WASHINGTON – Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, will hold a press conference Thursday, June 13, to increase the pressure on CMS to delay Round 2 of competitive bidding, according to a news release from AAHomecare.

The pair of lawmakers, who are spearheading the push to delay the implementation of Round 2, plan to announce that a bipartisan majority of 226 members of the House of Representatives have signed their “Dear Colleague” letter to CMS Administrator Marilyn Tavenner.

Thompson and Braley will be joined at the press conference by Tyler Wilson, president and CEO of AAHomecare, John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, and fellow congressmen and healthcare advocates to discuss the need for a delay until CMS “fully investigates and addresses the program failures identified in their letter,” the release said.

The conference is scheduled for 10 a.m. at 122 Cannon House Office Building in Washington, D.C.

WASHINGTON – A “Dear Colleague” letter calling for CMS to delay Round 2 of competitive bidding has garnered 227 lawmaker signatures, Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, announced at a press conference June 13. 

“We are concerned that mishandling of the bidding process, as outlined in the letter, will impact Medicare’s ability to serve its beneficiaries and the taxpayers,” Thompson said. “We urge the administrator to do the right thing and delay the program through the end of 2013 to allow for adequate investigation and correction of the significant problems that we have identified.”

CMS plans to implement Round 2 on July 1.

The letter, which began circulating May 20, earned support from a majority of lawmakers in the House from both sides of the aisle in less than a month. 

“When the government picks winners in a flawed bidding system for the medical equipment business, seniors on Medicare and the small businesses that serve them lose,” Braley said. “The free market should be allowed to work within Medicare, and a bipartisan group of representatives comprising a majority of the U.S. House agree.” 

Of the 227 lawmakers supporting the delay, 145 are Republicans and 82 are Democrats. Among them: Rep. Tom Price, R-Ga., who introduced H.R. 1717, a bill to replace competitive bidding with a market-pricing program (MPP). His bill currently has 119 co-sponsors. 

“The fundamental failings of the current DMEPOS competitive bidding program is a threat to patients, families, physicians, and providers,” Price said. “To ensure Medicare is successfully serving its beneficiaries, we ought to delay implementation of the current bidding program as requested by a bipartisan majority in Congress and then move to real reform of the program to make it truly market-based.”

Lawmakers released a video of the press conference and a copy of the letter to the press. 

WATERLOO, Iowa – The tide may be turning on CMS and its competitive bidding program, industry stakeholders told attendees at The VGM Group’s Heartland Conference last week.

The same week as the conference, Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, introduced a bill that would delay Round 2 of competitive bidding (see top story). Earlier in the week, they had sent a “Dear Colleague” letter signed by 227 lawmakers, a majority in the House of Representatives, to CMS.

“This will send shockwaves,” said John Gallagher, vice president of government relations for VGM.

Gallagher was one of 75 speakers at the conference, held June 10-13. He was joined by almost 600 providers and 300 representatives from various vendors.

The letter gives Thompson and Braley built-in support for their legislation, stakeholders say.

 “This is a huge, huge step forward,” said Jay Witter, vice president of government affairs for AAHomecare.

Stakeholders have been hammering lawmakers with data that competitive bidding is built to fail. In addition to hundreds of contract suppliers that don’t currently meet licensure requirements in states like Tennessee and Maryland, research conducted by Invacare shows 46% have “serious financial issues,” says Cara Bachenheimer.

“In Round 1, I think it was 27%,” said Bachenheimer, senior vice president of government relations for Invacare.

Even Sen. Max Baucus, D-Mont., who led efforts to expand Round 2 as part of the healthcare reform law, is having second thoughts, stakeholders say.

“He talked to (CMS Administrator Marilyn Tavenner) about (the licensure issues) and he was not pleased with her response,” Witter said. “That shows you how far we’ve come.”

In other bidding news last week, members of the House of Representatives and the Senate held briefings with CMS to discuss concerns with the program; and the number of co-sponsors for H.R. 1717, a bill to replace competitive bidding with a market-pricing program (MPP), hit 122.

React to change

Regardless of what happens with competitive bidding, attendees realize changes are afoot, however, and speakers like Chad Knaus, the NASCAR crew chief for the No. 48 Spring Cup Series car driven by Jimmie Johnson, told attendees: “You can’t be afraid when challenges change.”

Facing mounting pressure and increasing regulations, Knaus told attendees of how it was only after he delegated more responsibility to his team that he was able to end a four-year dry spell and win a championship again in 2006.

“A magical thing happened,” he said. “It’s amazing what happens when people have to react.”

Inspire ‘real negotiators’

Like Knaus, HME business owners need to react to succeed. Speaker Miriam Lieber told attendees to adapt their leadership skills to reflect the current environment.

“Would you hire the same staff today?” asked Lieber, president of Lieber Consulting. “They need to be real negotiators, not order takers.”

WASHINGTON – Robert Steedley, president of Barnes Healthcare Services in Valdosta, Ga., becomes chairman of AAHomecare at a time of change for both the HME industry and the association. Here’s what he had to say about his appointment and AAHomecare’s role in shaping the future of the industry.

HME News: What’s your background in the HME industry?

Robert Steedley: I started out in 1988 in pre-hospital care as an EMT in Tennessee. I got a degree in nursing and became an RN in 1992, then began working in emergency and critical care in Columbia, Tenn. In 1996, I moved to Valdosta and began working for Barnes Healthcare Services, where I reported directly to Charles Barnes, a third generation owner and pharmacist.

HME: Why did you decide to get involved with leadership at AAHomecare?

Steedley: The association was an opportunity for me to be exposed to some of the former leaders, and I began paying more attention to the importance of their work. Working with them helped me realize that we’re all here to take care of companies, and I still feel very strongly about that. I am as passionate today as I was then. I think the industry is part of the solution, and the association can provide the advocacy and regulation relief the industry needs to continue doing what it does.

HME: You’re coming in as chairman at a time of change for both the industry and AAHomecare. How do you plan to shepherd both through these changes?

Steedley: Short-term, we really have four things we’re focusing on. There’s the advocacy piece, and trying to replace competitive bidding with the market-pricing program (MPP). Secondly, we want to improve communication with CMS, since that relationship is critical. We want to improve value and return on investment for our current members. And lastly, a major focal point is membership growth.

HME: How do you see AAHomecare changing shape as a result of these changes?

Steedley: I am aggressively working to bring in other organizations and associations that share our values and goals. We’re very proud of the NAIMES merger, and we’re actively working with another organization that I hope will be announced soon. We’re constantly looking for the right team members to join us, and I see that coming into fruition.

HME: Do you like the industry’s chances of replacing competitive bidding with MPP?

Steedley: As an industry, we need to win. We’ve had some wins along the way, but clearly we need a big win. Part of this involves understanding the political climate in Washington, D.C., and looking for other larger bills for our bills to get attached to. But we fully expect victory here, and we’re working all hands on deck to bring a delay and get MPP signed into law.

HME: Why is it important for providers to be part of AAHomecare?

