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    04/21/2017
    Liz Beaulieu

    WASHINGTON – AAHomecare is asking lawmakers for relief from a “double-dip” oxygen cut in the 2017 Medicare fee schedule for stationary oxygen.

    The move reinforces a letter that the association sent to previous leadership at CMS in December, asking the agency to recalculate its rates, which have dipped below competitive bidding rates in rural and non-bid areas.

    “We would like to reinforce these efforts by generating congressional interest and support on the issues, as well,” the association states.

    AAHomecare is also engaging the new leadership at CMS and the Department of Health and Human Services.

    The association is calling HME providers to action, asking them to contact their members of Congress to educate them about the issue and have them contact CMS.

    AAHomecare argues that CMS has improperly reduced payments for E1390 by applying a regulation introduced in 2006—called the budget neutrality offset—that only should be applied to unadjusted fee schedules. The association says the 2017 fee schedule for stationary oxygen must be consistent with those based on regional single payment amounts from competitive bidding areas.

    Legal action: Apria Healthcare, Lincare

    LAKE FOREST, Calif. – A man from Santa Ana, Calif., has filed a class-action lawsuit against Apria Healthcare for allegedly contacting him without his permission regarding money he allegedly owed the provider. Frank Gutierrez filed a complaint on April 3 in the U.S. District Court for the Central District of California, alleging Apria violated the Telephone Consumer Protection Act. Between July 2015 and July 2016, Apria allegedly contacted Gutierrez on his cell phone to collect payment on an alleged outstanding debt, according to the lawsuit. Apria has been charged with allegedly failing to receive prior express consent to contact Gutierrez and using an automatic dialing system.

    Former employee sues Lincare

    Charles Hartwig, the former CIO for Lincare, has filed a wrongful termination lawsuit against the company, according to local news reports. Hartwig in November 2015 accepted Lincare’s employment offer, which included a base salary of $325,000 a year, a $50,000 signing bonus and relocation expenses to move his family from New Jersey to Florida, according to the lawsuit. Five months later, however, he was fired. Hartwigargues in the lawsuit that Lincare allegedly failed to pay all of his relocation expenses and that it must repay his signing bonus. Hartwig, who previously worked at Johnson & Johnson, says in his lawsuit that Lincare hired him, in part, for helping the company complete its acquisition of American Home Patient

    Many sleep apps lacking in basic information

    YARMOUTH, Maine – Apps for sleep apnea may not be going far enough to help users understand the importance of a good night’s sleep, researchers say. There are hundreds of apps available that use soothing sounds to help people fall asleep, but less than half of the apps researchers looked at offer information about sleep or its importance, according to the Voice of America. “We were surprised that some of the apps didn’t say anything about the recommended amount of sleep someone should get on a regular basis,” said Diana Grigsby-Toussaint, a kinesiology and community health professor at the University of Illinois, who led the new analysis with colleagues at the New York University School of Medicine.

    Cardinal Health expands scope in home health care

    DUBLIN, Ohio – Cardinal Health has entered into a definitive agreement to buy the patient care, deep vein thrombosis and nutritional inefficiency business of Medtronic for $6.1 billion in cash.

    Total revenues for that business, which encompasses 23 product categories across multiple market settings, were $2.3 billion for the 12 months ending October 2016. More than 70% of total sales were in the U.S., according to a press release.

    “Given the current trends in health care, including aging demographics and a focus on post-acute care, this industry-leading portfolio will help us further expand our scope in the operating room, in long-term care facilities and in home healthcare, reaching customers across the entire continuum of care,” said George Barrett, chairman and CEO of Cardinal Health, in the release.

    Cardinal Health says the business is complementary to its medical consumables business and, once the transaction is complete, it will become part of its medical segment, which is led by Don Casey, that segment’s CEO.

    Cardinal Health expects to finance the deal with a combination of $4.5 billion in new senior unsecured notes and existing cash. It expects to close the deal in the first quarter of its fiscal year 2018.

    UPitt develops waterproof power wheelchair

    PITTSBURGH – The University of Pittsburgh Human Engineering Research Laboratories (HERL) has designed, developed and constructed a patent-pending waterproof power wheelchair that runs entirely on compressed air. The PneuChair pneumatic wheelchair was unveiled this month at Morgan’s Wonderland, a 25-acre theme park in San Antonio that was built specifically for people with disabilities. Ten of the wheelchairs will be available for use at the venue’s new splash park, Morgan’s Inspiration Island, when it opens this spring. The wheelchair uses high-pressured air as an energy source instead of batteries and electronics. It weighs about 80 pounds and takes 10 minutes to charge, compared to eight hours for an electric mobility device. HERL, which is a joint effort between UPitt, the University of Pittsburgh Medical Center and the U.S. Department of Veterans Affairs, was already working on a prototype of the PneuChair when it was contacted by representatives from Sports Outdoor and Recreation (SOAR), which oversees Morgan’s Wonderland, to help develop a power wheelchair for the splash park.

    Numotion buys Horn’s

    BRENTWOOD, Tenn. – Numotion has acquired Horn’s Medical Supply in Athens, Texas, the company announced April 14. The acquisition allows Numotion to better serve customers in eastern Texas, it says. Horn’s has been in business for more than 20 years and serves thousands of customers, according to a press release. “Expanding our presence in East Texas brings more mobility options to those who need them most,” said Mike Swinford, CEO of Numotion. Numotion will continue to serve customers from the Horn’s location in Athens. Horn’s employees, including founders Jim and Jerry Horn, will support customer sales and care, and product service and repair. As part of Numotion, they will have access to a larger product offering and support infrastructure that will help increase efficiency, according to the release. Numotion now has locations in nearly every state and serves more 250,000 customers annually, it says.

    Thelma Prial passes away

    GOOSE CREEK, S.C. – The wife of Sheldon Prial, a long-time advocate of the HME industry, passed away on April 17. Thelma Prial is survived by her husband of 67 years, and her children and grandchildren. “Mom and Dad were truly inseparable in both their lives and their careers,” wrote Pam Stein and Jon Prial, their children. “From the pharmacies they ran to the home health care dealer co-operative they established, they made every decision as a team and they never disagreed on anything (according to Dad).” Sheldon Prial, who turns 90 on May 5, will be moving from their home in Goose Creak, S.C., to an assisted living facility in Summerville, S.C. He will continue to have access to email at shelly@prialfamily.net.

    GAO studies challenges, opportunities surrounding remote patient monitoring

    WASHINGTON – Concerns over payment and coverage restrictions are barriers to healthcare providers and patients using telehealth and remote patient monitoring to improve quality of care, according to a new study from the Government Accountability Office. An example of such a restriction, the GAO says: Medicare telehealth coverage limits the geographic and practice settings in which beneficiaries may receive these services. For the study, the GAO reviewed Medicare documents and regulations, and interviewed agency officials. It also selected nine general and medical specialty associations with expertise and interest in telehealth or remote patient monitoring, and interviewed representatives from each of those associations. The GAO also found that Medicare models, demonstrations and a new merit-based incentive payment system have the potential to expand the use of telehealth and remote patient monitoring. It notes that CMS supports eight models and demonstrations in which certain Medicare telehealth requirements have been waived, such as requirements for the locations and facility types where beneficiaries can receive telehealth services.

    DME MACs move custom items to set allowables

    WATERLOO, Iowa – Custom cushions and backs—codes E2609 and E2617—now have set allowables in jurisdictions B and C, VGM Group reports. Previously, the custom items were individually priced and were averaging about 70% of MSRP/supplier price. Now E2609 has a set price of $450 and E2617 $550, VGM reports. “We are hearing that the new established allowables will not even cover acquisition cost for any of the products that are coded as custom fabricated,” it stated in a bulletin to members. Stakeholders are also concerned with the way the DME MACs in the two jurisdictions made the change—internally and without notice to the provider community. “There are many issues that are unsettling with how this came about and all are being addressed with CMS and the DME MACs,” VGM stated. “All industry advocates are aware of these issues and are reaching out to get answers and request that this change be rescinded.” Jurisdictions A and D have not implemented the change, VGM says.

    Rotech Healthcare buys Griffin Home Health Care

    ORLANDO, Fla. – Rotech Healthcare has bought Griffin Home Health Care, which has locations in Charlotte, Concord and Gastonia, N.C. Bill Griffin opened Griffin Home Health Care in 1983. “Griffin Home Health Care has been a quality provider for years,” said Tim Pigg, CEO of Rotech, in a press release. “They have a broad range of services and we are pleased to be able to bring them into the Rotech family of locations.” Rotech currently operates in 18 markets in North Carolina. This appears to be Rotech’s first acquisition this year. It had a quiet 2016, after a busy 2015, when it bought a number of HME companies, including Alert Medical in Fort Myers and Naples, Fla., in July. Duckridge Advisors served as the exclusive M&A adviser to Griffin Home Health Care.

