, will continue in their current roles.

    PE firm picks up HME company

    NEW YORK – Tailwind Capital, a middle-market private equity firm, has acquired Therapy Support through a merger with its portfolio company, National HME of Richland Hills, Texas. “This key acquisition aligns with our vision for the continued growth of National HME and further expands our DME benefit management geographic footprint,” stated Geoffrey Raker, a partner at Tailwind, in a press release. Therapy Support is a multi-state, full-service provider of DME for the hospice and long-term care industries. It has 21 locations in eight states. Tailwind also has investments in Freedom Innovations, a designer and maker of advanced lower-limb prosthetic devices; and Long’s Drugs, a specialty pharmacy.

    New wheelchair technology attracts investment

    FITCHBURG, Wis. – Rowheels, the developer of a reverse propulsion technology for manual wheelchairs, has secured a $1.5 million investment led by WISC Partners, a Madison, Wis.-based strategic operating capital fund. Rowheels will use the money to commercialize its technology, which is designed to counteract many of the debilitating effects of traditional wheelchair propulsion, according to a press release. “With this investment and working relationship with WISC Partners, we are prepared to effectively go to market with our new product family,” stated Rimas Buinevicius, CEO. The technology uses pull-based geared wheels that mimic the activity of rowing, helping to engage the larger set of upper torso muscles that are underutilized in traditional push-only wheeling. Rowheels was co-founded in 2011 by Buinevicius and Salim Nasser, who will serve as the company’s CTO.

    Joystick armrest poses medical risk, says study

    ELKINS PARK, Pa. –A new study has found that central driving has several benefits over traditional armrest mounted joysticks. “(Armrest mounted joystick controllers) force a change in body posture and weight distribution with deleterious effects over time,” said Alberto Esquenazi, director of the Gait & Motion Analysis Laboratory at MossRehab, which conducted the study. “When operating a PWC with an armrest mounted drive control, the user often leans on the armrest where the joystick is mounted in order to improve drive control.” The result: muscular skeletal conditions and pressure ulcers, according to the study. On the other hand, subjects who used central driving controls sat more erect and reported more comfort.

    NC battles insurance cuts

    RALEIGH, N.C. – The North Carolina Association of Medical Equipment Services has retained legal representation to fight Blue Cross Blue Shield of North Carolina’s plan to reduce reimbursement rates for HME to 25% below the 2016 Medicare rural fee schedule, or, where necessary, 25% below the non-rural state fee schedule, according to a bulletin from the association. In December, after the insurer announced the change, NCAMES asked BCBS to freeze pricing at the 2015 fee schedule. NCAMES also discussed this situation with the Department of Insurance on Dec. 31, 2015, and sent a letter to BCBS officials, once again, requesting a freeze.

    Pride launches Lift Finder

    EXETER, Pa. – Pride Mobility Products has launched a new online vehicle lift tool. The Lift Finder is designed to help consumers and providers match the proper lift with a vehicle and mobility product. Using drop-down menus, users can select a combination of vehicle and mobility products to access a list of compatible lifts, and browse for further information and product specifications, according to a press release. The Lift Finder is continuously updated with information.

    Medtrade Spring seeks retail products

    LAS VEGAS – Medtrade Spring show organizers seek manufacturers to submit their retail products for the biannual Innovative HME Retail Product Awards. The top eight products will be presented in a session at the event led by Jim Greatorex of VGM Retail Services. Any manufacturer exhibiting at Medtrade Spring can submit an entry form by Jan. 29 to put themselves in the running for the award. The winners of the awards at Medtrade in the fall included Pride Mobility’s Go Go Folding Scooter. Medtrade Spring takes place Feb. 29-March 2 at the Mandalay Bay Convention Center in Las Vegas.

    ResMed’s Farrell sells $1M in shares

    SAN DIEGO – Peter Farrell, founder and chairman of ResMed, sold 20,000 shares of company stock valued at $1.04 million in a transaction on Jan. 4. Farrell still owns 347,978 shares in the company, valued at $18.2 million. On that same day, David Pendarvis, chief administrative officer and global general counsel, sold 6,000 shares valued at $312,960. He still owns 74,287 shares.

    Short takes: AAH, VGM, Progressive Care

    AAHomecare has named Mike Nicol senior director of membership services. Previously, Nicol has worked in varying capacities at some of the major nursing and pharmacy associations. Most recently, he was managing industry partnerships for the National Transitions of Care Coalition. At AAH, Nicol will focus on new member recruitment and current member engagement…The VGM Group seeks speakers for its Heartland Conference, scheduled for June 13-16 in Waterloo, Iowa. Those interested should contact Lori Schilling at lori.schilling@vgm.com by Jan. 16. Registration is already open for the event, which is celebrating its 15th year…Miami-based Progressive Care, through its subsidiary Pharmco, has named Shital Mars CEO. Mars, who currently serves as COO, will succeed Alan Jay Weisberg. Weisberg will remain chief financial officer, as well as chairman of the board of directors. Pharmco is a South Florida health services organization and provider of prescription pharmaceuticals; it specializes in, among other things, the sale and rental of DME.

     

     


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    01/13/2016
    HME News Staff

    NASHVILLE – CMS has awarded CGS Administrators a $78 million contract for DMEPOS claims in Jurisdiction B, according to a press release. 

    The contract represents approximately 20.7% of the national DMEPOS workload and covers claims by more than 6.8 million beneficiaries and 18,000 DME suppliers in Kentucky, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

    Nationally, CGS will now administer about 60% of Medicare DME claims.

    CGS, which has been headquartered here since 1966 and employs more than 800, will add about 150 new jobs as a result of the new contract, it stated.

    “We are committed to continuous improvement and innovative approaches to serving our customers, and it is that commitment by each person in our company that makes this kind of growth possible,” said Steven Smith, CGS president and COO.

    The transition of the contract is expected to take about four months.


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