WATERLOO, Iowa – VGM Insurance Services has wrapped up its Quarter Century of Caring Campaign.

Over the course of a year, $27,000 was donated to charitable organizations.

The campaign was created to celebrate VGM Insurance’s 25th anniversary, and as a way to thank providers for the good deeds they do in their communities. VGM Insurance customers, members, partners and affiliated insurance agents were asked to nominate their favorite charity for a $1,000 donation. The campaign wrapped up in December 2015.

“We had a fantastic response to the campaign,” said Mike Kloos, president of VGM Insurance in a release. “We received an overwhelming number of charity nominations, and it was amazing to learn about all the community service projects our customers and partners are involved in all across the country.”

The winning projects included wheelchair accessible playgrounds, baseball programs, camps and therapeutic riding programs; non-profit hospice services; domestic violence education and support; and special events for children with rare and life-threatening diseases.

“Many of the selected charity winners rely solely on individual donations to continue their work,” added Bill Wilson, vice president of sales and marketing in the release. “So the knowledge that the Quarter Century of Caring Campaign has helped these charities continue benefiting others for months and years to come is wonderful.”

YARMOUTH, Maine – HME providers are torn between expanding their businesses and maintaining the status quo, according to respondents to a recent HME Newspoll.

“While it would be our endeavor to continue our 31-year growth and leadership in the home ventilation DME industry, CMS's ventilator rate reduction of 43% in California will devastate any potential plans to grow the company,” wrote one respondent. “Our advisers are telling us we should strongly consider leaving the industry.”

Of the 48% of respondents that said they do plan to grow in 2016, 38% said they plan to open a new location; 34% said they hope to have a bigger location; and 28% intend to merge with another company.

Now that competitive bid pricing has been rolled out nationwide, opportunities abound for companies looking to merge or buy.

“With the cutbacks in the rural areas, which is where we are, we believe one or more business will want to merge or close their doors,” said Don Dobbins, president of Heritage HME in Wichita Falls, Texas. “We will be first in line to take their business over.”
But expansion is not limited to opening or expanding locations or merging, pointed out one respondent.

“We're expanding by adding several new product lines, the majority of which will be sold outside of CMS's reimbursement,” said the respondent. “I expect a 25% to 30% increase in sales as a result of these additions.”

Still others are waiting to see how the Round 2 re-compete shakes out before making any big decisions.

“Everything for 2016 hinges on the upcoming round of competitive bidding, so we are in a holding pattern right now,” wrote Lori Sears, owner of Home Medical Supply in Lapper, Mich., who hopes to add new cash lines of business.

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.

VGM Insurance gives $27,000 to charities

WATERLOO, Iowa – VGM Insurance Services has wrapped up its Quarter Century of Caring Campaign.

Over the course of a year, $27,000 was donated to charitable organizations.

The campaign was created to celebrate VGM Insurance’s 25th anniversary, and as a way to thank providers for the good deeds they do in their communities. VGM Insurance customers, members, partners and affiliated insurance agents were asked to nominate their favorite charity for a $1,000 donation. The campaign wrapped up in December 2015.

“We had a fantastic response to the campaign,” said Mike Kloos, president of VGM Insurance in a release. “We received an overwhelming number of charity nominations, and it was amazing to learn about all the community service projects our customers and partners are involved in all across the country.”

The winning projects included wheelchair accessible playgrounds, baseball programs, camps and therapeutic riding programs; non-profit hospice services; domestic violence education and support; and special events for children with rare and life-threatening diseases. 

“Many of the selected charity winners rely solely on individual donations to continue their work,” added Bill Wilson, vice president of sales and marketing in the release. “So the knowledge that the Quarter Century of Caring Campaign has helped these charities continue benefiting others for months and years to come is wonderful.”

ASP Global expands reach with buy

ATLANTA. – ASP Global, a medical supply sourcing company, has acquired InHome Medical Solutions, a Jacksonville, Fla.-based distributor of wholesale medical products serving physicians and home health/hospice providers. “InHome expands our distribution capabilities and advances the organization's mission of supporting the full continuum of care in any setting: hospitals, IDNs, home health, hospice and group practices," said Lorne Tritt, CEO of ASP Global in a release. Through the new partnership, InHome will be able to obtain medical products at the point of care, according to the release. InHome has five U.S. distribution centers to provide one- to two-day delivery to 96% of the country.

New year brings changes to Bellevue

BELLEVUE, Wash. –Bellevue Healthcare has kicked off 2016 with a new retail location and headquarters, and changes to its executive team. The new location, the provider’s 17th, is located in Redmond and is connected to its headquarters. As to the staff changes: Joel Gallion, a 13-year veteran with the company, is now president; former president Peter Norman will transition to CEO; Josh Moritz is now executive vice president of internal operations; and Bryce Schaffner is now executive vice president of business development. The changes will allow Bellevue to look for strategic growth opportunities, the provider said.

BOC elects new board

OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) has announced its 2016 Executive Committee. Elected to a one-year term are Chairman Brad Watson, owner of Clarksville Limb & Brace and Rehab; Vice Chairman Rod Borkowski, general manager of Health Essentials DME; Treasurer Shane Ryley, area clinic manager at Hanger Orthopedic Group; and Immediate Past Chairman James Hewlett, consultant for DME and O&P facilities. “I look forward to giving back to the profession and keeping BOC on the cutting edge of credentialing,” said Watson in a release. BOC also welcomes Wayne Rosen, former owner of W.R. Rosen, as secretary; and William Powers, a retired COO of the American Nurses Association, re-elected as member at large.

Convaid releases roster of representatives

TORRENCE, Calif. – Convaid has announced its list of 2016 Convaid ambassadors—community volunteers who will serve a one-year term as representatives for the wheelchair manufacturer. As current Convaid users, ambassadors will attend regional events, write blog posts and share videos, participate in Convaid case studies and share photo essays of the places they visit using Convaid products. The Ambassador program was established in 2015 to promote information and resources about Convaid online and in special needs communities. 

Johnson tapped for promotion

EXETER, Pa. – Seth Johnson has been promoted to senior vice president of government affairs for Pride Mobility Products. Johnson, an 18-year veteran of the mobility industry, has been with the manufacturer since 2004. He served on the CMS DME Program Advisory and Oversight Committee for more than four years and has served in a relationship role with industry coalitions on a host of issues, including, most recently, fighting to prevent reimbursement cuts to complex rehab technology. “We are looking forward to Seth continuing his excellent work in advocating for those with disabilities and making strides to create an equitable regulatory environment for all,” said Scott Meuser, chairman and CEO of Pride.

VMI, NMEDA celebrate ‘Local Hero’

PHOENIX – Vantage Mobility International and the National Mobility Equipment Dealers Association will deliver a free 2015 Honda Odyssey with VMI Northstar wheelchair ramp conversion to Cynthia Noonan of Oakland, Calif., on Jan. 14. Noonan is a Local Heroes Winner of the NMEDA’s 2015 National Mobility Awareness Month contest. She has Transverse Myelitis, a rare autoimmune disease, which made her a C5 quadriplegic. Noonan serves as a board member for the Bay Area Outreach and Recreational Program, where she provides sports, recreational and outdoor activities to people of all ages with all types of physical disabilities. The modified vehicle will be awarded to Noonan during a ceremony at the Mobility Works dealership in Oakland.