    Philips says its Trilogy 100 saves big money

    AMSTERDAM – Royal Philips says its new Trilogy 100 non-invasive ventilator can reduce hospital readmissions for COPD patients, compared to patients not using NIV or using less advanced NIV therapy, following discharge. As a result, both hospitals and payers can see a significant cost savings, Philips says. Among a study’s findings for hospitals: After examining 1,000 COPD patients being treated with a multifaceted therapy approach using the Trilogy versus no NIV treatment or less advanced NIV therapy devices, hospitals saved $1.6 million in the first 30 days and $1.8 million in 90 days. For payers, the study found: Payers studying admissions of 100,000 severe COPD patients found cumulative three-year savings of $326 million. The study was paid for by Philips.

    VGM: Take impact survey

    WATERLOO, Iowa – The VGM Group is asking HME providers who haven’t already done so to take its Supplier Impact Survey. The survey measures the impact of policies and reimbursement cuts implemented in 2016 on providers and patients. Since launching in late 2016, the survey has garnered more than 350 responses.

    Short takes: BOC appoints new board members

    The Board of Certification/Accreditation (BOC) has named Margy Imlay and Richard Todd to its board of directors. Imlay is owner and president of Just Like a Woman, a women’s health boutique in Portland, Oregon. She is also a consultant and instructor for OandPEdu, where she is the principal instructor for hands-on mastectomy fitter classes around the country. Todd is owner and managing partner of Collier Orthotics and Prosthetics, KneedABrace Inc. and Comfort Sleeves, with locations in Sacramento and Pleasant Hills, California. He has more than 30 years of experience in the orthopedic field.

     

     

     


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  • 04/24/17--11:37: Are you RAC ready?
  • 04/24/2017
    Liz Beaulieu

    Since it’s been so long since HME providers have had to grapple with a RAC, stakeholders offered these pieces of advice:

    Be proactive. “Suppliers must have an internal quality assurance and compliance program that regularly monitors the claims that are being submitted,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group. “They should review the RAC website regularly to perform a risk assessment on their proactive audits. Suppliers can minimize the impact of these audits for themselves.”

    Read carefully. “Some are medical necessity reviews and some are documentation reviews,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “Pay attention to your audit request letters and know which you are dealing with.”

    Keep organized. “Use separator sheets to tell the auditors, this is where the face-to-face evaluation is, this is where the proof of delivery is,” said Andrea Stark, a reimbursement consultant with MiraVista. “They’re going to itemize the things they want you to send back to them, so make it as easy as possible on them. It predisposes you to a favorable opinion.”


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    04/27/2017
    HME News Staff

    WASHINGTON – Nearly 41% of HME providers have dropped Medicare since July 2013, according to AAHomecare.

    That was when Round 2 of the competitive bidding program kicked off in 91 cities with an average reimbursement cut of 45%.

    Three states—California, New York and New Jersey—saw declines of more than 60%, while the District of Columbia saw a decline of 85.7%, according to data AAHomecare analyzed from the Medicare Supplier Directory.

    Bigger picture, the association found the total number of unique companies dropped from 10,465 in July 2013 to 6,181 as of April 2017; and the number of unique locations declined 38.7%.

    By comparison, the number of Medicare beneficiaries increased 8.6% from 2013 to 2016.

    With the application of bid pricing to non-bid areas beginning Jan. 1, 2016, the decline has accelerated, with a 26.4% reduction in HME providers and a 23.3% reduction in total locations, according to AAHomecare.

    “AAHomecare plans to highlight this data in our advocacy efforts on Capitol Hill and at CMS,” said the association in its weekly bulletin. “HME suppliers and other stakeholders are encouraged to reference both national and state data in your contacts with legislators.”

    AAHomecare pulled from the Medicare Supplier Directory using counts for companies and locations providing beds, negative pressure wound therapy, support surfaces, wheelchairs and accessories, respiratory and oxygen products.


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    04/28/2017
    HME News Staff

    WASHINGTON – Nearly 41% of HME providers have dropped Medicare since July 2013, according to AAHomecare.

    That was when Round 2 of the competitive bidding program kicked off in 91 cities with an average reimbursement cut of 45%.

    Three states—California, New York and New Jersey—saw declines of more than 60%, while the District of Columbia saw a decline of 85.7%, according to data AAHomecare analyzed from the Medicare Supplier Directory.

    Bigger picture, the association found the total number of unique companies dropped from 10,465 in July 2013 to 6,181 as of April 2017; and the number of unique locations declined 38.7%.

    By comparison, the number of Medicare beneficiaries increased 8.6% from 2013 to 2016.

    With the application of bid pricing to non-bid areas beginning Jan. 1, 2016, the decline has accelerated, with a 26.4% reduction in HME providers and a 23.3% reduction in total locations, according to AAHomecare.

    “AAHomecare plans to highlight this data in our advocacy efforts on Capitol Hill and at CMS,” said the association in its weekly bulletin. “HME suppliers and other stakeholders are encouraged to reference both national and state data in your contacts with legislators.”

    AAHomecare pulled from the Medicare Supplier Directory using counts for companies and locations providing beds, negative pressure wound therapy, support surfaces, wheelchairs and accessories, respiratory and oxygen products.

    Invacare cleared for re-inspection

    ELYRIA, Ohio – Invacare has complete the final milestones required to lift a consent decree with the U.S. Food and Drug Administration, paving the way for a re-inspection, the company announced April 27.

    “The re-inspection is an important step before the company may resume full operations at the impacted facilities,” Invacare stated in a press release.

    The decree has limited Invacare’s ability to manufacture and sell certain products from its corporate headquarters and Taylor Street facilities since December 2012.

    Most recently, Invacare’s third-party auditor submitted a third and final certification report confirming its compliance with specified FDA regulatory requirements. Invacare also submitted its own report substantiating its compliance. Both of these steps have now been completed.

    “Since I arrived at Invacare in 2015, our No. 1 priority has been to build a culture of quality excellence,” stated Matthew Monaghan, chairman, president and CEO. “Our associates have embraced this, and we have made significant progress. We look forward to demonstrating this progress to FDA during its inspection.”

    Invacare says it cannot predict the length or outcome of the re-inspection.

    Earlier this month, the FDA notified Invacare that it had accepted an updated second certification report submitted by the company’s auditor, allowing it to resume design activities at its corporate headquarters and Taylor Street facilities.

    CMS implements audit improvements

    WASHINGTON – CMS has announced significant improvements to the processing of serial claims for capped rental items and certain inexpensive and non-routinely purchased items, according to a bulletin from AAHomecare.

    It’s an issue that has been a challenge for providers for years and contributed to the massive appeals backlog, the association says.

    Improvements include:

    • Instructing the DME MACs to change the process by which they adjudicate appeals of serial claims. Once the reason for denial for one claim in a series is resolved at any appeal level, the DME MACs will identify other claims in the same series that were denied for the same or similar reasons, and take that determination into consideration when adjudicating such claims. 
    • The DME MACs will also communicate favorable decision(s) to the DME QIC and the Office of Medicare Hearings and Appeals (OMHA) to consider when adjudicating related appeals pending at those levels. 
    • Instructing the DME MACs to update the CMN in the ViPS Medicare System (VMS), when appropriate, to reflect when a favorable decision has been rendered for a serial claim, allowing future claims in the same series to pay without requiring suppliers to continually resubmit evidence.
    • Instructing the DME MACs to perform data analysis of all favorable serial claim appeal decisions made over the past three years, in an effort to capture all currently pending appeals in the series that could be included in this initiative. Suppliers do not need to take any action and should not reach out to the DME MAC within their jurisdiction to request that their appeal be considered for this initiative. 

    Med Emporium expands footprint

    CHARLOTTE, N.C. – Med Emporium LLC, a home respiratory services provider, has acquired Mobile Med Inc. with locations in Greenville, S.C., and Rome, Ga. The acquisition allows Med Emporium to better serve customers in South Carolina and expands its territory into Georgia. Mobile Med has been in business for more than 10 years. Mobile Med’s employees, including founders Doug Trenor and Tim Hayes, will support sales and growth efforts in those markets. As part of Med Emporium, they will have access to advanced clinical systems and support infrastructure that will help increase efficiency, according to a release.

