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    ‘We are disappointed that they are taking away quality customer service and care’
    08/18/2017
    Liz Beaulieu

    YARMOUTH, Maine – Managed care organizations targeting single-source or preferred provider contracts to provide DME and supplies for Medicaid recipients is a trend that’s spreading across the country, according to the results of a recent HME Newspoll.

    Fifty percent of respondents to the poll report that an MCO in their state has successfully implemented such a contract, and 61% report an MCO in their state is in the process of moving to such a contract.

    “Providers were not involved or asked for input with this decision,” wrote Tamme Dustin, president and owner of Herron & Smith in Hooksett, N.H., where MCO New Hampshire Healthy Families, part of Centene Corp., has contracted with Medline to provide incontinence supplies for its members starting Oct. 1. “We are disappointed and frustrated that they are taking away quality customer service and care for the beneficiaries who have built relationships over the past few years with the provider group.”

    The Newspoll is a follow-up to a story on MCOs in Indiana and Texas targeting contracts with distributors to provide DME and supplies to their members. One of the MCOs, Superior HealthPlan, also part of Centene, recently delayed the start date of its contract with Medline until Oct. 1 and is contemplating recasting the contract as “preferred provider” vs. “single-source” to make it more clear that members will still have their choice of provider.

    In some states, more than one MCO is targeting these contracts. In Tennessee, for example, there are three MCOs administering the Medicaid program: One contracted with Medline to provide incontinence supplies in 2015; another has contracted with the Edgepark Medical Supplies, part of Cardinal Health, to provide those supplies starting Nov. 1.

    “Amerigroup rounds out the MCOs in our state,” wrote Juli Kirby, the office manager for Health Care Plus in Knoxville. “Will they follow suit?”

    In Illinois, stakeholders have been successful so far in beating back these contracts, but one respondent is realistic that the threat will likely never be gone.

    “This was on the table in Illinois a couple of years ago but was pulled back,” the respondent wrote. “Our state association got involved and helped with the efforts against this, but we still feel single-source contracting is a strong possibility in the state. I am also wondering if other payers will move to this model. It is concerning how this will affect the beneficiaries, in regards to the lack of face-to-face instruction of the products.”

    A respondent in Pennsylvania reported that an MCO there will at least have an “any willing provider” provision in its contract. But when the reimbursement attached to these contracts are as low as they are, that’s little consolation.

    “We’re so sick of being cut,” said one respondent. “There is nowhere left to cut.”


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    08/18/2017
    HME News Staff

    WASHINGTON – Claims submitted by providers that have the highest claim error rates or billing practices that vary significantly from their peers will soon face increased scrutiny, CMS has announced.

    As part of an expanding “Targeted Probe and Educate” program, the Medicare Administrative Contractors will identify these providers through data analysis.

    “TPE claim selection is different from that of previous probe and educate programs,” the agency stated in an Aug. 14 announcement on its website. “Whereas previously the first round of reviews were of all providers for a specific service, the TPE claim selection is provider/supplier specific from the onset. This eliminates burden to providers who, based on data analysis, are already submitting claims that are compliant with Medicare policy.”

    Per the program, the MACs will review 20 to 40 claims per provider, per item or service, per round, for a total of up to three rounds of review. After each round, providers will be offered individualized education based on the results of their reviews.

    Providers with moderate and high error rates in the first round of reviews, will continue on to a second round of 20-40 reviews, followed by additional education. Providers with high error rates after the second round will continue to a third and final round of reviews and education.

    Providers with continued high error rates after three rounds of review may be referred to CMS for additional action, which may include 100% pre-pay review, extrapolation, referral to a Recovery Auditor Contractor, or other action.

    Providers may be removed from the review process after any of the three rounds of review, if they demonstrate low error rates or sufficient improvement in error rates, as determined by CMS.

    The program began as a pilot project in one MAC jurisdiction in June 2016 and was expanded to three additional jurisdictions in July 2017. CMS will expand the program to all jurisdictions later this year.

    Lawmakers question CPAP bundling program

    WASHINGTON – A bipartisan group in the House of Representatives is circulating a congressional sign-on letter that asks CMS to delay a CPAP bundling pilot program from the next round of competitive bidding.

    The letter states a number reasons for delaying the program, including the lack of evidence that it will save money or enhance care, and CMS’s lack of authorization to test alternative payment models as part of its competitive bidding program.

    “Instead, we encourage the agency to work with Congress and stakeholders to prioritize efforts that bring stability to the program,” the letter states. “If the agency is interested in reforms to ensure better compliance with CPAP therapy and other home respiratory care, we stand ready to work with you on initiatives that have a greater potential to save money and improve health outcomes.”

    AAHomecare encourages HME providers and other stakeholders to ask their representatives to add their names to the letter by Sept. 13.

    The association has argued that bundling a CPAP device, consumable items, maintenance and service into a single monthly payment could cause disruption for providers, could provide an incentive to furnish inferior products, and could result in lower quality of care.

    CMS announced earlier this year that it had added 10 new competitive bidding areas for the CPAP product category. In five of those CBAs, payment for CPAP devices, related accessories and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like other existing CBAs.

    The sign-on letter is being spearheaded by Reps. Tim Walberg, R-Minn., Debbie Dingell, D-Mich., Cathy McMorris Rodgers, R-Wash., Scott Peters, D-Calif., and Michael Bishop, R-Mich.


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    08/18/2017
    HME News Staff

    NEW YORK – The D.C. Circuit on Aug. 11 ordered a federal judge to take a deeper look at whether or not the U.S. Department of Health and Human Services can clear a backlog of about 600,000 appeals by 2021, while still protecting taxpayer dollars, according to Law360. The ruling is a setback for the American Hospital Association, which has been fighting HHS in court over the backlog for several years. The D.C. Circuit, in a 2-1 ruling, said the judge didn’t properly evaluate HHS’s assertion that it could only clear the backlog by entering into mass settlements that would pay hospitals regardless of the merits of their appeals, something that would violate the agency’s legal duty to pay only legitimate claims, Law360 reports. The AHA first filed a lawsuit over the backlog in 2014 and since then the case has gone back and forth between the district and circuit courts. Most recently in January, the U.S. District Court for the District of Columbia stood its ground, with Judge James Broasberg refusing to rescind a previous order on Dec. 5 requiring the agency to eliminate the backlog by 2021.