Steedley: The association is impotent if it doesn’t have members. When staff is on Capitol Hill, we have to speak for our membership, and our membership has to be reflective of the industry. We need members of all sizes. It’s not the size that matters, but the voice and passion. We need members to get legislation passed, to get meetings with CMS, to get regulatory relief. Otherwise, the program laid on top of us will continue to grow without any relief in sight. 

WASHINGTON – AAHomecare and People for Quality Care (PFQC) have partnered to offer a hotline number for Medicare beneficiaries to log complaints about their access to HME, according to a press release. The number, which will go live June 18, will be staffed 24/7 by a PFQC live operator, who, with the caller’s permission, will forward complaints about competitive bidding to a Medicare ombudsman. Those complaints will then be added to a list, which will be presented to members of Congress. “Medicare reports to only have received one to 200 complaints since the beginning of their program in 2011,” stated PFQC Director Kelly Turner. “We want to make sure that the voices of equipment users are heard in this battle.” PFQC plans to conduct follow-up calls to patients to determine if their issues were resolved. The number: 800-404-8702.  

Study: Walker use increases among baby boomers

CHICAGO – A study recently featured in the Journal of the American Medical Association found that baby boomers are twice as likely to use an assistive walking device than the generation before them. While medicine has improved substantially during the lifetimes of baby boomers and their life expectancy has risen, the study suggests that overall health is lower than the previous generation and this may, in part, explain the increased use of walking devices. Among baby boomers analyzed in the study, 6.9% used an assistive walking device, compared with 3.3% in the previous generation. Other noteworthy findings: 13.2% of baby boomers reported “excellent” health, compared to 32% of individuals in the previous generation; and 38.7% were obese, compared to 29.4% in the previous generation.

Analysis: Medicare Advantage enrollment soars

WASHINGTON – An analysis by the Kaiser Family Foundation found that Medicare Advantage enrollment increased nearly 10% in 2012 and by 30% since 2010, putting enrollment at a record high. The program grew from 5.3 million people in 2004 to a record 14.4 million in 2013, according to the analysis. From 2012 to 2013, Medicare Advantage enrolled an additional 1 million people.

Prodigy teams up with pharmacy

CHARLOTTE, N.C. – Prodigy Diabetes Care has formed a partnership with Rx ‘n Go, an alternative pharmacy network, to offer fixed price diabetes monitors and test strips, according to a press release. The initiative, which takes effect July 1, 2013, is designed to reduce medical costs on diabetes supplies for self-funded employers. Under the partnership, payers are incentivized to offer their diabetes members access to supplies at no cost. “With all the changes healthcare reform is bringing, we know it’s important to continue to meet the needs of existing customers while finding new ways to grow our business,” stated Rick Admani, Prodigy COO. “Our new relationship with Rx ‘n Go is designed to help us do that.”

NASL joins call to delay bidding program

WASHINGTON – The National Association for the Support of Long Term Care (NASL) stands behind lawmakers in the House of Representatives who want to delay implementation of Round 2 of competitive bidding, according to a press release. The association applauded the leadership of Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, who crafted a “Dear Colleague” letter to garner support for the delay, saying a myriad of concerns need to be addressed. “NASL continues to voice serious concerns about the process that CMS used in evaluating the ability of those with winning bids to deliver quality care,” stated Cynthia Morton, executive vice president.

Study: OSA increases risk of sudden cardiac death

WASHINGTON – A moderate case of obstructive sleep apnea (OSA) can significantly increase a person’s risk for sudden cardiac death (SCD), according to a large study published in the Journal of the American College of Cardiology. “The prevalence of OSA in Western populations is high and will likely only continue to grow given the obesity epidemic and direct relationship between obesity and sleep apnea,” stated Apoor Gami, MD, lead author of the study and a cardiologist at Midwest Heart Specialists–Advocate Medical Group. The study found that people with sleep apnea more often died suddenly from cardiac causes during the hours between 10 p.m. and 6 a.m., the least likely time for SCD among the general populace. Of the 10,071 subjects, who were followed for an average of 5.3 years, 142 patients experienced SCD, with the most common predictors being over 60 years old, having 20 apnea episodes an hour, and having a lowest oxygen saturation level of 78%, according to the study. 

NCART develops funding guide

BUFFALO – NCART has created a guide to better secure funding for people in need of standing complex rehab devices, according to a press release. The guide is designed to offer advice to clinicians, providers and consumers about evaluation, documentation requirements and costs. The NCART Standing Device Funding Guide includes information on specific types of devices, a glossary of terms, and contact information, the release noted.

Provider short takes

Medical Supply Liquidators, an online supplier of diabetic supplies, is celebrating its grand opening. Established by entrepreneur Scott Twaddle, the Internet store carries a range of diabetes supplies, including insulin syringes and lancets…Medical Specialties Distributors (MSD), an alternate-site infusion therapy provider, has acquired Medical Technologies Resources (MTR), a Columbus, Ohio-based provider of infusion pumps and a healthcare billing service…Beacon Health System plans to begin construction June 12 on its new general home care building, according to an article from the South Bend Tribune. The 36,500-square-foot facility will house a Medicare- and Medicaid-licensed home health agency, a pharmacy, a retail store with HME, and a personal-services agency.

Vendor short takes

The Inogen One G3 portable oxygen concentrator has been reviewed by a third-party testing service and named the top performer in several categories, according to a press release...Cleanis has announced that its Carebag Commode Liner was voted 2013 Best New Product for Caregiver and Family Member by Caregiver Magazine…The Law Offices of Todd M. Garber is investigating potential claims against Invacare concerning possible violations of federal securities laws related to the company’s problems with the Food and Drug Administration (FDA), according to a press release.

People news

Home Care Medical, based in New Berlin, Wis., promoted Coleen Zinda to director of sales. In the newly created position, Zinda will implement sales strategies, target new audiences and track the latest healthcare trends…Raleigh, N.C.-based Active Healthcare has hired Bobbie Brees as an account representative to support the company’s respiratory programs…Dan Smith, formerly the director of membership sales and marketing at AAHomecare, has joined Global Medical Equipment of America (GMEA) as vice president, business development…Handicare AS, headquarter in Moss, Norway, promoted Hans Sigvardsson to president. In the new position, Sigvardsson will be in charge of all aspects of the company’s day-to-day business in the U.S. 

WASHINGTON – Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, have introduced a bill to delay the implementation of Round 2 of competitive bidding, according to The VGM Group.

H.R. 2375, the “Transparency Accountability in Medicare Bidding Act of 2013,” would delay the implementation of Round 2, scheduled to go live July 1, until Dec. 31, 2013. It would also delay the Round 1 re-compete, set for Jan. 1, 2014, until six months after Round 2 starts.

During the delay, the bill calls for the secretary of Health and Human Services to contract three auction experts, a health economist and an econometrician to work as a team to independently review and assess all aspects of Round 1 and Round 2, including the program’s design, development, implementation, market fairness and sustainability.