    BD accelerates offerings with Bard

    FRANKLIN LAKES, N.J., and MURRAY HILL, N.J. – Becton, Dickinson and Company will buy C. R. Bard for $24 billion, the companies announced April 23.

    The deal builds on BD’s position in medication management and infection prevention, and increases its opportunities in fast-growing clinical areas like vascular therapy, according to a press release.

    "Combining with Bard will accelerate our ability to offer more comprehensive, clinically relevant solutions to customers and patients around the globe, creating a strong partner for healthcare providers who are increasingly focused on delivering better outcomes at a lower total cost,” said Vince Forlenza, BD’s chairman and CEO. “Our two purpose-driven organizations are well-aligned strategically, sharing a strong track record of performance and a deep commitment to addressing unmet needs in today's challenging healthcare environment.”

    Under the terms of the transaction, Bard common shareholders will be entitled to receive approximately $222.93 in cash and 0.5077 shares of BD stock per Bard share, or a total of value of $317.00 per Bard common share based on BD's closing price on April 21, 2017. At closing, Bard shareholders will own approximately 15% of the combined company.

    By combining Bard's strong leadership position and innovation pipeline in fast-growing vascular access segments—PICCs (peripherally inserted central catheters), midlines and drug delivery ports—with BD's leadership and innovation in IV drug preparation, dispensing, delivery and administration, the combined company will be better positioned to provide end-to-end medication management solutions across the care continuum, according to the release.

    “Bard will expand BD’s focus on the treatment of disease states beyond diabetes to include peripheral vascular disease, urology, hernia and cancer,” it states.

    Following the acquisition, BD expects to create a third segment within the company called BD Interventional, where the Bard business will report both operationally and financially. Separately, BD also announced on April 23 that Tom Polen, currently executive vice president and president of the BD Medical Segment, will become president of BD effective immediately. In this new role, he will oversee BD’s Medical and Life Sciences segments, as well as the new Interventional segment.

    BD previously bought CareFusion, which manufacturers everything from infusion pumps and IV sets to ventilation and respiratory products, for $12.2 billion in 2014.

    Bard previously bought Liberator Medical, a direct-to-consumer provider of home medical supplies, including catheters, ostomy, diabetes and mastectomy, for $181 million in 2015.

    ResMed hits market with travel CPAP

    SAN DIEGO – ResMed unveiled its travel CPAP, the AirMini, April 25. Weighing just 0.66 pounds and measuring just 5.4 x 3.3 x 2 inches, the company is hailing the device as “the world’s smallest CPAP machine.” “CPAP is now more portable and accessible than ever before,” said Mick Farrell, CEO, in a press release. “I have been traveling all over the world with a prototype of the AirMini system, using AutoSet, humidification, and an AirFit P10 pillows mask, and it has changed my travel life. I am so excited to see that this technology is now available to many millions of sleep apnea patients.” In a recent survey, 65% of CPAP users said the size of their devices is the No. 1 reason why they don’t take their CPAP machines every time they travel, breaking the cycle of adherence, according to the release. Users of the AirMini can change their comfort settings and track their usage data through an accompanying phone app. ResMed is making the AirMini, which also features portable waterless humidification, available through HME providers. It will begin taking pre-orders on May 3, and the device will begin shipping by May 31. ResMed first announced plans to launch the AirMini during a conference call in January.

    ASMS launches online store for CPAP

    ENCINO, Calif. – Advanced Sleep Medicine Services has launched a new online store at www.sleepdr.comto offer CPAP equipment and sleep therapy accessories. Unlike most other online sellers of CPAP equipment and accessories, ASMS also accepts health insurance, including most commercial plans and many medical groups in southern California, according to a press release. ASMA has provided diagnostic sleep testing and therapy services in southern California for more than 20 years. It has provided educational materials about sleep studies and CPAP therapy at www.sleepdr.comfor the past 10 years. “We recognize that many people prefer to do most of their research and shopping online,” said Kermit Newman, CEO of ASMS. “By offering this easy option of online shopping in addition to our brick-and-mortar sleep centers across California, we hope to reach more patients.”

    Ascensia teams up with Dr. Oz

    PARSIPPANY, N.Y. – Ascensia Diabetes Care has announced a partnership with The Dr. Oz Show to launch a 60-day “Take Charge” Diabetes Challenge. Ascensia is sponsoring the challenge, which is designed to increase awareness of diabetes among the general public and to help encourage better management of the condition. As part of the challenge, which launches during the April 26 episode of The Dr. Oz Show, participants who have diabetes will use Ascensia’s ContourNext One Blood Glucose Monitoring System to monitor their blood glucose; and all participants will use higi, a network of self-screening health stations and an online community platform that is linked to more than 80 health devices, trackers and apps, to monitor their weight and body mass index. The April 26 episode will also highlight the experiences from some of the 60 participants who have already completed the challenge. Members of the public can participate in the challenge by joining at doctoroz.com, where they can see if they are eligible to receive one of 1,000 free ContourNext One meters.

    Home mods bill returns in the House

    WASHINGTON – Reps. Charlie Crist, D-Fla., and Bruce Poliquin, R-Maine, have introduced a bill in the House of Representatives that would provide tax credits to seniors who install home modifications. H.R. 1780 or the “Senior Accessible Housing Act” has six original co-sponsors and has been referred to the Ways and Means Committee. “Giving seniors the option to live more independently in their own home is less costly and can improve their quality of life,” Crist said. “Providing tax credits for home modifications is smart policy—it’s better for our seniors and better for our communities.” Rep. Patrick Murphy, D-Fla., introduced a similar bill last year. The bill would provide incentives to individuals 60 years of age and older to “age in place” by providing a $30,000 tax credit for home modifications like the widening of doorways and the installation of ramps, handrails, grab bars and non-slip flooring.

    Etac names new exec

    TORRANCE, Calif. – Etac AB has named Ryan Williams as president, Etac NA, effective immediately. Williams has extensive experience in health care, including stints as CEO for Avera Health System in Sioux Falls, S.D., and COO of Passy-Muir in Irvine, Calif., according to a press release. As president, Williams is responsible for the Convaid and R82 brands in North America, and will report directly to CEO Torben Helbo. "Ryan is a dynamic, results-orientated leader with over 20 years of experience in healthcare and has a proven record of success in building strong teams,” stated Helbo.

    Cure Medical launches new website

    NEWPORT BEACH, Calif. – Cure Medical has launched a new website, curemedical.com, to highlight its expanded portfolio of intermittent and enclosed system catheters. The site will also feature customized content for customers, medical professionals and HME providers. Visitors to the site will find product videos, downloadable product flyers and a catalog, a support program for catheter users, lifestyle advice and medical research updates. “Everything we do at Cure Medical is centered on providing quality care for the people we serve,” said CEO John Anderson in a press release.

    VGM ready to retail

    WATERLOO, Iowa – VGM has leased a retail storefront to create a Retail Training Lab at the upcoming Heartland Conference. Located across from the convention center, the 1,100-square-foot showroom will feature healthcare products and display ideas. VGM’s online marketing agency, Forbin, will also be in the showroom discussing online marketing tactics and trends to help providers reach their target audience. “We’re proud to enhance Heartland Conference attendees’ experience by offering this innovative, hands-on approach to learning,” said VGM’s Director of Retail Programs Rob Baumhover. “The showroom will be designed as an ideal retail store, providing a unique platform to highlight opportunities for our members to strengthen their retail program.” The training lab will be open throughout the conference, which takes place June 12-15 in Waterloo, Iowa.

    Fall show on ‘track’

    ATLANTA – Booth sales for Medtrade, which takes place Oct. 23-26 at the Georgia World Conference Center, are on track, show organizers say. Exhibitors such as Tennessee-based ramp manufacturer American Access are returning after a two-year absence, ready to tap into renewed industry optimism, according to a press release. “After the positive vibe from Medtrade Spring and renewed hope for regulatory change in Washington, we are optimistic,” said Kevin Gaffney, group show director, in the release.

    Maine providers score ‘win’

    AUGUSTA, Maine – MaineCare will return to the 2015 Medicare fee schedule on May 1, according to a bulletin from the Home Medical Equipment and Services Association of New England (HOMES). Additionally, the rates will not be affected by the federal match reduction in the 21st Century Cures Act. "This is a huge win for our Maine members," said Karyn Estrella, HOMES President and CEO. "These companies have been struggling for the past year because of the national roll out of competitive bidding rates.”