Partnership highlights women’s health market

LAS VEGAS – The organizers of the Power Symposium and Medtrade Spring have partnered to offer workshops on women’s health products and services from Amoena and Juzo. “Compression 101” and “Amoena Fit School” will take place March 2 at the Mandalay Bay Convention Center as part of Medtrade Spring. The cost is $20 over and above the registration fee for the Symposium. Attendees will receive four CEU credits. Those who register for the symposium, which takes place one day after Medtrade Spring, will also qualify for a pass to the show floor. “We are giving Symposium attendees a chance to arrive one day early and experience the Medtrade Spring show floor,” said Kevin Gaffney, group show director. Medtrade Spring takes place Feb. 29-March 2 at the Mandalay Bay Convention Center. The Symposium takes place March 2-4 at the Tropicana Las Vegas. 

Beth Bowen got her start composing newsletters for the North Carolina Association for Medical Equipment Services in 1991. Now she’s the executive director of four state associations: NCAMES, the Virginia Association of Durable Medical Equipment (VADMEC), the Florida Alliance of Home Care Services (FAHCS), and, as of January, the Association for Tennessee Home Oxygen & Medical Equipment Services (ATHOMES). HME News recently spoke to Bowen about juggling four sets of issues.

HME News: With four state associations to manage, how do you balance different issues? 

Beth Bowen: All the federal topics are the same, but I think the key is having a strong committee on the ground in each state to handle legislative and Medicaid issues. Also, I’ve been in the industry long enough to know who to go to if I don’t have the answers. 

HME: Have you seen association enrollment going up or down?

Bowen: The numbers are down because of consolidation and closings, but it’s on the upswing. The vendors are the sales force of the association. They’re the ones that go out, see the providers and say, “Hey, you need to go to this meeting” or “Hey, for just a couple hundred bucks you could sit in on this program and learn all this information.”

HME: What should be on providers’ radar in 2016?

Bowen: Making do with less revenue. The providers who prepared for the national roll out and streamlined efficiencies are better able to cope with the expansion of competitive bidding. And many are finding other niches, whether retail or different product lines, that aren’t quite so reliant on Medicaid/Medicare reimbursement. 

HME: Where do you see the HME industry going?

Bowen: The industry will always be part of the healthcare continuum. I think the government is going to realize it can’t keep cutting reimbursement, because if it continues to deny proper reimbursement for products and services, patients will end up in the hospital, costing the government 10 times more.

YARMOUTH, Maine – January brought with it the cold, hard reality of reduced Medicare pricing nationwide and providers are bracing themselves for storms ahead.

“We have reduced our footprint and we have reduced what we are offering in certain areas,” said Mike Calcaterra, northern zone vice president for Boise, Idaho-based Norco, which has locations in in Montana, northern Idaho, and central and eastern Washington state. “Liquid oxygen is something we are holding back on. Under the new rates, it is almost impossible to provide.”

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

Provider Glenn Steinke, made the hard decision to drop nebulizers, which in his area saw a reimbursement drop from  $17.87 to $14.49—a loss he can’t absorb.

“We are a DME that focuses on respiratory and we can no longer do nebulizers,” said the owner of Bishop, Calif.-based Airway Medical. “Before, we were breaking even, but I’ve got to watch every penny.”

So far, Steinke has resisted cutting his service area—he’s the only provider covering about 10,000 square miles—but he will cut back on nursing visits to seniors from 45 days to 60 or 90 days, he says.

“The patients are the losers in this whole thing,” he said.

Cutting his service area is also a last resort for Clark McInroy, who instead is assessing the number of oxygen cylinders his company delivers.

“In the past we were pretty lenient and some patients would take advantage of that,” said McInroy, owner of COPD Respiratory Services in Cheyenne, Wyo. “We are trying to be smarter, but we realize it’s going to get even tougher.”

McInroy plans to reassess his budget in three months, and again in six months, when the second phase of cuts is implemented in July.

“If it gets bad, we’ll have to do something,” he said.

Unfortunately, things will have to get bad, especially for beneficiaries, if the industry is to make headway in its fight against competitive bidding pricing, says Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England.

“My concern is that CMS is just going to believe that they were right all along and that providers have been overpaid,” she said.

WASHINGTON – The CERT error rate for DMEPOS dropped to 39.1% in 2015 from an all-time high of 73.8% in 2010, but further improvements may be harder to come by.

Industry stakeholders credit HME providers for doing a better job preventing errors due to technical issues, and the DME MACs for applying policies more consistently for the dramatic decrease in the error rate in five years.

“A lot of the technical issues have been resolved,” said Wayne van Halem, president of the van Halem Group. “When providers realized how important those tiny issues were and the contractors became more consistent, they were mostly resolved.”

From 2014 to 2015, alone, the CERT error rate dropped 14%, according to the recently published supplementary appendices for the “Medicare Fee-for-Service 2015 Improper Payments Report.” (At press time, stakeholders were still waiting for the agency to publish the actual report, which will contain its interpretations of the results.)

Stakeholders acknowledge that the 39.1% error rate for DMEPOS is still very high. Because the majority of those errors are due to insufficient documentation (67.3%), further reductions will be more difficult, they say.

“That’s always going to be a challenge for HME providers, because they’re relying on physicians,” van Halem said. “In some ways, it’s out of the provider’s control.”

Stakeholders say providers are making progress, however, by requesting documentation from physicians up front, prior to submitting claims and providing equipment.

“They’re looking at the documentation before they set up patients and they’re not accepting patients until the documentation is good,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “They have to be that way. If the documentation is not good, they have to say no.”

Stakeholders say various policy changes at play could also help providers make a dent in the number of errors due to insufficient documentation, including required prior authorizations for certain DME and reinstated clinical inference by medical reviewers.

“The elimination of clinical inference has had a huge impact on increasing the error rate in the past,” van Halem said. “If it were to be reinstated, we’d easily see the error rate drop even more.”

Additionally, providers should consider the DME MACs partners and take advantage of the increasing number of resources they provide, such as the pre-claim reviews offered in jurisdictions C and D, stakeholders say.

“We are seeing the contractors really rolling up their sleeves and taking a more one-on-one approach,” said Andrea Stark, a reimbursement consultant with MiraVista.

WASHINGTON – While overall Medicare spending has increased more than 175% from 2000 to 2014, spending on HME accounted for just 1.25% of overall Medicare spending in 2014, dropping from 2% in 2004, according to AAHomecare’s analysis of a December update of the National Health Expenditure Accounts. Furthermore, spending on DME can lower overall Medicare costs in the long-term, the association argues. Every $1 spent on mobility equipment, for example, saves $16.78 in fall-related recovery; every $1 spent on supplemental oxygen therapy for COPD saves $9.62 in complications; and every $1 spent on CPAP therapy saves $6.73 in obstructive sleep apnea complications.