The bill then calls for the experts to submit a report to the secretary and Congress. Items in the report would include, among others:

•    Appropriateness of HCPCS codes selected
•    Ability of beneficiaries to obtain these items and services
•    Analysis of current or future adverse affects on health outcomes
•    Identification of any material deterioration in the quality of items and services provided
•    Evaluation of the costs of any preventable or prolonged hospitalizations due to lack of timely access to items and services
•    Identification of the winning suppliers and the number of such suppliers that have not previously supplied the products bid

The report would also include recommendations for changes to the program.

The bill comes one day after Thompson and Braley held a press conference and sent a letter to CMS asking the agency for a delay. The letter was signed by 227 lawmakers, a majority in the House of Representatives.

WASHINGTON – Round 2 of competitive bidding may be the law of the land in 91 cities, but that’s not stopping lawmakers who oppose the program from pressuring CMS.

On June 27, Sens. Lamar Alexander, R-Tenn., and Bob Corker, R-Tenn., introduced S. 1265, a bill that would delay the implementation of Round 2 in Tennessee. The bill would also terminate contracts in all bid areas in the state, require CMS to re-bid those areas and impose a $10,000 penalty on contract suppliers that, going forward, provide incorrect information or are not licensed.

Alexander and Corker introduced S. 1265 after CMS disqualified 30 contract suppliers for Tennessee because they didn’t meet state licensure requirements.

There are two other competitive bidding-related bills in Congress right now: H.R. 1717, a bill to replace the program with a market-pricing program (134 co-sponsors); and H.R. 2375, a bill to delay Round 2 until Dec. 31, 2013 (27 co-sponsors).

Also late last week, lawmakers delivered another round of letters to CMS Administrator Marilyn Tavenner outlining their concerns with the program—everything from the unresolved licensure issues in Maryland to lack of transparency surrounding financial standards.

Lawmakers who put pen to paper include Sens. Robert Casey, D-Pa.; Benjamin Cardin, D-Md.; Barbara Mikulski, D-Md.; Mike Crapo, R-Idaho; Pat Roberts, R-Kan.; John Thune, R-S.D.; Michael B. Enzi, R-Wyo.; John Cornyn, R-Texas; Richard Burr, R-N.C.; Roy Blunt, R-Mo.; Johnny Isakson, R-Ga.; Rob Portman, R-Ohio; and Lamar Alexander, R-Tenn.

Rep. Glenn Thompson, R-Pa., who introduced H.R. 2375, says he hopes having more senators engaged in the issue will create new pressure for the administration to “do the right thing” and delay the program.

“The administrator has the full authority to do so without congressional action,” he said in a statement to HME News. “Ignoring systemic flaws will only exacerbate the problems, as the program’s scope is about to be increased tenfold.”

WASHINGTON – Round 2 of competitive bidding may be the law of the land in 91 cities, but that’s not stopping lawmakers who oppose the program from pressuring CMS.

On June 27, Sens. Lamar Alexander, R-Tenn., and Bob Corker, R-Tenn., introduced S. 1265, a bill that would delay the implementation of Round 2 in Tennessee. The bill would also terminate contracts in all bid areas in the state, require CMS to re-bid those areas and impose a $10,000 penalty on contract suppliers that, going forward, provide incorrect information or are not licensed.

“We appreciate the senators’ work, but we would like to see that expanded to all Round 2 areas,” said Jay Witter, vice president of government affairs for AAHomecare.

Alexander and Corker introduced S. 1265 after CMS disqualified 30 contract suppliers for Tennessee because they didn’t meet state licensure requirements.

There are two other competitive bidding-related bills in Congress right now: H.R. 1717, a bill to replace the program with a market-pricing program (134 co-sponsors); and H.R. 2375, a bill to delay Round 2 until Dec. 31, 2013 (27 co-sponsors).

“It’s full steam ahead on our legislative strategy,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “I expect now we will start hearing complaints from beneficiaries and that will help our cause on Capitol Hill.”

Also late last week, lawmakers delivered another round of letters to CMS Administrator Marilyn Tavenner outlining their concerns with the program—everything from the unresolved licensure issues in Maryland to lack of transparency surrounding financial standards.

Lawmakers who put pen to paper include Sens. Robert Casey, D-Pa.; Benjamin Cardin, D-Md.; Barbara Mikulski, D-Md.; Mike Crapo, R-Idaho; Pat Roberts, R-Kan.; John Thune, R-S.D.; Michael B. Enzi, R-Wyo.; John Cornyn, R-Texas; Richard Burr, R-N.C.; Roy Blunt, R-Mo.; Johnny Isakson, R-Ga.; Rob Portman, R-Ohio; and Lamar Alexander, R-Tenn.

Rep. Glenn Thompson, R-Pa., who introduced H.R. 2375, says he hopes having more senators engaged in the issue will create new pressure for the administration to “do the right thing” and delay the program.

“The administrator has the full authority to do so without congressional action,” he said in a statement to HME News. “Ignoring systemic flaws will only exacerbate the problems, as the program’s scope is about to be increased tenfold.”

WASHINGTON – Bad data is preventing CMS from collecting “currently not collectible” overpayments, according to a report from the Office of Inspector General (OIG). CMS reported $543 million in new “currently not collectible” overpayments across all contractors for fiscal year 2010, but it provided detailed information on $69 million “currently not collectible” overpayments for only seven contractors. Citing contractor transitions, the agency did not provide detailed data for the remaining 32 contractors. For 54% of the overpayments associated with the seven contractors, the provider type was missing in the Healthcare Integrated General Ledger Accounting System. The OIG recommends that CMS, among other things, ensure that the Healthcare Integrated General Ledger Accounting System variable for provider type is populated for all overpayments.

Harrison wants legal fees covered

NEW BRAUNFELS, Texas – Doug Harrison, the former CEO of The Scooter Store, along with a committee that oversees an employee stock ownership plan, has asked a Delaware bankruptcy court to make sure that the company or its insurers cover their attorneys fees in a class action, according to Law360. Harrison and the committee argue that The Scooter Store agreed in the company’s governing documents to indemnify them against losses or expenses related to legal proceedings. The lawsuit accuses Harrison and the committee of breaching their fiduciary duties by failing to disclose information about The Scooter Store’s financial prospects.

Proposed rule seeks to clarify grandfathering, routinely purchased policies

BALTIMORE – CMS clarifies a grandfathering provision related to the three-year minimum lifetime requirement and the definition for routinely purchased DME in a proposed rule issued July 1. For more information, go to this link and click on “End-Stage Renal Disease Prospective Payment System, Quality Incentive Program and DMEPOS”: http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1.

Numotion acquires ATS

ROCKY HILL, Conn. – Numotion has acquired Boise, Idaho-based ATS Wheelchair and Medical. ATS, founded in 1988, is a leading provider of rehabilitation products and medical supplies to clients throughout the state, according to a press release. "The purchase of ATS helps strengthen our services throughout Idaho," stated Tim Hadley, executive vice president, in the release. "ATS and its experienced staff will be a great fit with Numotion, and we look forward to serving and supporting their customers for many years to come."