    Short takes: Studies on COPD, CPAP

    When it comes to encouraging people with COPD to exercise, a mobile phone app with dialogue support works best, according to a study published in the Journal of Medical Internet Research. As part of the study, researchers reviewed three prototypes for mobile apps using different persuasive technology: dialogue support, primary task support and social support. They assessed opinions on these prototypes through 28 interviews with COPD patients, caretakers and healthcare professionals, and through 87 questionnaires completed by COPD patients. Generally, researchers found that the prototypes for mobile apps were received positively, and more specifically, they found that the prototype using dialogue support was most likely to be used or recommended by those interviewed. “Dialogue support and primary task support are considered to be both acceptable and likely to be persuasive by (COPD patients),” the study stated. “In the future, these approaches should be considered when designing apps to encourage physical activity by (COPD patients)”…Technological interventions like changes in masks, modes and pressures can help to re-initiate CPAP use, according to a study published in the Journal of Respiratory Care. Researchers found technology related problems due to mask discomfort/leaks, pressure intolerance, and residual breathing events were associated with CPAP failure in subjects seeking second opinions. But with the application of re-titration of PAP protocol (REPAP), 72% of subjects re-initiated CPAP use.

     


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    04/28/2017
    HME News Staff

    WASHINGTON – CMS has announced significant improvements to the processing of serial claims for capped rental items and certain inexpensive and non-routinely purchased items, according to a bulletin from AAHomecare.

    It’s an issue that has been a challenge for providers for years and contributed to the massive appeals backlog, the association says.

    Improvements include:

    • Instructing the DME MACs to change the process by which they adjudicate appeals of serial claims. Once the reason for denial for one claim in a series is resolved at any appeal level, the DME MACs will identify other claims in the same series that were denied for the same or similar reasons, and take that determination into consideration when adjudicating such claims. 
    • The DME MACs will also communicate favorable decision(s) to the DME QIC and the Office of Medicare Hearings and Appeals (OMHA) to consider when adjudicating related appeals pending at those levels. 
    • Instructing the DME MACs to update the CMN in the ViPS Medicare System (VMS), when appropriate, to reflect when a favorable decision has been rendered for a serial claim, allowing future claims in the same series to pay without requiring suppliers to continually resubmit evidence.
    • Instructing the DME MACs to perform data analysis of all favorable serial claim appeal decisions made over the past three years, in an effort to capture all currently pending appeals in the series that could be included in this initiative. Suppliers do not need to take any action and should not reach out to the DME MAC within their jurisdiction to request that their appeal be considered for this initiative. 

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    05/03/2017
    HME News Staff

    WASHINGTON – CMS has delivered “a slap in the face” to the HME industry with its updated fee schedule for rural and non-competitive bidding areas, AAHomecare says.

    The agency released the updated fee schedule to meet a provision in the Cures Act that requires the agency to retroactively delay a second round of reimbursement cuts that went into affect in those areas on July 1, 2016, until Jan. 1, 2017, allowing HME providers to recoup six months worth of payments.

    The problem, AAHomecare says: CMS recalculated the rates based on the July 1, 2016, fee schedule instead of the Jan. 1, 2016, fee schedule, resulting in rates that are lower than they should be.

    “CMS’s decision to recalculate these rates based on the July 1 fee schedule are a slap in the face to the HME community, as well as to members of Congress who worked hard to include relief for our industry into the Cures bill,” said Tom Ryan, president and CEO of AAHomecare. “Individuals on Capitol Hill that we’ve spoken with are perplexed that CMS has defied clear congressional intent to essentially extend the Jan. 1 rates for the second half of 2016.”

    For oxygen concentrators, for example, the January 2016 rate in New England was $140.56; the original July 2016 rate was $77.72; and the updated July 2016 rate is $125.30. The updated July 2016 rate represents a 10.9% reduction from the January 2016 rate.

    AAHomecare says it is “more determined than ever” to advocate for better reimbursement for HME providers.

    “This development lends additional urgency to our industry’s efforts to provider longer term relief for rural and non-bid providers, and I expect these rates will help spur the HME community into heartfelt advocacy on this issue,” Ryan said.


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    05/04/2017
    Theresa Flaherty

    RICHMOND, Va. – Owens & Minor, a global healthcare services company providing supply chain services to healthcare providers and manufacturers, has agreed to pay about $380 million for Byram Healthcare, it announced May 2.

    The White Plains N.Y.-based Byram is a leading supplier of home medical supplies, including ostomy, wound care, urology, diabetes and incontinence supplies.

    “Expanding across the continuum of care is a strategic imperative for us,” said P. Cody Phipps, president and CEO of Owens & Minor in a press release. “With the addition of Byram to the Owens & Minor family, we can quickly advance our strategic agenda with providers and manufacturers by expanding our reach beyond the hospital setting all the way to the patient’s home.”

    Of particular attraction for Owens & Minor: Byram’s portfolio of more than 600 payer contracts covering 200 million lives.

    The deal is the latest in the popular home medical supplies space. In 2016, Coloplast acquired Comfort Medical for $160 million; and Domtar acquired Home Delivery Incontinence Supplies for $45 million. In 2015, C.R. Bard acquired Liberator Medical for $181 million. C.R. Bard was just acquired in April by Becton Dickinson and Company for $24 billion.

    Owens & Minor is expected to close the transaction in the third quarter of 2017.


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    Adjusted fee schedule not what Congress intended, they say
    05/05/2017
    Theresa Flaherty

    WASHINGTON – While there is “no question” that Congress intended for CMS to reset rural and non-bid area rates for the second half of 2016 to match those of the first half of the year, the agency’s decision not to was, technically, legal, say industry stakeholders.

    “From a strictly legal perspective, CMS is acting within the bounds of the law,” said Cara Bachenhiemer, senior vice president of government relations for Invacare. “So it’s a very difficult legal argument to make, saying that congressional intent trumps the actual black and white letter of the law.”

    The agency released the updated fee schedule to meet a provision in the Cures Act that requires the agency to retroactively delay a second round of reimbursement cuts that went into affect in those areas on July 1, 2016, until Jan. 1, 2017, allowing HME providers to recoup six months worth of payments.

    Unfortunately, CMS recalculated the rates based on the July 1, 2016, fee schedule instead of the Jan. 1, 2016, fee schedule, resulting in rates that are lower than they should be.

    “We argued our point with the agency and they stuck with their interpretation,” said Tom Ryan, president and CEO of AAHomecare. “Many people on the Hill are disappointed.”

    Many providers, meanwhile, took to Twitter to vent their frustration.

    “Medicare does whatever they want, without any fear of industry efforts or congressional intent,” read one tweet.

    “@SenPriceMD this has to stop. They are openly defying a congressional order. No one has the guts to stand up to them,” read another.

    With the fee schedule coming on the heels of recently released CMS data that shows a 41% decline in the number of HME providers since July 2013, provider frustration is understandable, says Ryan, who received some “unpleasant calls” from AAHomecare members last week.

    “They are outraged and they should be outraged,” he said. “They need to come out and show that sense of outrage to members of Congress—that this is a small industry being attacked by CMS.”


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  • 05/05/17--11:52: HME infrastructure crumbles
  • ‘I’ve been saying for a while that I think we’ve crossed the tipping point,’ says one provider
    05/05/2017
    Theresa Flaherty

    YARMOUTH, Maine – CMS set out to reduce the number of HME providers with competitive bidding and, as recent data shows, it has done just that, say providers.

    AAHomecare released data recently that shows nearly 41% of providers across the country have dropped Medicare or closed their doors since July 1, 2013, when Round 2 of the program kicked off in 91 cities.

    “This is what the program was designed to do,” said Ben Hertz, store manager of Elmora Pharmacy in Elizabeth, N.J. “It seems like a lot of stores in the suburbs and rural areas have closed down, not so much here in the city.”

    New Jersey was the hardest hit, shrinking from 330 unique supplier companies in July 2013, to 114 currently, a decline of 65.5%.

    Also topping the 60% mark were California (60.8%) and New York (60.1%).

    “A lot of people have been acquired or are going out of business,” said Anthony Cecere, president of Homecare USA in West Babylon, N.Y., who has been in business nearly 21 years but hasn’t drawn a salary the past three years. “I think we are going to see more fallout over the next six months to a year. People cannot continue to do business without reimbursement.”

    Two hundred miles away, in Green Island, N.Y., outside of Albany, the number of providers has stayed relatively stable but the makeup of those providers has not, says provider Irene Magee.

    “There are fewer independents—more of the locals were purchased by Lincare so that consolidated our area,” said Magee, vice president and director at Northeast Home Medical Equipment. “In our market, we’ve also seen the entry of a number of bid winners that have never serviced this area. There are true access issues here if a person with traditional Medicare wants to get (discharged) timely.”