PlayMaker CRM lands $3 million credit facility

DURHAM, N.C. – Square 1 Bank, a division of Pacific Western Bank, has provided a $3 million credit facility to PlayMaker CRM, a cloud-based customer relationship management solution for post-acute care, it announced. “PlayMaker CRM has experienced a tremendous amount of growth under the leadership of its seasoned management team,” said Zack Mansfield, senior vice president of Square 1 Bank’s technology banking practice, in a release. “We are delighted to serve as their partner and support a Nashville-based, high impact company.” Proceeds from the facility will be used to support the company’s growth.

Respiratory provider agrees to $600,000 settlement

MIDDLEBURY, Conn. – J&L Medical has agreed to settle allegations that it violated state and federal regulations by using unlicensed technicians to set up CPAP and Bi-level machines. J&L president John Loyer said using patient care technicians, LPNs and others supervised by licensed RTs is common practice in the industry, but he agreed to pay $600,000. "We think it's important for our patients and the members of the medical community to understand that the government never claimed J&L Medical Services failed to deliver quality care or equipment," said Loyer, who is also co-owner of the company. "This was a matter of our disagreeing with their interpretation of Connecticut law about who can work with sleep apnea patients to do the initial setup of their CPAP machines." John Hart, a licensed RT formerly employed at J&L, filed a whistleblower complaint.

Health system sells HME business

GRAND HAVEN, Mich. – North Ottawa Community Health System has sold its HME business to CareLinc Home Medical & Equipment Supply in Grand Rapids, Mich., according to a local newspaper. CareLinc now has 20 locations in Michigan. The health system’s Grand Haven location fills a gap in CareLinc’s footprint in the lakeshore market, the newspaper reports. The health system says it decided to exit the HME business due to declining Medicare reimbursements. It says CareLinc has the economies of scale to withstand the 30% cuts. “From a financial viability, we knew this was something that we were not going to be able to sustain, but on the other hand, there was a need in the community,” Dan Holwerda, COO of the health system, told the newspaper.

O&P companies become ESOP

SOUTH BEND, Ind. – Midwest Orthotic & Technology Center and Surestep are now owned by their 170 employees, according to a local newspaper. The center is a full-service O&P company; Surestep manufactures, markets and sells a bracing system and complete line of products for children with developmental challenges. The owners of the company, Bernie Veldman and his wife Pam, will remain president and vice president, respectively. The Veldmans transitioned Dienen, Inc., the parent company of Midwest Orthotic & Technology Center and Surestep, to an employee stock ownership plan or ESOP on Jan. 4, the newspaper reported.

CCS debuts streamlined website

DALLAS – CCS Medical has launched a redesigned website at www.ccsmed.com. The new website has a more current look and improved functionality, making it easier for customers and healthcare providers to do business with the company online, says Rodney Carson, president and CEO. “One of our highest priorities going forward is to streamline things for our customers,” he said. More specifically, the new website, which is optimized for mobile use, simplifies the process of reordering supplies, paying bills and other tasks. It also provides health living tips. CCS Medical is a provider of medical supplies to patients with chronic conditions.

ACHC golfs for charity

Cary, N.C. – The Accreditation Commission for Health Care (ACHC) will host its inaugural charity golf tournament at the Brier Creek Country Club in Raleigh, N.C.,on May 16, the non-profit accreditation organization announced. Proceeds from the tournament will go to two local charity organizations: the Inter-Faith Food Shuttle, which supports hunger relief, and Big Brothers Big Sisters of the Triangle. “We hope the donations raised through the tournament will make a difference in the lives of those around us,” said José Domingos, ACHC CEO, in a release. “We are grateful for the volunteers, corporate sponsors, and players who have come together to support our local community.”

Harmar donation puts 12-year-old in the pool

SARASOTA, Fla. – Harmar has donated a pool lift to a 12-year-old with Duchenne Muscular Dystrophy. The P350 pool Lift has restored Grayson Tullio’s ability to get in and out of the pool, according to a release. “For Grayson, swimming puts a smile on his face and gives him great joy, and we are so pleased we could help him,” said David Baxter, vice president of marketing for Harmar. 101 Mobility of Sarasota donated their time to perform an evaluation and install the lift.

Short Takes: VGM Insurance, InfuSystem Holdings, 3B Medical, Thermoskin

VGM Insurance Services has partnered with AAHomecare to offer preferred pricing to AAHomecare members. Going forward, AAHomecare members will receive a 10% discount on Medicare/Medicaid Surety Bond premiums, and general and professional liability insurance…InfuSystem Holdingshas announced the implementation of InfuSystem EXPRESS, which includes the company's patent-pending EMR connectivity solution, at The Ellis Fischel Cancer Center at The University of Missouri Hospital & Clinics…3B Medical has committed to allocating a significant portion of its profits to fund adult autologous stem cell research for use in treatment of pulmonary fibrosis, diabetes and neurological diseases. "We spend a lot of resources treating the symptoms of diseases, and not enough trying to target the actual causes,” said President Thomas Thayer, Sr., in a release…Thermoskin has appointed Orthozone as the new exclusive distributor of its full line effective Jan. 1.

People news: O2 Concepts, SleepQuest

02 Concepts has named Cory Smith CFO. Smith has held leadership positions in finance and information technology for more than a decade, most recently at Endologix, which has gone from a $7 million device maker to a $150 million company…SleepQuest has named Bill Vandervennet as president and CEO. Vandervennet has held healthcare leadership positions for more than 25 years, most recently as COO for URAC, an accrediting organization.

WASHINGTON – Industry champion Sen. John Thune recently asked CMS officials if six months is long enough to monitor the impact of rolling out competitive bid pricing nationwide.

At a Senate Finance Committee hearing Jan. 21, Thune, R-S.D., asked CMS Acting Administrator Andy Slavitt how CMS is monitoring the roll out and whether or not the agency would consider extending the current phase-in period beyond July 1.

“We have the absolute authority, when we see access issues, to step in and prevent them,” replied Slavitt. “So, we can’t let the goals of this program, which I think are noble and are good for our budget, get in the way of common sense when we run into those issues, so we have hopefully been responsive along the way.”

Thune then asked, “Do you think six months is long enough?”

Slavitt: “We should not assume that six months is going to be enough until we work though it. Candidly, I want to see the data from our team that’s doing the monitoring and understand the impact, and if we believe that we are going too fast, then we will slow down.”

On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the current fee schedule and adjusted rates from its competitive bidding program. On July 1, it will base pricing only on adjusted rates.

Thune in November introduced a bill that would require a two-year phase-in period for the national rollout. It currently has 20 co-sponsors.

WASHINGTON – Industry stakeholders are shifting gears in their fight against Medicare’s competitive bidding program.

Stakeholders are now advocating for a freeze of the current reimbursement rates in regional and rural areas, according to AAHomecare’s weekly bulletin, “Wednesday in Washington.”