    Superior HealthPlan makes changes to Medline contract

    AUSTIN, Texas – Superior HealthPlan, a managed care company that’s administering part of the state’s Medicaid program, has decided to delay a contract with Medline until Oct. 1, according to the San Antonio Express-News. The contract, which includes 244 codes for DME and supplies, was set to start Sept. 1. Superior Health Plan, part of Centene Corp., also plans to recast the contract as “preferred provider” vs. “single source,” making it clearer that Medicaid recipients will still have their choice of provider, the newspaper reported. The changes to the contract come on the heels of a hearing before the state’s Committee on Human Services in the House of Representatives on Aug. 9. During the hearing, lawmakers suggested that Superior HealthPlan amend its notice to patients to say they can “opt out for any reason or no reason at all,” the newspaper reported. Prior to the hearing, a number of providers, including Respiratory & Medical Homecare and Alliance Medical Supply, had sent letters of protest to different offices of the Texas Health and Human Services Commission, as well as Superior HealthPlan. Superior HealthPlan’s contract in Texas is only one of many such contracts between managed care companies and distributors spreading nationwide.

    NSM buys Alabama Wheelchair Specialists

    NASHVILLE, Tenn. – National Seating & Mobility has acquired Alabama Wheelchair Specialists in Birmingham, Ala. NSM will serve the company’s clients from its existing branch in Pelham, Ala. “This acquisition not only expands our service area in the state, but also broadens the service offerings and choices for individuals with mobility challenges in Alabama,” said Bill Mixon, NSM CEO. Assistive technology professionals Mike Oliver and Dave Nix, representing 77 years of experience, will continue to service clients from the Pelham branch. NSM will also add a funding specialist and technician to the branch’s staff. NSM also serves clients in the state from branches in Mobile and Montgomery, Ala. Already this year, NSM has acquired Mobility Healthcare, with locations in Carrollton and Lewisville, Texas; Dependable Medical Equipment in Seattle; Columbus Medical Equipment in Columbus, Ohio; and most recently, the mobility division of Wright & Filippis in Rochester Hills, Mich.

    PA update: Docs may request decision letter

    WASHINGTON – The prescribing physician/practitioner may contact the DME MAC to request a copy of the prior authorization decision letter, CMS has announced. The request for the letter may be included with the documentation sent to the provider as part of the prior authorization request, or may be made separately. The DME MAC will not automatically send the letter. AAHomecare, which has expressed concern with the lack of physician involvement in the correspondence of the PA decision, applauded the change. “Unlike the PMD demonstration, under the PA expansion, DME MACs cannot automatically communicate with referring physicians on the PA decision,” the association stated. “AAHomecare thanks CMS for the opportunity to provide feedback and for implementing a crucial modification to the program.” In July, providers in all states began submitting prior authorization requests for two complex rehab codes, K0856 and K0861.

    Lofta launches website for AirMini

    SAN DIEGO – Lofta, a home medical device retailer, has launched a new e-commerce website devoted exclusively to the AirMini, ResMed’s new travel CPAP device. The website, www.buyminicpap.com, features a la carte purchasing for the AirMini and compatible full-face, nasal and nasal pillows masks, as well as complete bundles. Lofta offers unlimited access to its support team through the website’s online chat or by phone. The company also offers a 30-day risk free trial period and a zero interest 12-month payment program. In addition to the new website, Lofta offers a “Complete Path” for sleep therapy, a streamlined, concierge-style service that moves sleep apnea sufferers through the necessary steps to therapy, all from the convenience of their own homes. ResMed launched the AirMini this summer.

    Aeroflow criticizes decision to drop sleep reg

    ASHEVILLE, N.C. – Aeroflow Healthcare says the federal government’s decision to scrap a regulation to require sleep apnea screening for commercial drivers and rail workers is ill advised. “This is a clear and present danger on our roads, rails and highways,” said Michael Trufant an industrial manager at Aeroflow, in a statement. “Our traveling public should not be exposed to danger on their commutes.” Trufant says the arguments against the regulation have everything to do with the cost of testing and treatment, not with safety. “The cost is minimal,” he said. “The safety imperative is pressing.” Aeroflow released the statement in support of Sen. Chuck Schumer, D.N.Y., who says the rulemaking process for the regulation should be re-instated. Earlier this month, the Federal Railroad Administration and the Federal Motor Carrier Safety Administration said they were scrapping the regulation, arguing that it should be up to trucking and railroad companies to decide whether or not to screen their employees. It’s a change in direction for the agencies under President Donald Trump, who has pledged to drastically slash federal regulations. Last year, the agencies announced a proposal to require screening for commercial drivers and railroad workers, and sought public input.                                                                            

    Coloplast reports 8% organic growth for Q3

    MINNEAPOLIS – Coloplast says its integration of Comfort Medical continues to “progress to plan” and its U.S. chronic care business saw double-digit organic sales growth in the third quarter. The company, which has its U.S. headquarters here but is based in Denmark, announced last year that it was buying Coral Springs, Fla.-based Comfort Medical for $160 million in cash, combining a manufacturer of ostomy, urology, continence and wound care supplies with a provider of those supplies. Overall, Coloplast reported organic growth of 8% in the third quarter of the 2016-17 fiscal year. Growth by business was 7% for ostomy care, 10% for continence care, 10% for urology care, and 1% for wound and skin care. Coloplast reported EBIT was up 9% for the quarter at constant exchange rates and EBIT margin was at 33% at constant exchange rates. The company says revenues for the third quarter were adversely affected by a one-off adjustment made after the company identified “incorrect management of contractual obligations” related to an agreement with the Department of Veterans Affairs for 2009-17. Coloplast continues to expect organic revenue growth of 7% to 8% at constant exchange rates. EBIT margin guidance remains at 33% to 34% at constant exchange rates.