    Like Cecere, provider Doug Westerdahl believes there’s more fallout to be had. He says he’s concerned that the decrease in providers will only worsen as other payers adopt Medicare’s rates.

    “We’ve seen a significant drop in our profit margins and we’ve had to lay off 10 people since January,” said Westerdahl president of Rochester, N.Y.-based Monroe Wheelchair. “I’ve been saying for a while that I think we’ve crossed the tipping point and hopefully it won’t get worse.”


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    05/05/2017
    HME News Staff

    CORAL SPRINGS, Fla. – Arriva Medical on April 25 lost an appeal seeking to reinstate its Medicare billing privileges, according to news reports.

    Earlier this month, a spokesperson for the provider of diabetes testing supplies told HME News, “Arriva is in the midst of the administrative appeals process, with an appeal pending before an administrative law judge.”

    An administrative law judge for the U.S. Department of Health and Human Services has now ruled Arriva Medical’s admission that it shipped supplies to nine beneficiaries despite knowing they were deceased was enough to “demonstrate an abuse of billing privileges,” according to Boston Business Journal.

    Arriva Medical blamed those shipments on “consumer fraud” and believes they do not merit a ban on reimbursement, the journal reported.

    CMS revoked Arriva Medical’s billing status in 2016, alleging the provider submitted 211 claims for decreased patients between April 15, 2016, and April 25, 2016.

    The setback follows a decision by Abbott Laboratories earlier this month to move forward with its acquisition of Alere, the parent company of Arriva Medical, albeit for a reduced price of $5.3 billion vs. $5.8 billion. Abbott and Alere have been in and out of court for months, with Abbott trying to back out of the deal.

    The ALJ’s decision will not affect the pending acquisition, the journal reported.

    BioScrip earnings ‘in line’ with expectations

    DENVER – BioScrip reported net revenues of $217.8 million for the first quarter of 2017, reflecting a core revenue mix of 72% compared to 60% during the same quarter in 2016. Net loss was $19 million and adjusted EBITD was 5.2 million. For the full year 2017, BioScrip expects to achieve adjusted EBITDA in the range of $45 million to $55 million. “I am pleased with our company’s first quarter performance, which was in line with our plan,” said Dan Greenleaf, president and CEO in a press release. “Our sales team met our revenue target for the quarter and continued to increase our core revenue mix.”

    CHME secures $4M term loan

    COSTA MESA, Calif. – Pacific Mercantile Bank has extended a $4 million term loan to CHME, an HME provider. CHME, originally California Home Medical Equipment, was referred to Pacific Mercantile Bank by Unique Investment Corp., CHME’s private equity sponsor. “With the knowledge they gained, they were able to structure a loan that meets our financing needs and allows us to increase our working capital to support the growth opportunities we are seeing,” said Bernie Zimmer, president of CHME. “Pacific Mercantile Bank also presented us with a solution that helped us streamline our banking relationships, make us more efficient, and take costs out of the business.  With their support, we have a stronger foundation for generating profitable growth." Located in San Francisco, CHME specializes in respiratory equipment, custom power mobility and seating products, and DME. It has been in business for more than 30 years.

    AOPA asks RAC to rescind review

    ARLINGTON, Va. – The American Orthotic and Prosthetic Association has sent a letter to Peformant Recovery expressing concern that the national RAC contractor was not in compliance with its statement of work when it announced an automated review for L5845. In the April 28 letter, AOPA President Michael Oros outlines the criteria required to initiate such a review and asks for the review to be rescinded. Performant has not issued a formal response, but the announcement has been removed from its website, according to AOPA.

    Universal Software outgrows corporate office

    NOVI, Mich. – Universal Software Solutions has added a second office here. The company says business has grown so much in the past few years that it has outgrown its corporate office in Davison, Mich. “In the past few months, we have added many new programming, customer support and training staff,” said Dave Golen, vice president. While Universal Software Solutions will keep its corporate office in Davison, it moved its training, sales and marketing departments to the Novi office in April. A big reason business has grown: several large national healthcare providers have started using the company’s solution. “We will be adding all the necessary staff of all types to support, train and implement hundreds of new users,” said Christopher Dobiesz, president. Universal Software Solutions provides a practice management solution called Health Care Data Management System for the DME, home infusion, pharmacy and mail-order markets.

    BOC to move into larger digs

    OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) will nearly double it space, from 3,600 to 5,183 square feet, when it moves its headquarters in June to accommodate growth. BOC, founded in 1984, offers certification programs for orthotic fitters, mastectomy fitters and DME specialists, as well as facility accreditation for O&P practices and DME providers. “BOC’s main focus remains on our customers,” notes President & CEO Claudia Zacharias, MBA, CAE. “We are looking forward to the move to a larger space, where we will deliver the same award-winning customer service as we continue to grow.” To accommodate the move, BOC will close June 1 and reopen June 6.

    ABC releases pedorthist survey

    ALEXANDRIA, Va. – The American Board for Certification in Orthotics Prosthetics and Pedorthics will use the results of a recent survey to ensure that its pedorthist credentialing exam is relevant, and to identify content for in-service or continuing education, according to a press release. “The survey results will help define the certification, education and training of future pedorthists, in the development of valid and reliable examinations and convey to others outside our disciplines the scope of services provided by certified pedorthists,” said Dennis Dillard, C.Ped., CTO, chairman of the ABC’s Practice Analysis Task Force. The overall return rate for the survey was 27%.

    MAMES highlights awards, changes

    OMAHA, Neb. – The Midwest Association for Medical Equipment Services announced its “Above and Beyond Award” winners at its Spring Excellence in HME Convention & Exhibition, April 26-28. Lelia Wilkerson, a director at Heritage Medical Equipment and Supplies in Burlington, Iowa, won the association’s highest honor as a provider; and Golden Technologies in Old Forge, Pa., won as a manufacturer/vendor. Other highlights from the event include record attendance during the educational sessions; and votes by the board of directors to add a Retail Committee and change the association’s DBA to the Midwest Association for Medical Equipment, Services & Supplies.

    Events: United Spinal, VGM Heartland

    The United Spinal Association will host Andrea Dalzell, Ms. Wheelchair New York 2015, at its 6th Annual Roll on Capitol Hill in Washington, D.C., June 11-14. Dalzell, who was diagnosed with Transverse Myelitis at age 5, will advocate for providing greater access to complex rehab technology. More than 150 wheelchair users and advocates are expected to attend this year’s ROHC…VGM Heartland will host an inaugural meet-up for the HME Young Professionals Group in Waterloo, Iowa, during its Heartland Conference. HME YP will offer HME professionals under 40 the opportunity to network and share best practices with their peers. The conference takes place June 12-15. Visit www.vgmheartland.comfor more information.

    Vendor short takes: Invacare, Permobil

    Invacarehas introduced Invacare Outcomes by Design, a suite of programs designed to assist post-acute care facilities in improving clinical, financial and patient satisfaction outcomes. The suite currently consists of three modules: safe patient handling, pressure management and facility design…Permobil has the exclusive distribution rights in Canada for SoftWheel’s in-wheel shock absorption system for manual wheelchairs. Numotion is the exclusive distributor for SoftWheels in the US.

    Short takes: Head over Wheels, power soccer

    Bryan Anderson, Kiel Eigen and Mark Smith of Quantum Rehab have made a short film, “Head Over Wheels,” and entered it into the 2017 Easterseals Disability Film Challenge. As part of the challenge, filmmakers spend 48 hours writing, filming and producing a five-minute film addressing disability in a unique light. This year’s theme was “family comedy.” The films are judged on the number of views, shares and media exposure they receive through May 8…The U.S. Power Soccer Association and sponsor MK Battery are gearing up for the World Cup in Kissimmee, Fla., July 5-9. It’s the first time the event will be hosted in the U.S., with the previous two World Cups held in Tokyo in 2006 and Paris in 2011. The U.S. National Power Soccer Team is the only U.S.-based soccer team to ever win back-to-back World Cups. The U.S. team kicks off the event with a match against Denmark on July 5.

    People: Kucka, Randolph, Ramcharan

    George Kucka will receive the AAHomecare/Mal Mixon Legislative Advocate Award at the association’s Washington Legislative Conference later this month. Kucka is president of Fairmeadows Home Health Center in Schererville, Ind., and serves on AAHomecare’s board of directors, and chairs the HME/RT Council…Robin Randolph has joined technology startup Metamason as its chief marketing officer. Randolph has nearly 30 years of experience in the sleep industry, most recently as marketing manager for North America at Fisher & Paykel…Jeannette Ramcharan, president of Resplife Medical Solutions in Lanham, Md., will be featured in Worldwide Leaders in Healthcare published by the International Association of HealthCare Professionals. Ramcharan, an RRT, has practiced for more than 16 years.