“While these initial phase-in cuts will certainly cause financial hardships for HME suppliers in rural/non-bid areas, we believe that working to prevent planned subsequent cuts that could reduce prices for many items by as much as 45% is the best approach to keep these suppliers afloat and help maintain critical access to products and services,” the association stated in the bulletin.

On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the previous fee schedule amounts and the bidding amounts. On July 1, it will pay for HME in those areas based only on the bidding amounts.

Previously, stakeholders were focusing their attention on bills in the Senate and House of Representatives that included a longer phase-in period for the reduced reimbursement and a 30% increase to reimbursement in rural areas and a 20% increase in regional areas.

The industry’s champions in the House and Senate have “reacted positively to the proposal as a realistic course of action to get legislation passed this year,” AAHomecare said.

“In addition, we hope to engage CMS to consider freezing the rates at the current phase-in levels beyond the six-month period before further cuts take place,” it said.

Stakeholders agreed on pursuing the freeze after considering “a range of options and approaches,” AAHomecare said.

“We believe that this approach represents the best chance to keep the deepest and most damaging cuts from wreaking further havoc on rural/non-bid HME suppliers,” it said.

WASHINGTON – With only the first of two planned cuts in effect, industry stakeholders say a freeze of current rates in regional and rural areas is their best bet.

“It’s hard to put the genie back in the bottle,” said Tom Ryan, AAHomecare president and CEO. “The cuts are here so our champions believe that this is our best alternative.”

On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the previous fee schedule amounts and the bidding amounts. On July 1, rates in those areas will be based only on the bidding amounts.

At the same time as they advocate for a freeze, stakeholders and lawmakers are putting pressure on CMS to delay that full rate cut, with Sen. John Thune, R-S.D., asking CMS Acting Administrator Andy Slavitt at a Jan. 21 Senate Finance Committee hearing whether six months is enough time to monitor the impact of the changes.

“CMS needs to be able to show Congress what is it they are doing to monitor, in real time, basis access issues, quality of care, and the impact to small business,” said John Gallagher, vice president of government relations for The VGM Group. “They are not able to prove that, so there’s a lot of pushback to say, ‘OK, you need to back off on this.’”

A study from the Office of Inspector (OIG) on the impact of bidding in rural areas also should have been completed before CMS barreled ahead, say stakeholders.

In the meantime, providers must make do with the hand they have been dealt. While so far they aren’t reporting many issues, it’s only a matter of time, stakeholders say.

“For most providers, their accounts receivable hasn’t caught up with it yet, so they are not feeling that pinch,” said Gallagher. “But they will.”

Previously, stakeholders were focusing their attention on bills in the Senate and House of Representatives that included a longer phase-in period for the reduced reimbursement and a 30% increase to reimbursement in rural areas and a 20% increase in regional areas.

WASHINGTON – CMS has put physicians and HME providers on alert that they must soon comply with a face-to-face rule for Medicaid recipients.

Starting July 1, physicians must document that they’ve conducted face-to-face visits with Medicaid recipients no more than six months prior to those patients receiving certain home medical equipment and services, according to final regulations published last week.

“When the Affordable Care Act was enacted (in 2010), the face-to-face rule applied to Medicaid, as well,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “Even though CMS delayed Medicare enforcement, it did not apply to Medicaid. Many states started the enforcement back then; some have not, whether intentionally or not knowing. Now they will have to ‘know.’”

CMS will delay compliance with the rule for up to two years, according to the regulations, which will be published in the Federal Register on Feb. 2.

Even though the regulations span 147 pages, CMS has left certain details, like a written order prior to delivery requirement that’s part of a similar face-to-face rule for Medicare, up for interpretation, stakeholders say.

“The regulations, for example, don’t call out a written order protocol, though they refer to it in global terms,” said Andrea Stark, a reimbursement consultant with MiraVista. “We should assume conservatively that it applies broadly, here, too.”

While the rule for Medicaid builds on a rule already in effect for Medicare, there are nuances between the two, stakeholders say. One example: The rule for Medicaid OKs telehealth for face-to-face visits.

“(The Medicare rule) doesn’t really talk about that,” Stark said. “They don’t include it or exclude it. But, (in the Medicaid rule), there is language about telehealth.”

CMS implemented a face-to-face rule for Medicare on July 1, 2013. The agency began enforcing a WOPD requirement on Jan. 1, 2014, but it has not begun enforcing the face-to-face visit requirement.

In states like Georgia, there was a face-to-face rule on the books for Medicaid even before Medicare implemented its rule. Physicians and providers in that state have been conducting and documenting face-to-face visits since 2011, soon after the ACA was enacted.

“It was a little tough in the beginning, because the physicians weren’t always mentioning their order and the need for it in their documentation, but it has gotten a lot better,” said Trish Clayton, revenue cycle manager for Barnes Healthcare Services in Valdosta. “It has been a training issue with physicians.”

YARMOUTH, Maine – Industry stakeholders are weighing the recent shake up in the DME MACs.

For the first time ever, there will be two contractors handling claims processing for all four jurisdictions: CGS Administrators and Noridian Healthcare Solutions.

“This is definitely a big change,” said Wayne van Halem, president of The van Halem Group. “The four jurisdictions have been around since 1993 and there have always been four unique companies doing it. (CGS and Noridian) have become Super MACs.”

Nashville-based CGS snagged the contract for Jurisdiction B— worth $77.7 million and representing 20.7% of the DME workload—in January. CGS, which already holds the contract for Jurisdiction C, replaces National Government Services.

Fargo, N.D.-based Noridian snagged the contract for Jurisdiction A—worth $90.9 million and representing 18% of the DME workload—in December. Noridian, which already holds the contract for Jurisdiction D, replaces NHIC.

It’s a little unsettling to think about two contractors “holding all the cards,” says Kim Brummett, vice president of regulatory affairs for AAHomecare.

“CMS was intentional in creating four MACs so not all of the eggs were in one basket,” she said. “Having Super MACs could be scary.”

The word on the street is, however, that CGS and Noridian will have separate operations for each jurisdiction, stakeholders say.

“They will still have two different medical directors and two different operations directors,” said Andrea Stark, a reimbursement consultant for MiraVista. “There will still be some autonomy.”

There could also be a few positives to having just two contractors, stakeholders say. First, there could be more consistency in how policies are applied, reducing the error rate for DMEPOS claims. Second, CGS and Noridian have better reputations for educating and providing resources to providers.

“Perhaps we’ll see increased service as a result of these transitions,” van Halem said.

One thing’s for sure: Providers can likely expect a few bumps in the road until the transition is complete, stakeholders say. CGS will begin processing claims in Jurisdiction B on June 27. There’s no word yet from Noridian on when it will take over in Jurisdiction A.

“No transition is pretty,” Brummett said. “If you think about all the pre-pay audits, all the claims in process—all of that has to be moved over. It’s never pretty.”