ASP: Budesonide swings upward

BRIDGEVILLE, Pa. – Reversing its downward trend last quarter, pricing for respiratory medication budesonide (J7626) increased nearly 34 cents, to $5.09 per dose in average sales price figures for the third quarter 2013 released in June. The only other respiratory med to see any real increase was the brand-name drug Perforomist, which was up 12 cents to $5.91 per dose. Other pricing stayed relatively flat: albuterol (J7613) increased half a cent to 13.5 cents per dose; ipratropium (J7644) decreased nearly half a cent to 11.6 cents per dose; and Brovana (J7605) decreased nearly 3 cents to $5.34 per dose.

Patientco partners with provider

ATLANTA – Patientco has entered into a partnership with Medical Services of America (MSA), with a goal of increasing the provider’s patient payments, according to a press release. Patientco’s cloud-based technology will enable MSA to consolidate patient payment methods and payment data. Patientco’s platform works seamlessly with MSA’s Brightree system. Patientco’s platform was originally created for hospitals and physicians groups.

MK Battery sponsors power soccer

ANAHEIM, Calif. – MK Battery will be the title sponsor and official battery of the U.S. Power Soccer Association and the Team USA National Power Soccer Team, the company announced June 27. The multi-year agreement includes all of the U.S. Power Soccer Conference Cup tournaments and Team USA international competitions, including the World Cup 2015. Team USA is the current World Cup champion. “The sport of power soccer enhances the lives of those with disabilities and we are extremely proud to be taking such an active role in the program,” stated Mark Wels, president of MK Battery, in a release. “It is a perfect sponsorship match for our company.” The company plans to bring exposure to the sport through its contacts in the HME industry, according to the release.  

CareTouch creates seamless sharing

WESTMINSTER, Colo. – CareTouch Communications has added a feature to its CareTouch360 Platform that enables patients and home medical equipment providers to share and store patient data and documentation, according to a press release. The patient can scan or upload documentation into their record, eliminating miscommunication and ensuring everything is up-to-date. “When a patient is able to easily upload a prescription, therapy instructions or other information for their provider to see, nothing gets lost in translation,” stated Matthew Dolph, COO of CareTouch, in the release.

Convaid rebrands seating system

TORRANCE, Calif. – The self-tensioning system that Convaid includes on its compact, folding, lightweight wheelchairs has a new name: Self-Tensio, the company announced in a July 1 press release. The system provides therapeutic pelvic position similar to a solid seating system in an umbrella folding rehab chair. It offers a stable pelvic platform by distributing pressure throughout the contact area, improving support and positioning, according to the release. 

Harmar beefs up staff

SARASOTA, Fla. – Harmar has hired several employees to improve operations, engineering and quality assurance, according to a press release. Mark Welcer has been tapped as COO in charge of internal operations, covering production, quality and engineering systems. He also serves as chief compliance officer. Les Smith has been hired as engineering director; he is responsible for all facets of product development. Additionally, David Sapuppo has joined Harmar as quality assurance director. Sapuppo and Smith will report to Welcer.

WASHINGTON – Lawmakers in the House of Representatives and the Senate are asking for “solid data” on the negative impact of competitive bidding on Medicare beneficiaries, according to AAHomecare.

As a result, the association is asking providers to collect the following pieces of data:

•    Number of calls from beneficiaries regarding Round 2

•    Number of callers who have already contracted CMS, and whether CMS addressed the situation

•    Number of callers having problems getting equipment through CMS’s list of contracted providers

•    Number of callers offering to pay out-of-pocket

•    Number of callers who need equipment repaired, including power mobility devices

“We will aggregate the data, remove anything that could identify a specific company and give it to Hill staffers to counter CMS’s outrageous claims that the bidding program is working smoothly and that there are no negative impacts on beneficiaries,” AAHomecare stated.

The association asks that members send data on a weekly basis to Peter Rankin at peterr@aahomecare.org.

Additionally, AAHomecare is asking providers to encourage beneficiaries to make three calls to CMS (1-800-Medicare); People for Quality Care (1-800-404-8702); and their members of Congress (1-202-224-3121).

BALTIMORE – CMS has implemented a 120-day grace period for obtaining documentation for CPAP devices and supplies in areas included in Round 2 of competitive bidding, officials announced during an Open Door Forum July 9.

The move is in response to contract suppliers notifying CMS of their difficulty obtaining the required medical necessity documentation, which includes the doctor’s order for a sleep study and a copy of the study.

“Today, I would like to announce a transitional policy to facilitate and assist this process,” said Tangita Daramola, competitive acquisition ombudsman. “This has been a collaboration with CMS and suppliers.”

Round 2 of competitive bidding, which went into effect July 1, has forced a plethora of Medicare beneficiaries to switch from non-contract to contract suppliers, sending those contract suppliers on a wild goose chase to collect documentation to continue service.

During the Q&A portion of the forum, Kim Brummett, senior director of regulatory affairs for AAHomecare, asked Dr. Robert Hoover, the medical director for the Jurisdiction C DME MAC, who participated in the form: What about documentation that doesn’t meet the criteria?

“The grace period is a period to obtain the documentation,” Hoover said. “Whatever documentation you would need after Nov. 1, we would begin enforcing for audits.”

Brummett followed up: “So if I service a patient in August, get all the documentation in September and realize the study is not certified by a board certified doctor, I’m still exposed?”

Hoover responded: “That would be correct.”

A similar grace period was in effect during Round 1 of competitive bidding, Hoover said.

“We’ll be working on developing additional educational articles with more details,” he said.

ALEXANDRIA, Va. – With Round 2 of competitive bidding now underway, industry stakeholders plan to crank up the pressure on lawmakers with a virtual fly-in July 18.

AAHomecare is coordinating efforts with The VGM Group, The MED Group and state associations across the country to get providers and their patients to phone, fax or call lawmakers to report problems they’ve encountered since the program kicked off July 1. 

Less than two weeks into the program, stakeholders are hearing reports of equipment delays and shortages, and contract suppliers that are refusing to provide services in bid areas. But, according to AAHomecare, CMS is reporting only a few dozen complaints.

AAHomecare also urges providers to ask their members of Congress to support H.R. 2375, a bill to delay the bid program, and H.R. 1717, a bill to replace it with a market-pricing program. The latter, introduced April 24, currently has 137 co-sponsors.

Providers are also asked to forward any feedback they get from lawmakers to Jay Witter at AAHomecare, jayw@aahomecare.org.

For more information: http://action.aahomecare.org/

YARMOUTH, Maine – It doesn’t matter if you’re a contract supplier or a non-contract supplier: In the first few days of Round 2 of competitive bidding, you’re spending the bulk of your time educating shell-shocked Medicare beneficiaries, according to a recent HME NewsPoll.

“Many beneficiaries can’t deal with complex issues and have little family support,” said Janet Tersoff, the billing manager for New Hampshire Pharmacy & Medical Equipment in Washington, D.C. “They are finding these changes very difficult to understand and manage.”