     

     


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    05/05/2017
    HME News Staff

    NASHVILLE, Tenn. – NDC, a healthcare supply chain company, has acquired Dedicated Distribution, the companies announced May 4.

    NDC will use Dedicated Distribution, a wholesale supplier of home medical equipment and supplies, as a platform for its Home Care division. NDC currently serves several markets, including the acute care physician, extended care, dental and home care markets.

    “Our combination with Dedicated Distribution is a natural fit,” said Mark Seitz, president and CEO of NDC, in a press release. “Their reputation for excellent service and never competing with its customers mirrors ours.”

    Doug Harper, former president of Invacare Supply Group, will serve as president of NDC’s Home Care division, while Steve Cole will stay on as executive vice president of Dedicated Distribution, a division of NDC Home Care.

    “Steve Cole and I have more than 60 years of unwavering commitment to distribution,” said Harper. “We will leverage that experience, the skill of the Dedicated Distribution team and NDC’s extensive resources to be the partner of choice for the home healthcare provider.”

    Terms of the deal were not disclosed.


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    05/10/2017
    HME News Staff

    WASHINGTON – CGS will begin adjusting tens of thousands of claims from non-competitive bidding areas each day for about the next 24 weeks, the DME MAC for Jurisdictions B and C announced May 8.

    The adjustments come in response to a provision in the 21st Century Cures Act that requires CMS to retroactively delay a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing HME providers to recoup six months of payments.

    CGS says it will begin adjusting about 40,000 claims each day in Jurisdiction C and about 20,000 claims each day in Jurisdiction B. The claims will be “mass adjusted.”

    The full implementation date for the adjustments is not until July 3.

    While plans for the “mass adjustment” come as a relief, industry stakeholders take issue with what The VGM Group calls the “long delay in payment.”

    Stakeholders also take issue with the adjusted amounts, which are based on the July 1, 2016, fee schedule instead of the Jan. 1, 2016, fee schedule. The latter, they say, is what Congress intended.


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    05/12/2017
    HME News Staff

    WASHINGTON – CGS will begin adjusting tens of thousands of claims from non-competitive bidding areas each day for about the next 24 weeks, the DME MAC for Jurisdictions B and C announced May 8.

    The adjustments come in response to a provision in the 21st Century Cures Act that requires CMS to retroactively delay a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing HME providers to recoup six months of payments.

    CGS says it will begin adjusting about 40,000 claims each day in Jurisdiction C and about 20,000 claims each day in Jurisdiction B. The claims will be “mass adjusted.”

    The full implementation date for the adjustments is not until July 3.

    While plans for the “mass adjustment” come as a relief, industry stakeholders take issue with what The VGM Group calls the “long delay in payment.”

    Stakeholders also take issue with the adjusted amounts, which are based on the July 1, 2016, fee schedule instead of the Jan. 1, 2016, fee schedule. The latter, they say, is what Congress intended.

    Praxair, Linde deal back on

    DANBURY, Conn., and MUNICH – Praxair has agreed to buy Linde for about $35.2 billion, creating the largest supplier of industrial gases, according to Bloomberg. The news comes three months after a previous attempt failed due to concerns over job losses in Germany. Praxair won over Linde’s board by agreeing to keep operations in Munich and preserve jobs, according to the news agency. Shares of Praxair will be converted one for one into stock in a new company that will begin an offer to buy Linde, in what the companies call a “merger of equals.” By combining the two companies, Praxair and Linde expect to save about $1 billion, Bloomberg reported. A big question for HME providers: What impact the deal will have, if any, on the industry. In August 2012, Linde made a big splash in HME when it acquired Lincare for $4.6 billion. In December 2015, Lincare announced it would acquire American HomePatient, consolidating two of the four national HME providers.

    It’s official: Georgia gov signs licensure law

    ATLANTA – Georgia Gov. Nathan Deal has signed into a law a bill that requires licensure and a physical location in the state for HME providers. “Our licensure law is pro-business and pro-patient,” said Teresa Tatum, executive director for the Georgia Association of Medical Equipment Suppliers (GAMES). The association will work with the Georgia Board of Pharmacy on the rulemaking process for implementing the bill, which was passed in April.

    Companies to debut at Medtrade

    ATLANTA – Medtrade will see several new exhibitors at this year’s show. They include Softies CareWear, which makes customizable patient garments; JST Concepts, which offers a documentation solution; Web Talent Marketing, which offers marketing and design services; and Suzhou Sweetrich Vehicle Industry Technology Company, which will introduce a scooter line. “We view Medtrade as a new opportunity to bring our apparel expertise, patented fabrics and innovative designs direct to the medical industry and their patients,” said Tim Murphy, president of Softies, in a press release. This year’s event takes place Oct. 23-26 at the Georgia World Congress Center.

    NCPA, Union Springs Healthcare support indie pharmacists

    ALEXANDRIA, Va. – The National Community Pharmacists Association and Union Springs Healthcare have formed a strategic partnership to bolster pharmacy-patient relationships and grow pharmacy revenue. Through the initiative, NCPA will bring to independent community pharmacy owners and staff the Companion Care Counseling program developed by Union Springs Healthcare. The program features a suite of online resources to support community pharmacists, and foster proactive and effective patient counseling and, where appropriate, recommendations of non-prescription solutions. The program also gives independent community pharmacies exclusive access to the Union Spring Healthcare line of clinically validated, pharmaceutical-grade supplements that give patients more treatment options to common health problems. Union Spring Healthcare manufactures the NoctoPlex and NoctoPlex for KIDS sleep formulas, as well as LuciPlex for improved mood, memory, and mental acuity. NCPA members receive special pricing on these non-prescription products.


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    Stakeholders applaud the move, believe CMS isn’t moving fast enough to require PA for broader spectrum of HME
    05/17/2017
    HME News Staff

    WASHINGTON – Rep. Marsha Blackburn, R-Tenn., has introduced legislation that would require prior authorization for certain high priced HME, AAHomecare reported this morning.

    H.R. 2445, the DMEPOS Access and Transparency Act of 2017 or DATA Act, would also exempt claims that have been approved through the prior authorization process from pre- and post-payment audits.

    “This legislation will help stem the tide of Medicare audits that delay payments for providers and also tie up significant resources as providers answer and appeal them,” said Tom Ryan, president and CEO of AAHomecare. “We applaud Congresswoman Blackburn’s longstanding efforts to help rein in excessive audits by establishing an effective prior authorization process that will both improve cash flow for providers and also allow them to concentrate more of their resources and energy on serving their patients.”

    H.R. 2445 builds on a previous bill introduced by Blackburn in 2015. The new bill adds a provision that outlines a more detailed prior authorization process for respiratory equipment. Per the provision, the Department of Health and Human Services would establish a standard for medical necessity evaluation requests for physicians, hospital referral agents and non-physician practitioners.

    CMS launched the first phase of a prior authorization process for two complex power wheelchair codes, K0856 and K0861, in March. In this first phase, CMS has begun requiring prior authorizations in one state in each of the four DME MAC jurisdictions. In phase two, it will expand the program to the remaining states.

    CMS pulled the two codes from a “master list” of 135 codes for which it says it may, eventually, apply the process*. The list also includes CPAP devices, semi-electric hospital beds, manual wheelchairs and oxygen concentrators.

    As part of separate demonstration project, CMS has had a prior authorization process in place for power mobility devices since 2012. The process kicked off in seven states that year and expanded to an additional 12 states in 2014.


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    05/18/2017
    HME News Staff

    WASHINGTON – Rep. Cathy McMorris-Rodgers. R-Wash., is circulating a sign-on letter asking HHS Secretary Tom Price to make significant changes to HME policy.

    The letter, which is also addressed to CMS Administrator Seema Verma, asks for reform in four key areas: relief for non-competitive bid areas; reforms to the competitive bid program; relief for CRT accessories; and the restoration of oxygen rates in rural areas.

    “CMS has continued to implement further reductions with very little regard to the input from providers and the intent of Congress,” said John Gallagher, VGM’s vice president of government relations “The reforms outlined in this letter would provide great relief for providers who are struggling to provide care to their patients and must be implemented immediately.”