GREENSBORO, N.C. – ConvaTec, a manufacturer of wound care and ostomy products, will begin closing its manufacturing facility here, resulting in 250 layoffs, according to news reports. It expects to complete the closure during the first quarter of 2017. The company announced in 2014 that it would shutter its office in Skillman, N.J., resulting in 118 layoffs from its sales, marketing and human resources division. ConvaTec is owned by Avista Capital Partners and Nordic Capital. The firms have been seeking a corporate suitor or IPO for the company, but have not succeeded, according to reports. Avista and Nordic purchased the wound care unit from Bristol-Myers Squibb for $4.1 billion in 2008. Nordic Capital formerly owned Permobil. ConvaTec has more than 9,000 employees, with 11 manufacturing facilities in eight countries. It owns 180 Medical, a provider of catheters and urological medical supplies.

Apria shifts order management to the web

LAKE FOREST, Calif. – Apria Healthcare has launched ApriaLink, an electronic order management system that it says will help it work smarter and more efficiently.

Apria says it’s the first national provider to launch such a system, which, among other things, allows physicians to sign electronically certificates of medical necessity, or CMNs, for oxygen orders for Medicare beneficiaries.

“Healthcare professionals can quickly and efficiently shift patients from the high-cost acute setting to the lowest-cost home setting through electronic means,” said Dan Starck, CEO, in a press release.

ApriaLink also provides instant, real-time access to the status of orders; simple, clear guidance about resolving issues around orders, including instructions for pending documentation requirements; and the ability to place new prescription orders online.

In these ways, the system not only empowers physicians but also patients, Starck says.

“With this ground-breaking portal, Apria is investing in our customers and leading the industry by putting powerful electronic homecare order management in the hands of our customers—giving them more control over the process,” he said.

ApriaLink is a web-based tool that is HIPAA-compliant, encrypted and secure from inappropriate access, according to the release.

AHP to close billing center

BRENTWOOD, Tenn. – American HomePatient plans to close a regional billing center in Buffalo, N.Y., in April, eliminating 42 jobs, according to Buffalo Business First. A company representative told the news agency that the move will not affect AHP’s branch locations in the area and the employees who work there providing HME. “We have been working on initiatives to drive cost out of our organization,” the representative said. The representative also told the agency that the move is not related to the pending acquisition of AHP by Lincare.

Sleep therapy reduces readmissions for CHF patients, study shows

PHILADELPHIA – Early diagnosis and treatment of sleep apnea may reduce six-month readmissions for patients hospitalized with heart failure, according to research recently published online by the American Journal of Cardiology. "Our research showed that early recognition and treatment of patients hospitalized with decompensated congestive heart failure is associated with a reduction in readmissions for patients who use their positive airway pressure (PAP) therapy on a regular basis," said first author Sunil Sharma, M.D., FAASM, associate professor of pulmonary medicine in the Sidney Kimmel Medical College at Thomas Jefferson University. "Importantly, hospitals can implement cost-effective screening programs to catch sleep apnea in hospitalized, high risk patients." Dr. Sharma and the team screened patients admitted to the hospital with heart failure for underlying sleep disordered breathing. Of the 75 patients that followed up with an outpatient polysomnography, 70 received the diagnosis of sleep-disordered breathing. Over the next six months, the team tracked patients' PAP compliance, ER visits and readmissions. By comparing pre- and post-treatment readmissions in compliant and non-compliant patients, the researchers found a reduction in hospital visits for those who used their PAP regularly over a period of six months.

MED Group expands payer network

LUBBOCK, Texas – The MED Group has signed an agreement with America’s Choice Provider Network, expanding its payer network by an additional 22 million covered lives, it announced Jan. 26. “We are confident this agreement will provide our members a great opportunity to continue to grow their business,” said Jeff Woodham, senior vice president and general manager. “With ACPN’s established network of healthcare providers, our members will now have access to more than 175 million covered lives.” In 2015, the member services organization expanded its payer network through agreements with several plans. The MED Group is a wholly-owned subsidiary of Managed Health Care Associates.

Former provider launches employee newsletter

COCONUT CREEK, Fla. – Valumatrix has launched The Fifth Element, a weekly newsletter to help engage employees, it announced Jan. 26. Each month the newsletter will have an overarching theme and each week it will have a different focus, including work, self, family and relationships“At a time when it is getting more and more difficult for companies to raise their prices, productivity improvements are becoming a preferred approach to shoring up the bottom line,” said Lynn Everard, managing director. “Our goal with this publication is to assist companies in increasing employee ultimately leading to productivity improvements and better work/life balance.” FMI: www.valumatrix.net.

Humana opens first of six pharmacies

New Braunfels, Texas – Humana opened its first community pharmacy in Texas at the Partners in Primary Care medical practice. The new pharmacy, an extension of Humana's mail-order prescription drug service, will provide clinical support and full pharmaceutical services to Humana customers. The insurance company intends to open a second pharmacy in Texas and four more in Florida over the next few months.

NCPA wants pharmacists included on chronic care teams

ALEXANDRIA, Va. – The National Community Pharmacists Association has provided Senate Finance Committee leaders a range of proposals aimed at improving care for the panel’s Chronic Care Working Group. “Our recommendation is to include pharmacists as essential health care providers on chronic care teams and the designated lead in coordinating safe and effective medication management,” wrote the NCPA in a letter to the committee. The NCPA also suggested improving care management services for individuals with multiple chronic conditions; expanding access to prediabetes education; and medication synchronization.

Össur, Ottobock fund research

REYKJAVIK, Iceland – Össur and Ottobock have joined forces to fund breakthrough research in mind-controlled prosthetic limbs. The companies have contributed a combined $1 million to the Össur and Ottobock Research Trust Fund at the University of Iceland. The fund will award international grants for scientific research and innovative projects in the field of advanced neural control of prosthetic limbs. It will award the first grants within one year. The fund will be governed by a four-person committee comprised of two University of Iceland representatives and one representative from each company.

Short takes: Active Healthcare, Executive Infusion Services

Lisa Feierstein, co-founder and president of Active Healthcare in Raleigh, N.C., was selected from more than 5,000 submissions to be featured in “The 2016 Woman’s Advantage Shared Wisdom Calendar.” The calendar provides advice for women business owners from influential women leaders across the U.S. and Canada. Featured on Jan. 30 and 31, Feierstein’s quote states: “Sleep is the ultimate detox”…Executive Infusion Services, an independent home infusion pharmacy based in Dearborn, Mich., has been accredited by the Accreditation Commission for Health Care.

WASHINGTON – CMS this week published final regulations for implementing a face-to-face rule for Medicaid.

Starting July 1, physicians must document that they’ve conducted face-to-face visits with Medicaid recipients no more than six months prior to those patients receiving certain home medical equipment and services.

CMS will delay compliance with the rule for up to two years, according to the regulations, which will be published in the Federal Register on Feb. 2.

CMS implemented a face-to-face rule for Medicare on July 1, 2013. The agency began enforcing a written order prior to delivery requirement on Jan. 1, 2014, but it has not begun enforcing the face-to-face visit requirement.