Of the 114 respondents to the NewsPoll, 70 submitted comments detailing their experiences in the first few days of Round 2, which kicked off in 91 cities on July 1. Words often used to describe the program: mess, chaos, ridiculous, frustrated, stupid and disaster.

Respondents reported beneficiaries who are upset they have to switch suppliers; who are waiting days or weeks to receive necessary equipment, sometimes delaying their discharge from hospitals; who are being asked to switch brands of diabetes supplies; who can’t find a contract supplier willing to take them; and who are giving up and paying cash to save themselves the trouble.

“Patients in my area are seeing access problems,” said Jerry Hall, owner of Hall-Moore Medical Supplies in Jacksonville, Fla. “They are being told it will be days to weeks before they receive much needed equipment. Some are choosing to private pay, even though they qualify through Medicare.”

None of this is making the jobs of referral sources—who, in many cases, have enjoyed working with the same provider for decades—any easier, respondents say.

“It has been hard letting referral sources know that after 35-plus years that we can no longer provide their patients with equipment through Medicare since we were not awarded a contract,” said Stephen Stanley, assistant manager at Suncoast Medical Supply in St. Petersburg, Fla.

And it’s not just the relationships between providers and their beneficiaries/referral sources that are strained under Round 2. Contract suppliers and sub-contractors are trying to iron out multiple wrinkles, respondents say.

“We are a subcontractor and our contract supplier wants a credit card or copy of patient personal check to bill if not paid,” said Brad Lipham, CEO of Durable Medical Equipment, Inc. in Carrollton, Ga. “The credit card or check is not encrypted so our patients will not honor the request.”

For some contract suppliers, all of this extra work isn’t even paying off, respondents say.

“We won a contract but you’d never know it,” said Dave Anderson, owner of Anderson’s Medical Products in Bloomington and Terre Haute, Ind. “We have two locations and each of our locations serves a nearby contract county we do some business in. But neither location has had any calls to provide the contracted services. So far, it is as if nothing happened.”

The results

If you’re a non-contract supplier in a Round 2 area, what has been your experience in the first few days of the program?

39%: Spending a lot of time educating beneficiaries and referral sources

27%: Hearing of delays in service

25%: Having trouble finding contract suppliers to take our patients

10%: Business as usual

If you’re a contract supplier in a Round 2 area, what has been your experience in the first few days of the program?

50%: Spending a lot of time educating beneficiaries and referral sources

25%: Business as usual

18.8%: Making a lot of calls to referral sources to get their business

6.2%: Handling an increased volume of business

CHARLESTON, S.C. – It’s a scenario that’s likely playing out in competitive bidding areas (CBAs) across the country: Medicare beneficiaries that can’t get the equipment they need.

Richard Drake, a retired businessman who suffers from hereditary neuropathy in both legs, which has left him unable to walk or stand, is one of those beneficiaries. Just prior to the July 1 start date of the program, he learned he qualified for a power wheelchair. 

The problem: There isn’t a local provider contracted to do Group 2 power wheelchairs, said Sarah Gassman Schultz, an occupational therapist and director of Charleston Home Health Agency, who has been working to help Drake get a power wheelchair.

“The next closest is in Savannah, Ga.,” Schultz said during a July 11 press teleconference hosted by People for Quality Care (PFQC). “I asked CMS what they were going to do, but they really didn’t have any answers for me, so here we sit. We are scrambling now to find an out-of-state (supplier) for a piece of equipment he desperately needs.”

PFQC, the advocacy division of The VGM Group, hosted the teleconference to highlight concerns in South Carolina, which has several CBAs in Round 2. Mainstream media participating in the conference included the Charleston Post and Courier.

Because Savannah is about 150 miles from Charleston, Drake would have to travel by special ambulance—at a cost of more than $350—and then would have no local provider to service the equipment after he gets it.

“As a clinician, I have grave concerns about not being able to work with a local provider on a chair like this,” Schultz said. “It’s going to require maintenance, batteries, adjustments. Our hands are tied; we do not have any options.”

The problems in South Carolina are the problems providers and beneficiaries are experiencing everywhere, says Kelly Turner, director of PFQC.

“The prices are artificially low—this means the quality of equipment and services to seniors and people with disabilities is dramatically lower than the past,” she said. “Also, winning providers were awarded contracts despite the fact that they are located far away from the beneficiary, in some cases over 1,000 miles away.”

Meanwhile, Drake is left using a manual wheelchair.

“I can’t operate the chair myself,” he said. “I have a condition that causes me to rely on others to get me out of bed and move from room to room.” 

BALTIMORE – CMS has implemented a 120-day grace period for obtaining documentation for CPAP devices and supplies in areas included in Round 2 of competitive bidding, officials announced during an Open Door Forum July 9.

The move is in response to contract suppliers notifying CMS of their difficulty obtaining the required medical necessity documentation, which includes the doctor’s order for a sleep study and a copy of the study.

“Today, I would like to announce a transitional policy to facilitate and assist this process,” said Tangita Daramola, competitive acquisition ombudsman. “This has been a collaboration with CMS and suppliers.”

Round 2 of competitive bidding, which went into effect July 1, has forced a plethora of Medicare beneficiaries to switch from non-contract to contract suppliers, sending those contract suppliers on a wild goose chase to collect documentation to continue service.

During the Q&A portion of the forum, Kim Brummett, senior director of regulatory affairs for AAHomecare, asked Dr. Robert Hoover, the medical director for the Jurisdiction C DME MAC, who participated in the form: What about documentation that doesn’t meet the criteria?

“The grace period is a period to obtain the documentation,” Hoover said. “Whatever documentation you would need after Nov. 1, we would begin enforcing for audits.”

Brummett followed up: “So if I service a patient in August, get all the documentation in September and realize the study is not certified by a board certified doctor, I’m still exposed?”

Hoover responded: “That would be correct.”

A similar grace period was in effect during Round 1 of competitive bidding, Hoover said.

“We’ll be working on developing additional educational articles with more details,” he said.

ALEXANDRIA, Va. – With Round 2 of competitive bidding now underway, industry stakeholders plan to crank up the pressure on lawmakers with a virtual fly-in July 18. AAHomecare is coordinating efforts with The VGM Group, The MED Group and state associations across the country to get providers and their patients to phone, fax or call lawmakers to report problems they’ve encountered since the program kicked off July 1. Only a few weeks into the program, stakeholders are hearing reports of equipment delays and shortages, and contract suppliers that are refusing to provide services in bid areas. But, according to AAHomecare, CMS is reporting only a few dozen complaints. AAHomecare also urges providers to ask their members of Congress to support H.R. 2375, a bill to delay the bid program, and H.R. 1717, a bill to replace it with a market-pricing program. The latter, introduced April 24, currently has 137 co-sponsors. Providers are also asked to forward any feedback they get from lawmakers to Jay Witter at AAHomecare, jayw@aahomecare.org. For more information: http://action.aahomecare.org/

Lawmakers seek data on bid problems

WASHINGTON – Lawmakers in the House of Representatives and the Senate are asking for “solid data” on the negative impact of competitive bidding on Medicare beneficiaries, according to AAHomecare. As a result, the association is asking providers to collect the following pieces of data:

Number of calls from beneficiaries regarding Round 2

Number of callers who have already contracted CMS, and whether CMS addressed the situation

Number of callers having problems getting equipment through CMS’s list of contracted providers

Number of callers offering to pay out-of-pocket

Number of callers who need equipment repaired, including power mobility devices

“We will aggregate the data, remove anything that could identify a specific company and give it to Hill staffers to counter CMS’s outrageous claims that the bidding program is working smoothly and that there are no negative impacts on beneficiaries,” AAHomecare stated. The association asks that members send data on a weekly basis to Peter Rankin at peterr@aahomecare.org. Additionally, AAHomecare is asking providers to encourage beneficiaries to make three calls to CMS (1-800-Medicare); People for Quality Care (1-800-404-8702); and their members of Congress (1-202-224-3121). 