    HME providers have been especially hard hit by a reduction in reimbursement of about 50% since the rural roll out began in January 2016. That, in turn has led to a 38% decrease in the number of HME providers nationwide, according to CMS’s own data. A recently announced fee schedule update, required by a provision in the Cures Act to retroactively delay a second round of cuts that went into effect on July 1, 2016, fell short of what Congress intended, say stakeholders. That’s because CMS recalculated the rates based on the lower July 1 rates, rather than the Jan. 1 rates.

    AAHomecare, VGM, and other industry stakeholders are asking providers to call their members of Congress and ask them to support the letter.

     


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    05/19/2017
    Theresa Flaherty

    WASHINGTON – AAHomecare hopes a new bill will be the legislative push for CMS to speed up a prior authorization process for certain HME.

    Rep. Marsha Blackburn, R-Tenn., introduced H.R. 2445, the DMEPOS Access and Transparency Act of 2017 or DATA Act, on May 17. The bill follows a prior authorization process being in place for power mobility devices since 2012, and a process being in place for two complex power wheelchair codes since March of this year.

    “I think having legislation will make it easier for CMS to embrace and move forward with doing some of those prior authorization processes that aren’t as similar to how the process for PMDs works,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “I know CMS feels logistically hand-tied by what they feel they have the authority to do.”

    Back in 2015, CMS issued a final rule that would establish a prior authorization process for certain high-priced HME, saying it would work off of a “master list” of 135 codes. But it wasn’t until 2017 that the agency picked the ball back up and selected two codes from that list—the two complex power wheelchair codes—for prior authorization.

    With prior authorization seen as a key way to help rein in excessive audits, that’s not fast enough, AAHomecare says. Additionally, Blackburn’s bill would also exempt claims that have been approved through the prior authorization process from pre- and post-payment audits.

    “We’re still going to have reviews where they are looking for proof of delivery or required documentation,” said Brummett. “But the medical necessity piece of the audits has always been the most subjective, so taking that away is huge.”

    Blackburn’s bill is similar to a previous version introduced in 2015, but it adds a provision requiring a more detailed prior authorization process for respiratory equipment. Per the provision, the Department of Health and Human Services would establish a standard for medical necessity evaluation requests for physicians, hospital referral agents and non-physician practitioners.

    “The respiratory folks were very clear that they want it to be prescriber-driven so that the supplier isn’t always caught in the middle,” said Brummett.


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  • 05/19/17--11:17: Appeals backlog wears on
  • ‘Hopefully we’re still in business when our cases get to a judge,’ says provider Donna Barraclough
    05/19/2017
    Liz Beaulieu

    YARMOUTH, Maine – A whopping 92% of respondents to a recent HME Newspoll say they have claims stuck at the administrative law judge level and are waiting—and waiting—for hearing dates.

    The largest majority of poll respondents (28%) say their claims are going on three years old.

    “This is a major cash flow problem,” wrote Mary Klavoon of Buffalo Wheelchair in Buffalo, N.Y. “We buy and pay for equipment, and dispense to our qualified Medicare recipients, only to have to wait three to four years to have something reviewed and hopefully paid.”

    At last count, 884,017 appeals were waiting to be adjudicated by the Office of Medicare Hearings and Appeals. Using its current resources (and without any additional appeals), it would take OMHA 11 years to process that backlog.

    Poll respondents say their businesses could fold, their patients could die—all by the time they’re scheduled for hearing dates to review their appeals.

    “We are a small business; if too many claims go to higher levels, this could jeopardize us staying in business,” wrote Donna Barraclough of Apple West Home Medical Supply in Emeryville, Calif. “We evaluate our case and if we feel we can win, we continue to appeal. Most denials are for reasons that can usually be overturned at the higher levels. If we lose, we learn more ways to help us make sure that future claims pass audits. Hopefully we’re still in business when our cases get to a judge. We recently won two cases from 2013.”

    And therein lies the biggest frustration for many poll respondents: In the large majority of cases (as much as 90% of the time, according to stakeholder estimates), they win on appeal, meaning the claims should never have been denied in the first place.

    “It’s very frustrating to see these same names over and over again on reports, servicing them and knowing that you are not being paid a dime,” wrote Ken Wells of Tucker-Wells Medical in Florence, S.C. “All of the claims were rejected for miniscule things or in error, and should have never been rejected. I appealed because I know that I will win 100% of them.”

    Despite their frustrations, poll respondents say they continue to appeal claims because they have few other options—and they do it on principle.

    “It’s killing us, but yes, we continue to appeal, otherwise the bad guys win,” wrote Terry Pinto of Home Medical in Aiken, S.C.


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    05/19/2017
    HME News Staff

    ATLANTA – Medtrade officials have shortened this year’s show and added a cash incentive to attendees who stick around for the duration.

    Show officials will end this year’s Medtrade, slated for Oct. 23–25 at the Georgia World Congress Center, on Wednesday evening instead of Thursday afternoon. Additionally, they will extend exhibit time by an extra hour on days two and three, keeping the show floor open until 5 p.m.

    The changes are based on exhibitor feedback and survey data, show officials say.

    “We are modifying the show schedule to provide exhibitors with the highest quality exposure to Medtrade attendees, as well as to offer the best experience for attendees—many of whom may be able to save additional money on hotel and expenses,” said Sarah Varner, marketing director, in a press release.

    The show will end on Wednesday evening with a networking reception on the show floor, during which attendees will have the chance to win a $5,000 cash prize.

    Medtrade got its start in 1979 and grew into the HME industry’s largest event, drawing thousands of attendees from all over the country. Drastic changes in reimbursement and industry consolidation, however, have chipped away at attendance from both providers and exhibitors.

    This year’s show has 243 exhibitors already, including several new companies. Fifty-three workshops and educational sessions will take place during the show’s three days.

    Early registration for Medtrade starts soon.

    Congresswoman releases support letter

    WASHINGTON – Rep. Cathy McMorris-Rodgers, R-Wash., is circulating a sign-on letter asking HHS Secretary Tom Price to make significant changes to HME policy.

    The letter, which is also addressed to CMS Administrator Seema Verma, asks for reform in four key areas: *relief for non-competitive bid areas; reforms to the competitive bid program; relief for CRT accessories; and the restoration of oxygen rates in rural areas.

    “CMS has continued to implement further reductions with very little regard to the input from providers and the intent of Congress,” said John Gallagher, VGM’s vice president of government felations. “The reforms outlined in this letter would provide great relief for providers who are struggling to provide care to their patients and must be implemented immediately.”

    HME providers have been especially hard hit by a reduction in reimbursement of about 50% since the national roll out of competitive bidding began in non-bid areas in January 2016. That, in turn, has contributed to a 38% decrease in the number of HME providers nationwide, according to CMS’s own data.

    A recently announced fee schedule update, required by a provision in the Cures Act to retroactively delay a second round of cuts that went into effect on July 1, 2016, fell short of what Congress intended, say stakeholders. That’s because CMS recalculated the rates based on the lower July 1 rates, rather than the Jan. 1 rates.

    AAHomecare, VGM, and other industry stakeholders are asking providers to call their members of Congress and ask them to support the letter.

    RAC to perform rare underpayment review

    ATLANTA – Performant Recovery, the new national RAC for DME, will perform an underpayment review for Group 3 power wheelchair options. The Patient Access and Medicare Protection Act mandates that adjustments to the 2016 Medicare fee schedule amounts for certain DME that are based on information from the competitive bidding program cannot be applied to wheelchair accessories, including seating systems, and seat and back cushions furnished in connection with codes K0848-K0864. The change was effective Jan. 1, 2016, but CMS was unable to implement changes to its processing systems until July 1, 2016. Payments during that time were based on adjusted fee schedule amounts. “DME suppliers rarely experience RAC underpayments, so this is a welcome change,” said Wayne van Halem, president of The van Halem Group, a division of the VGM Group. “Many folks don’t know this, but the RACs are funded to find underpayments, in addition to overpayments, and in this environment, every little bit helps.”

    Legal wrangle: ResMed withdraws complaint, plans to refile

    SAN DIEGO – ResMed has filed a motion to dismiss a complaint against Fisher & Paykel so that it can refile using new evidence it has gathered that will it a give stronger case, according to a press release. ResMed first lodged its complaint with the International Trade Commission in August 2016. ResMed claims that the New Zealand based Fisher & Paykel’s masks violated its patented technology. “We’re committed to protecting our innovation, which is why we’ve engaged in global legal proceedings with Fisher & Paykel,” said David Pendarvis ResMed’s global general counsel and chief administrative officer in the release. In January, ResMed settled a long-running patent infringement battle with BMC and 3B Medical.