A bill was passed last year that expands the types of healthcare providers who can document the face-to-face visit with Medicare beneficiaries to include physician assistants, nurse practitioners and clinical nurse specialists.

Stakeholders believe the expansion paves the way for CMS to start enforcing the face-to-face visit requirement for Medicare.

WATERLOO, Iowa – The VGM Group has made available a 26-page playbook with ideas and strategies to grow and adapt in this new age of HME.

The 2016 HME Business Playbook addresses market and healthcare trends, new business and revenue opportunities, product life-cycle economics, among other topics.

“This resource is truly a game-changer for our industry,” said Clint Geffert, president of VGM & Associates. “Similar to sports, in business you need to research ways to take advantage of the match-up or situation to have success.”

There are three versions of the playbook for providers in bidding, rural, and regional areas.

VGM plans to update the playbooks each quarter. Other topics that will be addressed include cybersecurity, healthcare retail, home modifications and business analytics.

“The landscape for HME has and will continue to change and that’s precisely why our team of experts works relentlessly to develop programs to take on and assist our members with their toughest business challenges.”

The playbook is free and available to members and non-members.

WASHINGTON – CMS has published an FAQ for the prior authorization process for DME. A number of the questions address the agency’s “master list” of 135 products for which a prior authorization could be required. Those products include CPAP devices, semi-electric hospital beds, manual wheelchairs and oxygen concentrators. Stakeholders are still waiting for sub-regulatory guidance on when prior authorizations will be required and for what products. CMS published its final rule for the prior authorization process on Dec. 30, with an effective date of Feb. 29.

ALJ sides with feds, Lincare must pay $240K penalty

CLEARWATER, Fla. – Lincare will pay nearly $239,800 in civil monetary penalties for violating the Health Insurance Portability and Accountability Act, a U.S. Department of Health and Human Services Administrative Law Judge ruled Feb. 3. This is only the second time in its history that the Office for Civil Rights has sought civil monetary penalties for HIPAA violations. Each time, the penalties have been upheld by the ALJ. OCR’s investigation of Lincare began after an individual complained that a Lincare employee left behind documents containing the protected health information of 278 patients after moving residences. OCR found that this employee removed protected health information form the company’s office, left the information exposed in places where an unauthorized person had access to it and then abandoned the information altogether. OCR found that Lincare had inadequate policies and procedures in place to safeguard patient information that was taken offsite. “Although aware of the complaint and OCR’s investigation, Lincare subsequently took only minimal action to correct its policies and strengthen safeguards to ensure compliance with the HIPAA rules,” HHS stated in a release. Lincare claimed it had not violated HIPAA because the patient information was “stolen” by the individual who discovered it on the premises previously shared with the Lincare employee. The ALJ rejected this argument, agreeing with OCR that under HIPAA, Lincare was obligated to take reasonable steps to protect its patient information from theft.

VGM offers playbooks

WATERLOO, Iowa – The VGM Group has made available a 26-page playbook with ideas and strategies to grow and adapt in this new age of HME. The 2016 HME Business Playbook addresses market and healthcare trends, new business and revenue opportunities, product life-cycle economics, among other topics. “This resource is truly a game-changer for our industry,” said Clint Geffert, president of VGM & Associates. “Similar to sports, in business you need to research ways to take advantage of the match-up or situation to have success.” There are three versions of the playbook for providers in bidding, rural, and regional areas. VGM plans to update the playbooks each quarter. Other topics that will be addressed include cybersecurity, healthcare retail, home modifications and business analytics. “The landscape for HME has and will continue to change and that’s precisely why our team of experts works relentlessly to develop programs to take on and assist our members with their toughest business challenges.” The playbook is free and available to members and non-members.

www.playbook.vgm.com

Cape Medical Supply reimagines CPAP experience

SANDWICH, Mass. – Cape Medical Supply will roll out a “Visual Learning Program” for all new CPAP patients on Feb. 15. The program uses iPads, visual instructions and hands-on training with CPAP machines to show patients how to set up, use and diagnose common problems with their sleep therapy. “In the summer of 2015, we began a very detailed study of what we call the ‘PAP Patient Experience,’” said Mike Sheehan, COO. “We felt the setup process was far too wordy and in an effort to help patients absorb important aspects of their therapy, we decided to pair the verbal approach with images, videos and easy-to-understand instruction packets.” Cape Medical Supply anticipates that the program will improve the company’s already industry-leading compliance rate and help patients adjust to their therapy faster. The program is only the latest improvement Cape Medical Supply has made to its sleep therapy program since 2012. Other recent improvements include an online reordering portal called MyResupply, online payment portals called AutoPay and BillPay, a Sleep Therapy Center in Sandwich, and SleepExpress locations in New Bedford and Plymouth.

Golden, VGM boost retail offerings

OLD FORGE, Pa. – Golden Technologies and The VGM Group have joined forces to further focus the HME industry on maximizing retail sales. “Ultimately, this partnership will be instrumental in leading the industry’s dependency away from the reimbursement model,” said Richard Golden, president and CEO of Golden Technologies, in a press release. The two companies, long-time proponents of retail in the HME industry, will embark on a nationwide tour, including the Heartland Conference in June, to train providers on branding and merchandising. Golden will also bring to the table its “business process modeling” for retail. “It has been proven that the most effective DME model is all about showing retailers the critical importance of focusing on selling prices,” said C.J. Copley, executive vice president of sales and marketing at Golden Technologies. “By focusing on business process modeling for retail, including bundling sales, GMROI, revenue per square foot, daily customer traffic and cost per sales, retailers can increase the average ticket selling price.” Golden gives a nice boost to the offerings and business solutions that VGM offers its members. “We look forward to this new partnership with Golden Technologies to further enhance retail solutions for our members,” said Clint Geffert, president of VGM & Associates.

Breas Medical celebrates 25 years

CHARLOTTESVILLE, Va. – Breas Medical, an affiliate of PBM Capital Group, a healthcare-focused investment firm based here, celebrates 25 years in business this year. The Gothenburg, Sweden-based Breas manufactures the Vivo homecare ventilation range and the iSleep CPAP and bi-level sleep therapy products. In its 25th year, Breas plans to launch multiple products and to grow globally, it says. PBM, which also owns Human Design Capital, maker of the Z1 portable CPAP device, and B&D Electromedical, bought Breas from GE Healthcare in 2014.

MK Battery makes executive changes

ANAHEIM, Calif. – MK Battery has appointed Rick Spiegel as vice president of sales. Spiegel, a 15-year veteran of the company with more than 25 years of experience in HME, was most recently vice president of operations. He also oversaw the company’s global OEM sales functions. Spiegel’s predecessor, David Brunelle, has transitioned to another division of the company. In another move, MK Battery has named Jeff Pitzer director of operations. He joined the company in 2004 and was most recently director of service & logistics.