    Cancer survivor opens HME business

    WINDSOR, Colo. – A 27-year-old cancer survivor has opened a medical supply business here called I Love Lucy’s Home Medical Supply and Equipment. Lucia Sodre told the Greeley Tribune she hopes her medical supply store will help others experiencing life-altering health issues, with a focus on offering education and options. "Just because you're going through an illness or a difficulty in your life and you have certain limitations doesn't mean that you don't want to be normal, that you don't want to look good," she told the newspaper. "And it doesn't mean that you're done living." After being diagnosed with cancer and having a lump removed from her throat, Sodre used a machine at home to keep her throat clear and a cane to help her walk.

    Delivery system in jeopardy, new white paper shows

    WATERLOO, Iowa – U.S. Rehab, a division of the VGM Group, has released a white paper analyzing the current state of the DME industry. The paper, “The Delivery of DMEPOS is in Jeopardy,” provides a data-driven perspective on the adverse effects of competitive bidding on both patients and providers of DME, complex rehab and O&P. “If the current issues with reimbursement are not addressed, irreparable harm will be done to this delivery system,” said Greg Packer, president of U.S. Rehab. “With reimbursement rates below cost of many products and repairs of those products, we are already seeing the rationing of health care and the inability of patients to receive products and services that have always been available and guaranteed by Medicare.” The paper is the first in a series that aims to provide stakeholders with tools to engage members of Congress and to share with advocates.

    Aeroflow moves up top ranked list

    ASHEVILLE, N.C. – Aeroflow Healthcare has ranked #2450 on the 2017 Inc. 5000, a list recognizing the country’s fastest growing private companies. This is the third consecutive year that Aeroflow has ranked on the list, coming in at #3089 in 2015 and #3100 in 2016. Only one in five companies makes the list three times in a row, the company says. Helping Aeroflow to move up this year: record-breaking yearly sales growth of 146%, the company says. “Aeroflow Healthcare is once again on track to have a record year in sales, achieving over $73.6 million in 2016,” it stated.

    Mediware signs up another HME biz

    LENEXA, Kan. – Quirantes Orthopedics has licensed CareTend Software for its HME business, Mediware has announced. Quirantes specializes in a full range of orthotics and prosthetic supplies to residents in Florida. “With CareTend software, we saw many opportunities to automate our business and save time using the workflow, reporting and inventory tools,” said Marino Reyes, vice president at Quirantes. “We look forward to using CareTend and transitioning from our manual, paper-based process to a completely automated business management solution.”

    Studies: COPD deaths increase, CPAP therapy improves with support from partner

    In 2015, 3.2 million people died from COPD worldwide, an increase of 11.6% compared to 1990, according to an article published in the journal The Lancet. There was a decrease in the age-standardized death rate of 41.9%, but this was counteracted by population growth and aging of the global population. From 1990 to 2015, the prevalence of COPD increased by 44.2%, whereas the age-standardized prevalence decreased by 14.7%. Smoking and ambient particulate matter were the main risk factors for COPD followed by household air pollution, occupational particulates, ozone, and secondhand smoke. Together, these risks explained 73.3% of disability-adjusted life years due to COPD…A person’s partner may play a pivotal role in diagnosing sleep apnea and adhering to therapy, suggests a study published in the journal Sleep Health. “Couple-directed interventions that advocate for a mutually engaging perspective and promote supportive relationships and positive dyadic coping may be targets for improving CPAP adherence,” the study states. Researchers found that facilitators to CPAP use were: the partner aiding diagnosis and treatment, couples working together using CPAP, the perceived benefits of CPAP for both partners, the patient being motivated to use CPAP for the benefit of the partner, and various types of support provided by the partner to encourage CPAP use, according to the study.

    Short takes: AAHomecare, Brightree

    “On account of requests from several providers,” AAHomecare is extending the deadline for submissions for second quarter 2017 data for the HME Audit Key to Aug. 25. The association reminded providers that individual data is not required to participate, just cumulative counts of pre- and post-payment audits and appeal claim outcomes. The survey is open to all providers…Brightree will hold its 2017 Brightree Summit on Oct. 23 at the Omni Hotel in Atlanta in conjunction with Medtrade, Oct. 23-25 at the Georgia World Congress Center. The Summit offers a variety of training, education and consulting tracks covering resupply, billing and AR, mobile delivery and more. New this year: an app for event information, and a networking reception from 5:30 to 7:30 p.m.

     


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    08/23/2017
    Liz Beaulieu