    Urgency grows for complex rehab accessories

    WASHINGTON – With July 1 looming, complex rehab technology stakeholders are asking everyone to step up efforts to get lawmakers to sign onto H.R. 1361 and S. 486 to stop Medicare from implementing reimbursement cuts for complex rehab accessories. Last year’s version of the bills drew 147 and 26 co-sponsors respectively, but many of those lawmakers have yet to sign on to this year’s bills, says Don Clayback, executive director of NCART. “There are almost 90 members of Congress who signed on as co-sponsors last year but have not yet resigned,” he said. “We need all stakeholders reaching out to Congress now.” Late last year, stakeholders were able to secure a six-month delay in CMS’s plans to apply competitive bidding-related pricing to accessories for complex power wheelchairs—a delay that expires July 1. Go to www.protectmymobility.org to find links to email or call your members of Congress. For a list of current sponsors, go here.

    NSM makes debut in Washington state

    NASHVILLE, Tenn. – National Seating & Mobility announced two acquisitions on May 12, including its first in Washington state.

    NSM has acquired Dependable Medical Equipment in Seattle, adding four assistive technology professionals (ATPs) and one rehab technology supplier (RTS) to its roster. “National Seating & Mobility is committed to expanding our reach to those in need of mobility and accessibility solutions,” said Bill Mixon, CEO. “We look forward to partnering with the medical and rehabilitation communities in Seattle to provide specialized products and services designed to maximize the mobility and independence of individuals with disabilities.”  NSM has also acquired Columbus Medical Equipment in Columbus, Ohio, adding three ATPs and one RTS to its roster, and increasing its existing service capabilities in the central Ohio area. Additionally, in conjunction with its acquisition of Columbus Medical Equipment, NSM will launch its first AccessNSM home solutions location in Ohio. NSM launched its home solutions company in 2015. Including Ohio, it now offers stair lifts, wheelchair lifts, ramps, door openers and barrier-free showers in nine states.

    SoClean recognized for innovation

    OXFORD, Mass. – SoClean, the makers of a CPAP sanitizer, was named the winner of the Small Business Association of New England Innovation award. The annual award is given to companies that transform innovative ideas into a product or service that delivers value to customers. “The SoClean team is honored to be the recipient of such a prestigious award,” says Mike Schmidt, president of SoClean, in a release. “We are committed to raising awareness of sleep apnea so sufferers will seek treatment.” 

    HOMES meeting wraps up with awards, boards

    FALMOUTH, Mass. – Cathy Hamilton of Coastal Med Tech and Sean Andrews of Bedard Medical received the 2017 Outstanding Volunteer Award from HOMES during the association’s annual meeting, held May 8-9. Jason Morin of Home Care Specialists received the Christopher J. Denmark Commitment to Excellence award. HOMES members also voted on a board of directors. Officers are: Chairman, Dana Lesperance, Absolute Respiratory; Vice Chairman, Rich Tobin, Keene Medical Products; Treasurer, Cathy Hamilton, Coastal Med Tech; Secretary, Peter Tallas, Charm Medical Supply; and Immediate Past Chair, Jason Morin, Home Care Specialists.

    Online CPAP provider compares travel devices

    WEST BERLIN, N.J. – With a number of travel CPAP devices now on the market, Agile Medical, the parent company of www.thecpapshop.com, has developed a specific landing page on the website and posted a comparison guide and videos. Featured on the website are the newly launched ResMed AirMini and Philips DreamStation Go, as well as existing devices in the market from Somnetics (Transcend) and Human Design Medical (Z1). “Consumers feel that they make a better buying choice when price and feature comparisons are transparently available from online shopping carts,” said Chris Vasta, president of www.thecpapshop.com. ResMed and Philips both launched their travel CPAP devices in April.

    QS/1 seeks new leadership

    SPARTANBURG, S.C. – Tammy Devine, president of QS/1, will retire later this year. Devine began her career at the company as a programmer, nearly 35 years ago. She became president in 2011 after holding a series of managerial roles, including executive vice president. QS/1’s parent company, J M Smith, is conducting a national search for Devine’s successor. One of her last acts of leadership: launching QS/1’s latest product, SharpRx, a next generation management system for independent pharmacies.

    Meet Emma, your home infusion guide

    ORLANDO, Fla. – Repro Med Systems, dba RMS Medical Products, will launch a social media marketing campaign at the National Home Infusion Association Conference and Expo on May 22. RMS will introduce “Emma” as the new face of the company. Emma will be on Twitter, Facebook, Instagram and other social media platforms connecting with medical professionals and patients, and sharing information about the industry and RMS products. RMS will also add an area called “Ask Emma” to its website so medical professionals and patients can ask questions and receive answers about infusion therapy. RMS manufactures products used for home infusions and suctioning. Its portfolio includes the Freedom60 and FreedomEdge syringe infusion drivers, Precision Flow Rate Tubing and High-Flo Subcutaneous Safety Needle Sets.

    Sleep apnea short takes: More testing for truckers, more cases among service members

    The U.S. Supreme Court’s refusal to hear a case from a truck driver who claimed his employer violated his rights by requiring him to get tested for sleep apnea opens the door for trucking companies to more widely require the tests, according to Trucks.com. The court’s decision in April follows Robert Parker’s appeal of a lower court decision that Crete Carrier didn’t violate his rights under the American with Disabilities Act when it required him to be tested because he had a body mass index of 35 or higher. While there are currently no federal regulations for tracking or treating sleep apnea in transportation workers, the government has been working on guidelines for more than a year…Sleep apnea cases have increased five-fold in the U.S. military over a decade, according to a recent study in the Journal of Sleep Research. Rates of sleep apnea and insomnia among service members are now about double those seen in the general U.S. population, the journal reports. Medical visits for sleep apnea increased from 44 per 1,000 service members per year in 2005 to 273 per 1,000 per year in 2014, researchers found. Sleep apnea rates were highest among men, African Americans, senior officers, Army personnel and those over the age of 40, they found.


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    05/19/2017
    HME News Staff

    ATLANTA – Medtrade officials have shortened this year’s show and added a cash incentive to attendees who stick around for the duration.

    Show officials will end this year’s Medtrade, slated for Oct. 23–25 at the Georgia World Congress Center, on Wednesday evening instead of Thursday afternoon. Additionally, they will extend exhibit time by an extra hour on days two and three, keeping the show floor open until 5 p.m.

    The changes are based on exhibitor feedback and survey data, show officials say.

    “We are modifying the show schedule to provide exhibitors with the highest quality exposure to Medtrade attendees, as well as to offer the best experience for attendees—many of whom may be able to save additional money on hotel and expenses,” said Sarah Varner, marketing director, in a press release.

    The show will end on Wednesday evening with a networking reception on the show floor, during which attendees will have the chance to win a $5,000 cash prize.

    Medtrade got its start in 1979 and grew into the HME industry’s largest event, drawing thousands of attendees from all over the country. Drastic changes in reimbursement and industry consolidation, however, have chipped away at attendance from both providers and exhibitors.

    This year’s show has 243 exhibitors already, including several new companies. Fifty-three workshops and educational sessions will take place during the show’s three days.

    Early registration for Medtrade starts soon.

     


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    05/23/2017
    HME News Staff

    HARTFORD, Conn. – CareCentrix has teamed up with Performant Financial Corporation, the new national RAC for DME, home health and hospice, to deploy specialized analytics and algorithms to better identify and decrease waste and fraud, it announced May 23.

    “You only need to look at recent headlines to know that the problems of fraud, waste and abuse are only increasing,” said John Driscoll, CareCentrix CEO, in a press release. “CareCentrix is committed to bending the cost curve in health care by working with payers to guide care for their members to the home. We are thrilled to expand our capabilities in identifying and decreasing waste and fraud insurance claims in home health care and DME, and look forward to working with Performant to stay on the cutting edge of curbing this trend for our clients.”

    Home health and DME are known as high-risk areas for insurance abuse and error, representing more than $11.4 billion in improper payments each year for Medicare alone, according to the release.

    Because home health and DME claims are often high volume, but low unit cost, traditional approaches to detecting waste and fraud often fall short, CareCentrix says.

    “By leveraging their collective experience in home health care and cost-containment solutions, CareCentrix and Performant will deploy specialized analytics and algorithms to better detect the patterns that are often overlooked but add significant cost to health care payers,” the release states.

    Performant says DME and home health have become a growing concern for healthcare payers.

    “We are excited to leverage CareCentrix’s unmatched knowledge of home care management in pursuit of our mutual goal to curb improper payments,” said Simeon Kohl, senior vice president of healthcare at Performant, in the release.


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