Congress seeks to eliminate barriers to telehealth

WASHINGTON – The Senate introduced a bill Feb. 2 that would lay the groundwork to expand Medicare reimbursement for telehealth services, according to Bloomberg. The bill, S. 2484, would create a program that would waive for participating providers Medicare’s requirements that telehealth services occur at a qualified site and other restrictions. The House of Representatives introduced an identical bill Feb. 3. The “bridge program” would require participating providers to submit annual reports to the Department of Health and Human Services on how their expanded use of telehealth affected their bottom lines. These reports would be used to prove that telehealth could reduce Medicare spending under the Merit-Based Incentive Payment System, according to Bloomberg.

Consumers want to monitor their health, survey finds

REDWOOD CITY, Calif. – More than eight out of 10 consumers believe that tracking their own health data with a clinically accurate monitoring device will help improve their overall health, according to a national survey of 1,000 respondents commissioned by The Society for Participatory Medicine and healthcare technology company Biotricity. Fifty-seven percent of consumers say they would wear monitoring devices for personal use and they would share the data those devices collect with healthcare professionals, the study found. “Increasingly, patients are actively monitoring their own health data to better self-manage their chronic diseases and collaborate with their healthcare professionals,” stated Daniel Sands, MD, MPH, co-founder and co-chair of the Society of Participatory Medicine and a practicing physician. “Self-monitoring is vital component of an efficient and high-functioning healthcare system. This survey shows that this concept resonates with the public and that most respondents are willing to utilize technology to gather this data to improve their health.” Biotricity is focused on delivering biometric monitoring solutions for medical, health care and consumer use.

Disability group launches capital campaign

STONE MOUNTAIN, Ga. – Friends of Disabled Adults and Children (FODAC), which will be an exhibitor at the upcoming Medtrade Spring, has launched a campaign to raise $1.5 million by the end of 2016. FODAC will apply the funds toward facility upgrades and paying off the mortgage on its corporate headquarters. “This campaign will help FODAC better leverage HME donations across the state for the benefit of the community,” said CEO Chris Brand. The nonprofit, which celebrates its 30th anniversary this year, provides more than $10 million annually in HME and supplies to those living with disabilities. The goal of the “Keeping People with Disabilities Moving Campaign” is to improve FODAC’s effectiveness in three ways: warehouse and product flow improvements, facility improvements, and financial improvements.

Short takes: ResMed, OMHA, NCART, Great Lakes

ResMedhas completed its acquisition of Inova Labs, officially making it a player in both the sleep and oxygen therapy markets…The Office of Medicare Hearings and Appeals will host the fourth Medicare Appellant Forum via webinar/teleconference on Feb. 25 from 1 p.m. to 4 p.m. It plans to discuss updates on steps that it and the Department of Health and Human Services are taking to address a huge backlog at the administrative law judge level of the appeals process. OMHA last held a forum in June 2015…Long-time complex rehab advocate Finn Bullers passed away on Jan. 30 from complications of an illness, according to NCART. Bullers, who was named Advocate of the Year in 2014 by the United Spinal Association, was 52…Great Lakes Caring Home Health and Hospice has made changes to its leadership team, naming Adam Nielsen as president; Marcy Miller, RN, as chief clinical officer; and Carry vandenMaagdenberg as CIO. William Deary will remain CEO.

WASHINGTON – The president’s proposed federal budget for fiscal year 2017 includes a provision to expand Medicare’s competitive bidding to new product categories.

The budget proposes that inhalation drugs; all prosthetics and orthotics; and ostomy, tracheostomy and urological supplies, all be included in the program.

“Since implementation, the competitive bidding program for durable medical equipment, prosthetics, and supplies has saved the Medicare program and beneficiaries billions of dollars by aligning payment amounts with market-based prices,” the budget states.

Expanding competitive bidding to these additional product categories would save $3.8 billion over 10 years, the budget states.

The budget also proposes eliminating the 36-month cap for oxygen equipment and, instead, reducing the monthly payment amount for oxygen and oxygen equipment by the necessary percentage to be budget neutral, according to AAHomecare’s analysis.

Another provision in the budget: Extend the authority to require prior authorization to all Medicare fee-for-service items and services, particularly those that are at the highest risk for improper payment. This would save $75 million in 10 years, the budget states.

A number of provisions in the budget are related to the Medicare appeals process, according to AAHomecare. They include:

·      Provide Office of Medicare Hearings and Appeals and Departmental Appeals Board Authority to use Recovery Audit Contractor collections.

·      Establish a refundable filing fee.

·      Establish magistrate adjudication for claims with amount in controversy below new administrative law judge amount in controversy threshold.

·      Expedite procedures for claims with no material face in dispute.

·      Increase minimum amount in controversy for administrative law judge adjudication of claims to equal amount required for judicial review.

·      Remand appeals to the redetermination level with the introduction of new evidence.

·      Sample and consolidate similar claims for administrative efficiency.

LAS VEGAS-The HME industry certainly provides significant value to the healthcare sector, but some stakeholders argue that more must be done to prove it.

At Medtrade Spring in Las Vegas, in a session titled “Monetizing the Value of Outcomes," Dewey Roof, president of LifeH2H, will explain the importance to HME providers of demonstrating financial value to hospitals and providers.

HME News: What are the most important outcomes for HME providers to be collecting and why?

Dewey Roof: Readmissions is the hot number, but a growing one is extended length of stay. Every hour spent in a hospital means they have to staff a hospital, so anywhere an HME provider can help facilitate a discharge, you can help them save money.

HME: Why should every HME provider be in the business of not only collecting and analyzing outcomes, but also sharing them with referral sources, insurers and others?

Roof: The industry has done a woeful job of demonstrating the value of our business. We know the spend is low in our arena, but what have we done to demonstrate that to our key clients?

HME: Are there technologies that can help HME providers in collecting, analyzing and sharing outcomes?

Roof: There is public data available, but it takes some effort to translate that into what you’ve done. You’ve got to track the patients, stay engaged with them, capture and report their experience, and then cross reference with public data.

HME: How can outcomes change the stereotypes that surround being an HME provider?

Roof: People want to be at home, and we know it’s a lower cost continuum, but we’ve never put a dollar amount to it.

HME: What’s the one thing you want attendees to take away from your session?

Roof: That there is probably an opportunity like there’s never been before to become relevant across the healthcare continuum.

WASHINGTON – The president’s proposed federal budget for fiscal year 2017 includes a provision to expand Medicare’s competitive bidding to new product categories.

The budget proposes that inhalation drugs; all prosthetics and orthotics; and ostomy, tracheostomy and urological supplies, all be included in the program.

“Since implementation, the competitive bidding program for durable medical equipment, prosthetics, and supplies has saved the Medicare program and beneficiaries billions of dollars by aligning payment amounts with market-based prices,” the budget states.

Expanding competitive bidding to these additional product categories would save $3.8 billion over 10 years, the budget states.

The budget also proposes eliminating the 36-month cap for oxygen equipment and, instead, reducing the monthly payment amount for oxygen and oxygen equipment by the necessary percentage to be budget neutral, according to AAHomecare’s analysis.

Another provision in the budget: Extend the authority to require prior authorization to all Medicare fee-for-service items and services, particularly those that are at the highest risk for improper payment. This would save $75 million in 10 years, the budget states.