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    AMARILLO, Texas – HME providers in Texas have solid ground to stand on when it comes to their criticism of a new Medicaid contract that makes Medline a single-source provider of 244 DME supplies, says an industry attorney.Pam Colbert, a member of the Health Care Group at the law firm Brown & Fortunato, outlined a number of ways the contract violates Texas law in her complaint on behalf of Alliance Medical Supply, a provider in San Antonio. It’s anything but competitivePer the Texas Government Code and the Texas Health and Human Services Procurement Manual, the “fundamental premise underlying public procurement is the requirement of equal opportunity allowing all qualified responsive and responsible vendors an opportunity to obtain the government’s business,” Colbert writes in the compliant.“The sole source contract provided to Medline from Superior does not have a valid justification for awarding Medline exclusive right to provide hundreds of DME supplies that numerous, local, participating Texas DME supplies are currently providing,” she wrote. “Superior’s sole source, exclusive contract with Medline diminishes, not stimulates, competition. The contract clearly promotes favoritism and does not secure the best work and materials at the lowest price, for the best interests of the taxpayers and property owners.”It eliminates choiceColbert points out that HHS this past June established “MCO Policy Guidance on Preferred Provider Arrangements” in direct response to recent efforts by several MCOs to establish preferred provider arrangements for medical supplies. The goal: to protect the ability of Medicaid recipients to choose the network participating DME supplier they prefer.“Superior has already begun to remove the ‘choice’ of suppliers as evidenced in its notice that it is automatically cutting off current suppliers’ DME services to members as of Aug. 31,” she wrote. “Further, Superior advised Alliance on a recorded call on July 7 that, ‘Patient does not have a choice starting Sept. 1—it will automatically go through Medline.’”It increases the chance for fraudColbert also points out that as part of the contract, Medline does not have to submit prior authorizations for any supplies. Furthermore, Superior has authorized the company to fill in and complete doctor’s prescriptions.“The removal of these compliance elements certainly lends itself to opportunities and implications for ‘kickbacks,’ upcoding, providing services not medically necessary and billing for services not provided,” she writes. “Exclusive removal of controls for one, large, exclusive DME supplier certainly puts Texas Medicaid funds at risk for fraud and abuse.”

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    08/23/2017
    Liz Beaulieu

    AMARILLO, Texas – HME providers in Texas have solid ground to stand on when it comes to their criticism of a new Medicaid contract that makes Medline a single-source provider of 244 DME supplies, says an industry attorney.Pam Colbert, a member of the Health Care Group at the law firm Brown & Fortunato, outlined a number of ways the contract violates Texas law in her complaint on behalf of Alliance Medical Supply, a provider in San Antonio. It’s anything but competitivePer the Texas Government Code and the Texas Health and Human Services Procurement Manual, the “fundamental premise underlying public procurement is the requirement of equal opportunity allowing all qualified responsive and responsible vendors an opportunity to obtain the government’s business,” Colbert writes in the compliant.“The sole source contract provided to Medline from Superior does not have a valid justification for awarding Medline exclusive right to provide hundreds of DME supplies that numerous, local, participating Texas DME supplies are currently providing,” she wrote. “Superior’s sole source, exclusive contract with Medline diminishes, not stimulates, competition. The contract clearly promotes favoritism and does not secure the best work and materials at the lowest price, for the best interests of the taxpayers and property owners.”It eliminates choiceColbert points out that HHS this past June established “MCO Policy Guidance on Preferred Provider Arrangements” in direct response to recent efforts by several MCOs to establish preferred provider arrangements for medical supplies. The goal: to protect the ability of Medicaid recipients to choose the network participating DME supplier they prefer.“Superior has already begun to remove the ‘choice’ of suppliers as evidenced in its notice that it is automatically cutting off current suppliers’ DME services to members as of Aug. 31,” she wrote. “Further, Superior advised Alliance on a recorded call on July 7 that, ‘Patient does not have a choice starting Sept. 1—it will automatically go through Medline.’”It increases the chance for fraudColbert also points out that as part of the contract, Medline does not have to submit prior authorizations for any supplies. Furthermore, Superior has authorized the company to fill in and complete doctor’s prescriptions.“The removal of these compliance elements certainly lends itself to opportunities and implications for ‘kickbacks,’ upcoding, providing services not medically necessary and billing for services not provided,” she writes. “Exclusive removal of controls for one, large, exclusive DME supplier certainly puts Texas Medicaid funds at risk for fraud and abuse.”


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  • 08/25/17--11:32: Round 2019 remains a mystery
  • ‘That it’s taking this long for them to make another announcement means there are changes being made’
    08/25/2017
    Liz Beaulieu

    WASHINGTON – HME providers shouldn’t be worried that they’re closing in on one year before the launch of Round 2019 of competitive bidding and they don’t have any details on how CMS plans to proceed, stakeholders say.

    CMS announced earlier this year that it would temporarily delay Round 2019 to give the new administration, including Tom Price, secretary of the U.S. Department of Health and Human Services, time to review the program. Since then, it has been radio silence.

    “That it’s taking this long for them to make another announcement means there are changes being made,” said John Gallagher, vice president of government relations for The VGM Group. “I think the longer it takes, the better it’s going to be.”

    CMS delayed Round 2019 on Feb. 7, just about a week after detailing its plans for the next round on Jan. 31. Those plans included a number of changes to the program, like adding a new product category for insulin pumps and supplies, implementing a lead-item bidding methodology, and introducing a bundled program for CPAP devices and supplies in five bid areas.

    What changes are in play behind the scenes—the original changes and/or other changes that are in line with Price’s previous efforts to replace the competitive bidding program with a market-pricing program—are unknown, stakeholders say.

    “We don’t know what direction they’re going in, or how far they’re going,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “But I don’t think anyone should be worried: Price is committed to making improvements to the program and anything that comes out will be better than what we have today.”

    Stakeholders point out that Price has the authority to extend the existing contracts for Round 1 for another year and the existing contracts for Round 2 for another six months, buying CMS more time to tinker with competitive bidding.

    “If I were a betting person, that’s what I’d bet is going to happen,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “That’s the logical thing to do.”

    Stakeholders say that extra time will be necessary to make substantive changes to the competitive bidding program, a process that will require multiple levels of approval, including from the Office of Management and Budget.

    “If they make the changes we want them to make, which are changes to the existing regulation, that’s a process with a capital P,” Bachenheimer said.


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    Puts emphasis on education, rewards improved performance
    08/25/2017
    Liz Beaulieu

    WASHINGTON – HME stakeholders and billing consultants are “cautiously optimistic” about a new program aimed at streamlining the number of audits.

    CMS announced Aug. 14 that the Medicare Administrative Contractors will soon start focusing their reviews on providers that have the highest claim error rates or irregular billing practices, eliminating the burden on providers who are already submitting claims that are compliant.