Sanomedics to buy sleep provider for $7M

MIAMI – Sanomedics International Holdings has entered into a definitive agreement to acquire its second sleep services business, Baytown, Texas-based Duke Medical, for $7 million. Duke Medical generated about $4 million in revenue and an EBITDA of $1.5 million in 2012, and is on target to hit an EBITDA of $2 million this year. Duke Medical provides medical products and supplies to patients with sleep apnea throughout Houston and Galveston. Vann Duke, who has held positions at Rotech Healthcare, Apria Healthcare and Lincare, leads the company. “This acquisition will take Sanomedics into new geographic markets and expand our efforts to build out a national platform of our sleep apnea service and product offerings,” stated Keith Houlihan, co-founder and president of Sanomedics, in a press release. The purchase price includes cash, the issuance of common shares of Sanomedics and debt consideration. The deal is expected to close by Sept. 30, 2013. In 2012, Sanomedics signed letters of intent to buy two unnamed sleep services businesses on the East and West coasts. Earlier this year, it also acquired Prime Time Medical, a Largo, Fla.-based HME provider, for $3 million. 

First Choice distributes for ActivStyle

JACKSON, Miss. – First Choice Medical has signed a distribution agreement with ActivStyle, a national in-home provider of incontinence and other medical supplies. Per the agreement, First Choice will take over a “strategic portion” of ActivStyle’s direct-to-home deliveries of supplies, according to a press release. “Considering their logistics experience, distribution center footprint and technology infrastructure, First Choice is well positioned to serve ActivStyle’s clients exceptionally well and assist us with our rapid growth and service mission,” stated Todd Cianfrocca, CEO of ActivStyle.

CPAP therapy reduces nightmares in vets with PTSD, OSA

DARIEN, Ill. – CPAP therapy may reduce nightmares in veterans with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA), according to a study abstract published recently in an online supplement of the journal SLEEP. Results of the study show the mean number of nightmares per week fell significantly with CPAP use, and reduced nightmare frequency after starting CPAP was best predicted by CPAP compliance. The study involved a retrospective review of medical records to identify OSA patients who also carried a PTSD diagnosis and were treated in a VA medical center sleep clinic between May 2011 and May 2012. Mean number of nightmares per week before treatment and up to six months after CPAP prescription were extracted. “One out of six veterans suffers from PTSD, which affects their personal, social and productive life,” stated Sadeka Tamanna, medical director of the Sleep Disorders Laboratory at G.V. Medical Center, in a press release from the American Academy of Sleep Medicine. “Nightmares are one of the major symptoms that affect their daily life, and prevalence of OSA is also high among PTSD patients and can trigger their nightmares.”

JustHomeMedical.com adds product videos

FULTON, Md. – JustHomeMedical.com has added 13 product videos to its website as part of a revamp designed to provide customers with a more streamlined and satisfying shopping experience. The product videos allow customers to determine the qualities and features of products like adjustable bed rails and gel/foam overlays before purchasing, the company stated in a press release. Several videos feature Co-founder Bryan Mercer, a licensed pharmacist, showing off his “Pharmacist’s Picks.”

Home Medical Equipment expands retail presence

DEPEW, N.Y. – Home Medical Equipment of WNY has opened the first of three planned new locations, according to Buffalo Business First. The 4,200-square-foot retail store in Depew is the company’s second in the city. The store offers a variety of DME for cash, including lift chairs, scooters, walkers, wheelchairs, compression stockings and CPAP devices. The company is also looking to open stores in Dunkirk and Rochester. Michael McCartney and Joseph DiDomenico also own Respiratory Services of WNY, which focuses on Medicare and other insurers.   

Itamar, Somnoware form strategic alliance

CHARLOTTE, N.C. – Itamar Medical and Somnoware Healthcare Systems have agreed to align their technology, marketing and business efforts to drive new growth opportunities. Through a strategic alliance, the companies will combine their hardware and software, enabling customers to transform delivery of care, reduce cost and improve productivity, according to a press release. “Integrating Itamar’s home sleep testing device, WatchPAT, with Somnoware’s proprietary cloud-based platform will accelerate the adoption of an integrated care delivery platform—an industry concept that uses workflow automation software and a care coordination platform to break down today’s device- and provider-centric silos of data-gathering and communication,” the release states.

OIG to NY: Establish bid program for diabetes test strips

WASHINGTON – The New York State Department of Health could have saved about $5.9 million by establishing a competitive bidding program for diabetes test strips like Medicare, according to a report from the Office of Inspector General (OIG). The department saved about 51% on strips by obtaining manufacturer rebates, but Medicare reimbursement for strips under Round 1 of competitive bidding were still lower than the average Medicaid reimbursement after the rebates, the report states. For example, the highest Medicare reimbursement for a 50-unit package of strips in Round 1 areas in calendar year 2011 was $15.62, whereas the department’s net average Medicaid reimbursement for a 50-unit package of strips provided from Oct. 1, 2009, through Sept. 30, 2010, was $24.54. The department generally concurred with the OIG’s recommendation. FMI: http://go.usa.gov/jrWj.

DME provider sentenced to prison

MCALLEN, Texas – The owner of a now defunct DME business has been ordered to prison for his role in a scheme to defraud Medicare and Medicaid through fraudulent billing, according to a press release from the U.S. Attorney’s Office for the southern district of Texas. The scheme involved about $11.1 million in false claims to the agencies. Marcello Herrera, the former owner of RGV DME in McAllen, Texas, pleaded guilty in February and has now been ordered to go to prison for 120 months, be under supervision for three years following his release and pay $6.1 million in restitution. Herrera and his accomplices admitted that they used marketers to obtain Medicare and Medicaid ID numbers and other information from beneficiaries, which they, in turn, used to fraudulently bill for DME that was either never prescribed or prescribed but never delivered. They also acknowledged that they attempted to obtain referrals of patients or orders for DME from doctors in exchange for gifts.

BALTIMORE – CMS has initiated recoveries from providers for medical items and services provided to Medicare beneficiaries who were incarcerated on the date of service.