A number of provisions in the budget are related to the Medicare appeals process, according to AAHomecare. They include:

·      Provide Office of Medicare Hearings and Appeals and Departmental Appeals Board Authority to use Recovery Audit Contractor collections.

·      Establish a refundable filing fee.

·      Establish magistrate adjudication for claims with amount in controversy below new administrative law judge amount in controversy threshold.

·      Expedite procedures for claims with no material face in dispute.

·      Increase minimum amount in controversy for administrative law judge adjudication of claims to equal amount required for judicial review.

·      Remand appeals to the redetermination level with the introduction of new evidence.

·      Sample and consolidate similar claims for administrative efficiency.

Brightree seeks buyer?

ATLANTA – Brightree has retained William Blair & Co. to explore a sale of the company, according to VentureWire.

Brightree, which in 2008 secured a significant investment from Battery Ventures, a Boston-based private equity firm, is attracting interest from a variety of buyers, including financial sponsors, according to the news agency, which is part of the Dow Jones family.

Brightree gave management presentations to prospective buyers before Thanksgiving, VentureWire reports.

Since Battery Ventures came onto the scene, Brightree has significantly expanded its foothold not only in the HME industry but the post-acute care market at large, mostly by acquisition. Brightree acquired CareAnywhere in 2013, Pacware in 2011, CAU in 2010 and C&S Billing in 2008.

Brightree also acquired Strategic AR in 2014, a provider of private-pay billing and collections solutions.

A sale of Brightree could pull in at least $450 million to $600 million, based on the company’s $45 million to $50 million of EBITDA, with multiples in the healthcare IT space running at least 10 to 12 times EBITDA, according to VentureWire.

NSM picks up complex rehab biz

NASHVILLE ­– National Seating & Mobility has expanded in eastern Pennsylvania with the acquisition of the complex rehab division of Webb Medical Systems. Short-term, NSM will continue operating out of the existing Webb Medical Systems locations in Reading and Allentown, Pa., according to a press release. Christopher Kritzer, ATP, will lead the Reading office, and Sarah Adams, ATP, will lead the Allentown office. Webb Medical Systems, which has provided complex rehab products and services for 30 years, will continue to expand its offerings in respiratory, HME and home accessibility, according to the release. “Sharon and I have long known and admired the reputation of NSM,” stated Richard Webb, owner of Webb Medical Systems. “Their mission and ours are so closely aligned that they were our only choice to continue the tradition.”

Providers lobby House Speaker

JANESVILLE, Wis. – The VGM Group and Mercy Health System hosted House Speaker Paul Ryan to discuss the challenges faced by the HME industry. Multiple health providers across the state, including Mercy Assisted Care DME, Agnesian Health, Home Health United, Home Care Medical, Home Care Pharmacy, Oxygen One and Knueppel Healthcare Services, asked for Ryan’s support of a payment freeze of the current rates in regional and rural areas. “Mr. Ryan agreed that the bidding program is a real problem and wants to be helpful where he can so DME suppliers can continue to serve those who need these services,” said Tom Powers, director of government relations for VGM & Associates.

Juzo opens office in Canada

CUYAHOGA FALLS, Ohio – Juzo has opened Juzo Canada in Burlington, Ontario, the manufacturer of compression garments has announced. Juzo has hired Byron MacPhee as sales director to lead the Juzo Canada sales force. He has nearly 15 years of experience in compression therapy and sales management. Prior to joining Juzo, MacPhee was vice president of sales for Sigvaris. Since opening, Juzo Canada has launched a website that includes a dealer locator; added two territory managers; launched Shop Juzo, an online product offering platform for authorized dealers; implemented credit card processing; and formed a dedicated support channel to field questions about product orders.

BMC wins action against ResMed

BEJING – BMC Medical has won a global patent infringement litigation action against ResMed, it has announced. The U.S. Patent and Trademark Office issued a series of judgments in connection with inter partes review of U.S. Patent No. RE44453 on Jan. 21, 2016, and found 32 claims invalid, the company says. “We have now built a powerful patent team to support our strong resources in research and development,” stated Denny Wu, BMC’s head of intellectual property department. “In less than three years, we have applied for hundreds of patents and now we are able to proactively protect our rights and interests.”

Short takes: QS/1, BraunAbility, RESNA

QS/1has received certification under the latest Payment Application Data Security Standard version 3.1, used to ensure safety through payment applications. To be certified, point-of-sale vendors must develop a secure payment application that does not allow storage of prohibited information, such as magnetic stripe, CVV or PIN data, and adhere to all the industry mandates for the secure handling of credit card data…BraunAbility has joined forces with Ford to create BraunAbility MXV, a wheelchair-accessible SUV. The SUV features patented sliding-door technology, removable driver and passenger seats, and a powered, lighted in-floor ramp…RESNA is now accepting innovative assistive technology designs for the 2016 RESNA Student Design Competition. Up to six semi-finalist teams will win a trip for two team members to attend the RESNA Annual Conference, July 10-14 in Arlington, Va, for final judging. The final deadline for submission is April 11.

People news: Vantage Home Medical Equipment, GF

Meadville, Pa.-based Vantage has appointed Melody Sidor vice president of Vantage Home Medical Equipment and Oxygen. She brings 25 years of experience in health care to the role. She will lead and manage all aspects of Vantage’s HME operations, and will be responsible for all five of the company’s locations in northwest Pennsylvania and Ohio. Most recently, Sidor was director of branch operations…GF Health Products has announced that 23 homecare and medical-surgical sales representatives have earned the “Accredited in Medical Sales” designation administered by the Health Industry Distributors Association. The AMS program consists of 13 scored courses covering topics such as Medicare/Medicaid reimbursement, healthcare trends, and medical products and procedures.

WASHINGTON – CMS has revised the look-back period for overpayments from 10 to six years, according to a final rule issued Feb. 11.

Medicare Parts A and B healthcare providerswho discover Medicare overpayments within six years of the initial date reimbursementwas receivedmust report and repay them within 60 days to avoid liability under the False Claims Act, the rule states.

“Creating this limitation for how far back a provider or supplier must look when identifying an overpayment is necessary to avoid imposing unreasonable additional burden or cost on providers and suppliers,” the rule states.

CMS originally proposed a 10-year look-back period, aligning with the maximum window for bringing FCA lawsuits. However, upon further review, the agency says it believes six years reflects the more common statute of limitations under the FCA.

In the rule, CMS also clarified the meaning of “identification.” It says identification has occurred when a provider “has or should have, through the exercise of reasonable diligence, determined that the person has received and overpayment and quantified the amount of the overpayment.”

In the event of overpayment, providers and suppliers must use an applicable claims adjustment, credit balance, self-reported refund, or another appropriate process to report and return overpayments. 

Providers are considered to be in compliance if they report a self-identified overpayment to the Self-Referral Disclosure Protocol managed by CMS or the Self-Disclosure Protocol managed by the Office of the Inspector General.