    “We’re cautiously optimistic, but it’s something we’ll be monitoring,” said Kim Brummett, vice president of regulatory affairs for AAHomecare.

    Sometime this year, as part of expanding its “Targeted Probe and Educate” program, the MACs will turn off service-specific reviews and turn on these provider-specific reviews across all jurisdictions.

    A big reason for the optimism surrounding the program: After each of up to three rounds of probes of 20 to 40 claims per provider, the MACs will offer individualized education to targeted providers based on the results of their reviews.

    “I’m excited about that,” said Mary Stoner, president of Electronic Billing Services in Sikeston, Mo. “That gives an opportunity for these providers to really get in there and learn what went wrong.”

    The pause between probes for education also gives targeted providers a breather from audits.

    “In the past, once providers got bad results, the audits were constant,” said Kelly Wolfe, owner of Regency, Inc. in Largo, Fla.

    Stakeholders and consultants hope the education also serves as a discussion period of sorts, allowing reviewers and targeted providers to work out issues with claims, some of which could benefit from clinical inference.

    “They may say the physician didn’t document why the patient couldn’t use a cane or walker, but the physician did write that the patient had bilateral wounds on their feet and was non-weight bearing,” Brummett said. “There’s this mentality that if you educate suppliers to do it right, life will be good, but the biggest fear is the nurse reviewer and an incorrect review.”

    Another reason stakeholders and consultants are optimistic: Targeted providers may be removed from reviews after any of the three rounds of probes if they demonstrate low or improved error rates.

    “Providers can prove themselves and close out these probes,” Stoner said. “They can stop.”

    Still, there are a number of vagaries about the program that concern stakeholders and consultants. While CMS says the MACs will target providers using data analysis, it doesn’t say what will be considered a high error rate.

    “They’re not publishing that,” Brummett said. “I get why—if they say it’s 50%, that looks like a ridiculously high number, especially on the Hill—but we’re hoping the MACs are going to be reasonable.”

    Additionally, stakeholders and consultants remind providers the stakes are still high under the new program. Providers with continued high error rates after three rounds of review may be referred to CMS for additional action.

    “CMS has made comments that they could be turned over to CMS, the RAC or to the ZPICs,” Brummett said. “The ZPIC is a bit terrifying. They have broad authority; they could kill a provider’s supplier number.”


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    08/25/2017
    HME News Staff

    LEBANON, Tenn. – Permobil has acquired Auckland, New Zealand-based Durable Medical Equipment, Ltd., the largest complex rehab company in the country, it has announced.

    The deal allows Permobil to “increase access to care” in New Zealand.

    “Permobil is dedicated to building a leading healthcare company by providing advanced rehabilitation technology driving growth through education and outcomes, delivered with passion and first-class service,” said Larry Jackson, president of Permobil Business Region Americas. “DME shares this vision, which makes this a strong match. We are excited to welcome DME’s employees to the Permobil family to further increase access to care in New Zealand.”

    DME was started in 1999. Permobil, which was founded in 1967, currently has 1,500 employees in 17 countries. It is owned by Patricia Industries, a subsidiary of Investor AB, a Swedish investment firm.

    Salter Labs acquires InnoMed

    LAKE FOREST, Ill. – Salter Labs has acquired Coconut Creek, Fla.-based InnoMed Technologies to broaden its airway management product offerings, according to a press release. InnoMed’s products include non-invasive ventilation and CPAP masks, including the Aloha and the Nasal Aire II. "Salter's strength in respiratory care and long-standing commitment to improving patient satisfaction were the perfect fit for InnoMed's products,” said Shara Hernandez, president of InnoMed Technologies. These technologies bolster Salter's capnography cannulas and strengthen its ability to solve airway management problems for anesthesiologists and respiratory therapists, according to the release.

    Dexcom ships G5 to Medicare beneficiaries

    SAN DIEGO – Dexcom has begun shipping the Dexcom G5 to Medicare beneficiaries who meet coverage requirements for continuous glucose monitoring, according to news reports. CMS in January classified “therapeutic” CGMs as DME, paving the way for coverage if certain criteria are met. In July, Dexcom reached an agreement with Ascensia Diabetes Care to bundle Ascensia’s ContourNext One glucose monitoring system with the G5. CMS has set a one-time fee of $236 to $277 for the CGM receiver, and a monthly allowable of $248.38 for related accessories. Demand for the G5 is so high that 20,000 beneficiaries are “in the pipeline” for a device. The G5 is currently the only CGM approved for insulin dosing.

    MedCare closes storefront

    BRADFORD, Pa. – MedCare Equipment Company has closed its retail store on East Main Street here. A company spokeswoman told The Bradford Era that the store was closed due to lower foot traffic and a change in business philosophy. “What we determined over the last several years is that serving people in a storefront doesn’t actually serve them where they are,” Robin Jennings told the newspaper. “Home medical equipment is served to people at their point of need.” MedCare will continue to offer diabetic and CPAP clinics at the location through the end of the year, according to the newspaper. The company will also continue to deliver HME to area patients in their homes, it said. MedCare had been operating the storefront since 2013, according to the newspaper. The company is headquartered in Greensburg, Pa., and has four other locations in Pennsylvania, and one location in Jamestown, N.Y.