CMS has identified previously paid claims that contain dates of service that partially or fully overlap a period when the beneficiary was incarcerated based on information from the Social Security Administration (SSA). The agency generally does not pay for medical items and services furnished to a beneficiary who was incarcerated when the items and services were furnished.

“A large number of overpayments have been identified and demand letters released with appeals instructions,” the agency states in a bulletin.

CMS asks, however, that providers not file appeal requests at this time. Providers receiving demand letters for denial of claims because the beneficiary’s SSA record indicates incarceration on the date of service and who have reason to believe that the beneficiary was not incarcerated on the DOS, may wish to contact the beneficiary to gather as much information as possible.

Information gathered indicated SSA record may need to be updated

If a beneficiary did not inform the SSA of his or her release from custody, this may result in his or her record being incorrect. If a provider believes this is the case, the provider may wish to encourage the beneficiary to contact his or her local SSA office to have his or her records updated. It can take up to one month for the beneficiary’s Medicare eligibility file to be updated with the revised SSA information. If the beneficiary tells the provider that SSA is updating his or her records, we suggest the provider contact the Medicare Administrative Contractor using the contact information on the overpayment demand letter.

Information gathered indicates SSA record is current

If the provider believes that the beneficiary was not incarcerated on the date of service in question and the beneficiary advises that SSA’s records are currently accurate, the provider can contact their local CMS Regional Office by fax found at http://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Ce....

CMS notes that there may be instances where providers believe that the beneficiary was not incarcerated when the service was provided. However, a beneficiary may be "incarcerated" even when the individual is not confined within a penal facility. For example, a beneficiary who is on a supervised release, on medical furlough, residing in a halfway house or other similar situation may, nevertheless, be in the custody of authorities under a penal statute. In such cases, Medicare payment may be barred.

BALTIMORE – Non-contract suppliers in Round 2 competitive bidding areas can provide service to Medicare beneficiaries if the patient agrees to pay cash and signs an advanced beneficiary notice (ABN), AAHomecare advised in a bulletin this week.

The ABN must clearly state that Medicare will not pay for specified items because the beneficiary has chosen to obtain them from a non-contracted provider.

The beneficiary then must choose whether to file the claim with Medicare or waive their Medicare rights. Such claims will be dinged with a patient responsibility code, which allows a non-contract supplier to collect from the beneficiary, the association says.

AAHomecare has confirmed this guidance with the CBIC, which expects to update its website soon.

Providers have reported to the association that beneficiaries in Round 2 areas are choosing to pay cash for needed items, either because they can’t find a contract supplier or they would rather stay with their current supplier.

Round 2 kicked off July 1 in 91 CBAs.

SAN DIEGO – ResMed announced July 18 that an investigation by the U.S. government has resulted in a recommendation that the International Trade Commission (ITC) stop Taiwanese manufacturer APEX Medical from importing and selling infringing products. In a March filing, ResMed argued patent infringement by two APEX masks (WiZARD 210 and WiZARD 220) and two APEX flow generators (iCH and XT Fit). The ITC case against APEX also named Medical Depot, doing business as Drive Medical. The ITC previously entered a consent decree against Drive, ordering it to stop importing and selling the Freedom 210 and Freedom 220 masks made by Apex, which are identical to the WiZARD masks. “We appreciate but are not surprised by the swift conclusion of this case against both APEX and Drive,” stated David Pendarvis, global general counsel and chief administrative officer for ResMed. “We will continue to defend our patents and innovations against any future threats.” ResMed has also filed a lawsuit against 3B Medical/BMC Medical for alleged patent infringement. ResMed claims 3B Medical infringed on three patents involving the elbow swivel of a nasal pillow mask and the water flow-back valve of a humidifier.

AAHomecare raises funds to fight bid program

WASHINGTON – AAHomecare expects to spend in excess of $180,000 on a legal challenge to stop competitive bidding—and the association needs help footing the bill, it says. AAHomecare is asking for contributions to a “STOP Competitive Bidding Fund” to help cover its legal costs, according to a July 15 letter. “Your kind support and payment to the fund will allow us to meet our current expenses and be better prepared for the next challenge,” the letter states. MK Battery has announced it will contribute to the effort, the letter states. Every company or group that makes a contribution of $200 or more will appear, if they choose to, on a list of donors on AAHomecare’s web site. “We are reaching out to every company and organization in the industry to spread this large burden across the entire homecare community,” the letter states.

Scooter Store downsizes headquarters

NEW BRAUNFELS, Texas – A U.S. Bankruptcy Court judge has allowed The Scooter Store to reject the leases on its headquarters and an adjacent building in New Braunfels, according to the San Antonio Express News. The Scooter Store employed more than 1,200 people at the headquarters before an FBI raid in February and a mass-layoff in March. About 200 employees will relocate to a 30,000-square-foot location, also in New Braunfels. The Scooter Store plans to auction off all of its assets in an Aug. 6 bankruptcy auction.

Cash + ABN can keep non-contract suppliers in the game

BALTIMORE – Non-contract suppliers in Round 2 competitive bidding areas can provide service to Medicare beneficiaries if the patient agrees to pay cash and signs an advanced beneficiary notice (ABN), AAHomecare advised in a bulletin this week. The ABN must clearly state that Medicare will not pay for specified items because the beneficiary has chosen to obtain them from a non-contracted provider. The beneficiary then must choose whether to file the claim with Medicare or waive their Medicare rights. Such claims will be dinged with a patient responsibility code, which allows a non-contract supplier to collect from the beneficiary, the association says. AAHomecare has confirmed this guidance with the CBIC, which expects to update its website soon. Providers have reported to the association that beneficiaries in Round 2 areas are choosing to pay cash for needed items, either because they can’t find a contract supplier or they would rather stay with their current supplier.

New 101 Mobility location to offer pool lifts, rentals

WEST PALM BEACH, Fla. – 101 Mobility has a new franchise to serve customers from Boca Raton to North Lauderdale, Fla., and all surrounding areas. Owners Melanie Sweet and Bill Bovett will focus on helping clients age-in-place by selling, installing and servicing stair lifts, ramps, patient lifts, pool lifts, vertical lifts and automobile lifts. They will also offer rentals. 101 Mobility has signed up more than 30 franchisees since September of 2010. 

VGM to providers: Speak4DME

WATERLOO, Iowa – The VGM Group has launched Speak4dme.com to provide independent DME and complex rehab providers a platform to share their stories about the negative impact that audits are having on their ability to do business and properly care for patients. The site is designed to help providers fight for greater transparency and oversight of CMS’s independent audit contractors.

Aeroflow enters negative pressure wound therapy market

ASHEVILLE, N.C. – Aeroflow has added negative pressure wound therapy (NPWT) to its list of offered products and services, the company announced July 12. Aeroflow, which already provides home respiratory and mobility equipment, will work with home health agencies and hospitals to provide NPWT, according to a press release. Aeroflow won 456 contracts as part of Round 2 of competitive bidding, which kicked off in 91 cities on July 1. The company did not say how many contracts it won for NPWT.