    Aeroflow forms advocacy group

    ASHEVILLE, N.C. – Aeroflow Healthcare today announced that it has formed a breastfeeding advocacy department to promote access to breastfeeding support, supplies and services for families nationwide. With the introduction of this team, the company expands its advocacy efforts for healthy families, aiming to increase breastfeeding rates on both a local and national scale. In February, Aeroflow, which has a Mom & Baby division, launched a petition to keep breastfeeding support as a preventive health benefit. “We want to make the choice to breastfeed an easier one, by continuing the conversation on a national scale, advocating that employers support it comfortably in the workplace, and by encouraging its inclusion in health care legislation and parental leave packages,” said Meghan Bausone, breastfeeding advocacy strategist at Aeroflow.

    van Halem Group gets HIPAAwise

    ATLANTA – The van Halem Group, a division of The VGM Group, has finalized an agreement with HIPAAwise to exclusively offer its online HIPAA Compliance Program application to healthcare providers in the post-acute care market. The application creates a comprehensive dashboard for providers to manage their HIPAA compliance program, including their policies and procedures, security and risk assessment, business associate management, employee awareness programs, location and inventory tracking, and breach management. With this agreement, providers get access to their own online HIPAAwise dashboard, an implementation consultant from The van Halem Group and ongoing support. Wayne van Halem, president of The van Halem Group, says HIPAAwise complements the company’s existing services. “We have always encouraged providers to be proactive and avoid compliance issues,” he said. “The HIPAAwise solution is a simple, efficient, comprehensive, and affordable solution that helps do just that.”

    Invacare adds to board, declares quarterly dividend

    ELYRIA, Ohio – Invacare has appointed Barbara Bodem to its board of directors, the company announced Aug. 21. Bodem has served as senior vice president of finance for Mallinckrodt, a global specialty pharmaceutical company, since October 2015. Invacare says Bodem brings “strong finance, senior management and industry expertise” to the board. The company now has eight directors, seven of whom are considered independent. The board recently declared a cash dividend of $.0125 per share of its common shares and $.011364 per share on its Class B common shares payable Oct. 16, 2017, to shareholders of record on Oct. 5, 2017.

    Geriatric Medical reduces carbon footprint

    WOBURN, Mass. – Geriatric Medical & Surgical Supply, a distributor of medical supplies, has completed construction on a 585kW solar project on the roof of its facility in Woburn, Mass. The company says it is among the largest roof-mounted solar projects completed in the state. The solar project consists of about 1,200 high efficiency solar panels and 540 inverters that will allow Geriatric Medical to produce in excess of 100% of its energy needs and supply the remainder to other environmentally conscious businesses. Based on projections from the U.S. Environmental Protection Agency, the project will save about 25 million pounds of greenhouse gas by 2040, the company says. “This clean energy initiative is very important to our company,” said Jeffrey Siegal, CEO of Geriatric Medical. “Our team is proud that we have drastically reduced our carbon footprint and our hope is to inspire other members of the community to do the same.”

    Greater Nebraska Home Infusion fills need

    GRAND ISLAND, Neb. – When a local pharmacy that provided home infusion services closed, Rick and Cindy Lobeda, who have owned Midwest LTC Pharmacy for 10 years, saw a need and opened Greater Nebraska Home Infusion. They opened their doors earlier this year, but they only recently completed the paperwork to get their services approved by Medicare, according to the Grand Island Independent. “We wanted to provide a better service and take care of those customers the other pharmacy has had over the years, so they didn’t have to lose a good service,” Cindy Lobeda, a licensed pharmacist, told the newspaper. In addition to providing home infusion services, Greater Nebraska Home Infusion has three infusion suites. The company also offers total protein nutrition.

    Short takes: Pride Mobility, Cure Medical, Medtrade

    Exeter, Pa.-based Pride Mobility Products responded to a local news report in Richmond, Va., about a woman whose scooter stopped working by hooking her up with a local provider, Trust Care Rehab and Mobility, and a new Go Go Elite Traveler. “The normal everyday person can’t just go out and buy a $2,000 scooter to get around,” Brad Rothwell of Trust Care told “12 on Your Side.” “To provide that for her at no charge is fantastic. That’s really why I do this—just to see how happy she was to be able to get out and go see her grandkids.” Gina Houchen has a number of health issues that require a mobility aide, including congestive heart failure and rheumatoid arthritis…Newport Beach, Calif.-based Cure Medical has launched a catheter specifically for children. The 10-inch Pediatric Hydrophilic Cure Catheter, which is free of DEHP, BPA and natural rubber latex, comes with free educational materials that teach children “How to Cath,” including flash cards and a coloring book…Medtrade has announced that Ford will be an exhibitor at this year’s event, Oct. 23-25 at the Georgia World Congress Center in Atlanta. The Dearborn, Mich.-based car giant, which hasn’t exhibited at the HME industry’s largest trade show in several years, will showcase the Transit, its full-size van offering, and the Transit Connect, its compact van offering.


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    08/28/2017
    Theresa Flaherty

    Millennials in the office are a hot topic these days, with older generations often bemoaning them for certain stereotypes. However, the under-40 workforce has plenty to offer, including the ability to look at the HME industry from a fresh perspective, says VGM’s Ryan Ball.

    “They are coming in and saying, ‘This is the landscape now and whatever happened 10 years ago isn’t important,’” said Ball, director of VGM Market Data. “”We have to figure out how to be successful now.”

    VGM recently launched the HME Young Professionals Group—which currently has 51 members—to allow HME professionals to network and share best practices with their peers. Ball spoke with HME News recently about the value of younger workers.

    HME News:Why did VGM form the Young Professionals Group?

    Ryan Ball:Having the ability to develop relationships over the long term with other folks that are in the same spot as you is really kind of what drove us to form this group. Not all of the younger people that have started in this business recently are able to go to a Medtrade or Heartland conference. There’s an advantage in being able to network with each other, partly online or with LinkedIn. In addition to those, we are hoping to schedule networking events at industry trade shows to help provide an opportunity for continued in-person engagement and relationship building.

    HME:What’s an example of the challenges facing people who are new to the workforce?
    Ball: How people tend to see the younger generation is they want to be able to move up quickly and they feel like they’ve done the work. But you have to start somewhere in a business, and just kind of understanding there are people that have been there longer than you and you need to learn for a while is a big piece of coming into a new company and being humble and understanding that no, you don’t have all the answers.

    HME:Is generational conflict an issue in the HME industry?

    Ball:I wouldn’t say that. What I’ve learned over the years is there’s so much value in understanding some of the broad strokes that describe a generation, like how they were brought up and how that relates to how you should interact with them, how they like to work and what they like to do.

    HME:Should the industry feel encouraged that younger people are getting into the HME biz?

    Ball:There’s reason to hope that young people and new people—no matter what age—are still getting into the market, because as tough as it is now relative to a few years back, the underlying demographics are attractive. If you can figure out how to streamline and how to take advantage of the tools that are available to you, there’s still a good business.


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    ‘There can be a lot of gray areas, so you need all the information you can get’
    08/28/2017
    Liz Beaulieu

    WATERLOO, Iowa – Just when HME providers think they have control over documentation and billing, Medicare throws them a curve ball. That makes it difficult for them to develop good habits—a big reason why they’re turning up for The VGM Group’s “Breaking Bad Reimbursement Habits” tour. Here’s what Ronda Buhrmester and Dan Fedor, two reimbursement specialists for VGM who are running the tour, had to say in April about how providers are getting themselves on the right path to reimbursement.

    HME News: You’ve had two tour stops so far. How has it been received?

    Ronda Buhrmester: With the industry the way it is, with the cuts in reimbursement and the high number of audits, people are hungry for information and how to work through audits. They want to get paid appropriately and they don’t want to lose their money. We’ve had anywhere from 30-50 attendees at the sessions.

    Dan Fedor: They also like that we’re coming to their backyards. It’s less costly and less out-of-office time. The CEUs also attract people.

    HME: What’s one of the top areas where providers need to break bad habits?

    Buhrmester: People think that, because they’re billing non-assigned, they have no liability. That’s not true. You’re just telling Medicare that you’re not accepting the fee schedule; you still have to follow guidelines, gather documentation and file a claim for the patient. That’s misunderstood across the industry.

    Fedor: The other part of that is, they’re afraid to ask patients for the money upfront. They’re afraid they’re going to lose their referrals and lose the business. But that’s not really happening. They’re slowly becoming more comfortable with it.

    HME: What’s a good habit that providers need to develop?

    Buhrmester: We all rely on physicians to do the documentation, but they don’t do it like we want them to. There are other resources that we can add to that, as well. Someone from pulmonology rehab or a wound care clinic—you can use their notes in the supporting documentation. People miss that. Yes, you have to have the note from the physician that the patient has this condition, but you can also have other information that can help support that.

    Fedor: I think another good habit to develop is not accepting an answer from a payer if it doesn’t seem right. I had a provider who thought he had to rent complex rehab. I told him, you don’t have to do that; there’s a purchase option. He was doing it that way because that’s what he was told by a Medicare customer service representative.

    HME: But even when they break bad habits, providers always need to stay on their toes, right?

    Buhrmester: Yes, you can have two different review nurses looking at a claim and they come to different conclusions. Who has the policy right? That is frustrating.

    Fedor: There can be a lot of gray areas, so you need all the information you can get.


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    08/28/2017
    Liz Beaulieu

    AMARILLO, Texas – HME providers in Texas have solid ground to stand on when it comes to their criticism of a new Medicaid contract that makes Medline a single-source provider of 244 DME supplies, says an industry attorney.

    Pam Colbert, a member of the Health Care Group at the law firm Brown & Fortunato, outlined a number of ways the contract violates Texas law in her complaint on behalf of Alliance Medical Supply, a provider in San Antonio.

    It’s anything but competitive

    Per the Texas Government Code and the Texas Health and Human Services Procurement Manual, the “fundamental premise underlying public procurement is the requirement of equal opportunity allowing all qualified responsive and responsible vendors an opportunity to obtain the government’s business,” Colbert writes in the compliant.

    “The sole source contract provided to Medline from Superior does not have a valid justification for awarding Medline exclusive right to provide hundreds of DME supplies that numerous, local, participating Texas DME supplies are currently providing,” she wrote. “Superior’s sole source, exclusive contract with Medline diminishes, not stimulates, competition. The contract clearly promotes favoritism and does not secure the best work and materials at the lowest price, for the best interests of the taxpayers and property owners.”

    It eliminates choice

    Colbert points out that HHS this past June established “MCO Policy Guidance on Preferred Provider Arrangements” in direct response to recent efforts by several MCOs to establish preferred provider arrangements for medical supplies. The goal: to protect the ability of Medicaid recipients to choose the network participating DME supplier they prefer.

    “Superior has already begun to remove the ‘choice’ of suppliers as evidenced in its notice that it is automatically cutting off current suppliers’ DME services to members as of Aug. 31,” she wrote. “Further, Superior advised Alliance on a recorded call on July 7 that, ‘Patient does not have a choice starting Sept. 1—it will automatically go through Medline.’”

    It increases the chance for fraud

    Colbert also points out that as part of the contract, Medline does not have to submit prior authorizations for any supplies. Furthermore, Superior has authorized the company to fill in and complete doctor’s prescriptions.

    “The removal of these compliance elements certainly lends itself to opportunities and implications for ‘kickbacks,’ upcoding, providing services not medically necessary and billing for services not provided,” she writes. “Exclusive removal of controls for one, large, exclusive DME supplier certainly puts Texas Medicaid funds at risk for fraud and abuse.”


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    ‘It sounds like a good thing, but we just don’t know what’s in it’
    08/30/2017
    Liz Beaulieu

    WASHINGTON – The website of the Office of Information and Regulatory Affairs and the Office of Management and Budget now shows an interim final rule pending review titled “Durable Medical Equipment Fee Schedule, Adjustments to Resume the Transitional 50/50 Blended Rates to Provider Relief in Non-Competitive Bidding Areas.”

    It sounds promising, industry stakeholders agree, but because the IFR hasn’t been published yet, they have more questions than answers and, therefore, have refrained from spreading the word.