Butler Mobility lifts new townhouses

PHILADELPHIA – Butler Mobility has teamed up with Total Access and the Philadelphia Housing Authority to add an inclined platform wheelchair lift to seven new, handicapped-accessible townhouses in the city. Butler Mobility designed the lifts to fit the stairs in each of the townhouses, and Total Access installed them. Lewisberry, Pa.-based Butler Mobility builds its products in the United States, meeting a funding requirement for the townhouses. “By meeting the project deadlines and delivering a quality, American-made product, Butler Mobility was able to help wheelchair-bound residents live independently and access the freedom they need to move floor to floor,” according to a press release.

CPAP Horizon Project turns to crowd funding

SUPERIOR, Colo. – CPAP Horizon Project seeks to raise $30,000 or more in phase one funding through the crowd funding website Indiegogo with a goal of improving the effectiveness of CPAP therapy in the United States. The money will help fund a national sleep apnea awareness and screening campaign; a free web and mobile application for CPAP users called ManageMyCPAP; the development of a health information exchange to facilitate technology integration and data sharing; and the legal formation of CPAP Horizon Project as a 501c3 non-profit organization, according to a press release. CPAP Horizon Project is an alliance of CPAP therapy stakeholders that exists to bring about positive change in the lives of millions of sleep apnea sufferers.

Home Care Medical expands program

NEW BERLIN, Wis. – Home Care Medical has expanded its best+fit PAP Therapy Program to its Sheboygan and West Bend, Wis., stores, according to a press release. The program entails collaborating and acting as a liaison for pulmonologists, local sleep specialists, primary care physicians and other area referrals for sleep apnea patients; assisting with patient verification; scheduling PAP set-up and instruction; and following up and managing compliance monitoring. Leading the expansion: respiratory specialist Debbie Sprengel, RPSGT, the company’s new registered polysomnographer. HME News first wrote about the program last year.

Somnetics picks up rights to pillow

MINNEAPOLIS – Somnetics International, the maker of the Transcend Sleep Apnea Therapy System and accessories, has snagged the exclusive rights to sell and distribute the SleepAngel Pillow in the United States. The pillow features PneumaPure Filter Technology, proven to block germs, mold, dust and allergens that can contribute to asthma, allergy sinus and respiratory conditions. “The SleepAngel Pillow complements the growing line of devices that Somnetics offers to help people breathe and sleep better and reduces the impact of allergens and germs in getting a good night sleep,” stated Clarence Johnson, CEO and president of Somnetics International in a press release. The pillow is manufactured by Ireland-based Gabriel Scientific, a research and development company dedicated to the design and manufacture of science-based products that improve the quality of sleep.

Therafirm expands capacity with new facility

KANSAS CITY, Kan. – Therafirm, a Knit-Rite company, has moved its North Carolina operations from Ellerbe to Hamlet. More than 250 people attended a grand opening ceremony recently to take tours of the newly renovated, state-of-the-art facility. Therafirm, which Knit-Rite acquired in 2000, designs, markets and manufactures compression hosiery and other textiles for the medical and consumer markets. The facility allows the company to expand capabilities and capacity, according to a press release.“We are proud of our 90 years in the medical textile business and our continued commitment to producing American made textiles, along with being grateful for the opportunities we have to contribute to innovative solutions for our customers and good jobs for our people and the U.S. economy,” stated Mark Smith, president and CEO. “We are excited to locate our plant here and look forward to growing in Hamlet in the years to come.”

Quantum, Pride make ‘strategic organizational moves’

EXETER, Pa. – Quantum Rehab and Pride Mobility Products have announced a new framework for their sales divisions, according to a press release. Quantum will now have a more clinical focus, emphasizing field leadership working directly with patients, therapists and providers. Pride Mobility will now have a more retail focus to help providers remain economically viable. “Due to the ongoing changes within the custom rehab technology and DME industry, Quantum Rehab and Pride Mobility continue to make strategic organizational moves to ensure providers and facilities receive the highest level of products and services,” stated Andrew Pyrih, senior vice president of domestic sales.

CareActive to roll out new line

RICHMOND HILL, N.Y. – CareActive, a division of CareApparel, will roll out a new line of HME products in the fall of 2013, including reusable incontinence products, therapeutic footwear, bibs, wheelchair accessories and bed pads. CareApparel specializes in special needs clothing, including “Easy On…Easy Off” adaptive clothing. CareActive will debut its new products at two industry trade shows: The National Association of Chain Drug Stores, Aug. 11-13, in Las Vegas; and Medtrade, Oct. 8-10 in Orlando, Fla. Additionally, CareActive has named Brad Slavin brand manager/director of sales.

People news

ArjoHuntleigh has named Rick Lytle as its North American president. Lytle will oversee the company’s sales and service operations in the United State and Canada. His initial focus will be to effectively integrate the commercial operations of the recently acquired Therapeutic Surfaces division from Kinetic Concepts, Inc…NovaSom has appointed John Spitznagel as its new CEO. Spitznagel will also serve on the company’s board of directors. He succeeds Richard Hassett, who has served as president and CEO since 2010. Prior to NovaSom, Spitznagel served as chairman and CEO of Oceana Therapeutics, a medical device company focused on pediatric urology, and colon and rectal surgery.

BALTIMORE – CMS has initiated recoveries from providers for medical items and services provided to Medicare beneficiaries who were incarcerated on the date of service.

CMS has identified previously paid claims that contain dates of service that partially or fully overlap a period when the beneficiary was incarcerated based on information from the Social Security Administration (SSA). The agency generally does not pay for medical items and services furnished to a beneficiary who was incarcerated when the items and services were furnished.

“A large number of overpayments have been identified and demand letters released with appeals instructions,” the agency states in a bulletin.

CMS asks, however, that providers not file appeal requests at this time. Providers receiving demand letters for denial of claims because the beneficiary’s SSA record indicates incarceration on the date of service and who have reason to believe that the beneficiary was not incarcerated on the DOS, may wish to contact the beneficiary to gather as much information as possible.

Information gathered indicated SSA record may need to be updated

If a beneficiary did not inform the SSA of his or her release from custody, this may result in his or her record being incorrect. If a provider believes this is the case, the provider may wish to encourage the beneficiary to contact his or her local SSA office to have his or her records updated. It can take up to one month for the beneficiary’s Medicare eligibility file to be updated with the revised SSA information. If the beneficiary tells the provider that SSA is updating his or her records, we suggest the provider contact the Medicare Administrative Contractor using the contact information on the overpayment demand letter.

Information gathered indicates SSA record is current

If the provider believes that the beneficiary was not incarcerated on the date of service in question and the beneficiary advises that SSA’s records are currently accurate, the provider can contact their local CMS Regional Office by fax found at http://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Ce....

CMS notes that there may be instances where providers believe that the beneficiary was not incarcerated when the service was provided. However, a beneficiary may be "incarcerated" even when the individual is not confined within a penal facility. For example, a beneficiary who is on a supervised release, on medical furlough, residing in a halfway house or other similar situation may, nevertheless, be in the custody of authorities under a penal statute. In such cases, Medicare payment may be barred.