    “If you just look at the title, it sounds like a good thing, but we just don’t know what’s in it,” said John Gallagher, vice president of government relations for VGM & Associates. “We’re waiting on hands and knees.”

    The OMB serves as a clearinghouse for federal regulations, a way station where their paperwork and economic burden are reviewed. When the IFR clears the OMB—not a definite but “probable,” says Cara Bachenheimer, senior vice president of government relations for Invacare—it will be published and become effective in 30 to 60 days.

    Chief among the questions stakeholders have is what rates CMS is referring to. They were disappointed earlier this year, when CMS implemented a provision in the 21st Century Cures Act requiring the agency to retroactively delay a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, by using the July 1, 2016, rates, instead of the Jan. 1, 2016 rates.

    “The way I read it, they’re either going back to the Jan. 1 non-adjusted rates or they’re looking to continue the adjusted rates for a period beyond what was provided in the Cures Act,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “So it appears there will be payment relief, but we’re not sure what that will look like.”

    An extension of the relief provided by the Cures Act could help providers get through 2017 and 2018, before another provision in the Cures Act requires CMS to modify how it calculates rates in non-bid areas by Jan. 1, 2019.

    “This could act as a bridge,” Bachenheimer said.

    But the relief from the Cures Act, while an improvement, was not what industry stakeholders and their champions in Congress had intended. For oxygen concentrators, for example, the Jan. 1, 2016, non-adjusted rate in New England was $140.56, while the original July 1, 2016, rate was $77.72 and the adjusted July 1, 2016, rate is $125.30. That’s still a 10.9% reduction.

    “That’s why we’re not getting too excited,” Gallagher said. “We have people hanging on by a string, and if we’re going back to July 1, that’s when we got gutted.”

    The other big question surrounding the IFR is the timing of the adjustments. Will they be retroactive to Jan. 1, 2017? Or will they start once the rule becomes effective?

    “I doubt, with (OMB Director Mick Mulvaney), it will be retroactive,” Gallagher said.

    With an IFR that could be published as soon as next week and a bill providing bid relief expected to be introduced in the House of Representatives in the next few weeks, September will be a roller coaster of a month.

    “We’re super interested to see what comes out of the IFR, but until then, we’re going to keep working this issue,” said Gordon Barnes, director of communications for AAHomecare. “We’re going to keep working with our contacts at CMS and we’re going to keep generating support on the Hill for a variety of fixes to the bid program.”


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    ‘The new administration is asking how to get rid of the regulations’
    09/01/2017
    Theresa Flaherty

    WASHINGTON – From accreditation to audits, HME providers let panel members at a Small Business Administration hearing last week know exactly how they feel about burdensome regulations.

    For provider Craig Rae, the cost of maintaining accreditation ranks at the top of his list. He estimates one-third of his staff does nothing but scrutinize minutiae to meet the compliance standards set forth in six categories—the first of which has seven sections containing 113 separate standards requiring documentation.

    “Our industry fully supports establishing effective measures to protect beneficiaries and reduce waste, fraud, and abuse, but only a bureaucrat could love what it’s become,” said Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment, at the Aug. 28 hearing in Washington, D.C.  “For example, if a customer leaves a message after hours asking ‘Are you open Saturdays?,’  we need to log the call, what time it came in, and keep a record of when we returned the call.”

    Don’t even get him started on HIPAA compliance rules dictating the type of clipboards he can use and the correct way to place documents on those clipboards.

    “These things have nothing to do with reducing fraud,” he said. “They are just so far overreaching, telling us how to manage our business.”

    Provider Frank Trammell’s key point of contention: audits run amok.

    “There’s a lack of transparency and the fact that the different levels of appeal clearly have different rules,” said Trammell, CEO of Matthews, N.C.-based Carolina’s Home Medical Equipment, who restructured his business a few years ago just to keep up.“The denial tends to be rubberstamped at redetermination, and then 80% are being overturned if it makes it in five years to the Administrative Law Judge. We’ve never lost an appeal at the ALJ.”

    The SBA holds hearings several times a year around the country and HME providers regularly make it a point to testify. Now, under President Trump’s administration, which has pledged to reduce regulations on business, industry stakeholders hope those efforts will finally pay off.

    “After the hearing convened, one of the panel members said they would like us to formulate a letter and get it back to them to be included into their write-up to send to the Department of Health and Human Services, CMS and the administration with the recommendation that the over-burdensome regulations be relieved on small businesses impacted within the HME industry,” said John Gallagher, vice president of government relations for VGM. “The new administration is asking how to get rid of the regulations, so it’s a different ballgame.”


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    09/01/2017
    HME News Staff

    DOWNEY, Calif. – SuperCare Health has acquired the respiratory assets of LifeCare Solutions.

    “Our acquisition of LifeCare Solutions California respiratory assets ensures that none of their patients will have any interruption in their respiratory care,” said John Cassar, CEO, SuperCare Health. “Our driving mission is to improve the lives of patients with chronic diseases and we are excited to bring our innovative care solutions to an ever-expanding high risk patient population.”

    The Phoenix-based LifeCare in July announced it would exit the California market, blaming reimbursement cuts related to the competitive bidding program. The provider had 30,000 patients and 13 locations in California.

    The deal does not include beneficiaries covered under the competitive bidding program.

    SuperCare Health, which has19 locations throughout California and Nevada, provides a broad range of respiratory services, including ventilation, CPAP/BiPAP nebulizer and inhalation medication and oxygen.  

    AeroCare makes two buys in Illinois

    ORLANDO, Fla. – AeroCare has acquired First Choice Medical Supply and Kelly’s Medical Equipment & Supply, two DME companies in Illinois, according to the Galesburg Register-Mail. Both companies have a presence in Galesburg, and First Choice also has offices in Peoria and Monmouth. First Choice and Kelly’s Medical serve about 300 oxygen patients in the area, according to the newspaper. First Choice’s office in Monmouth will close Sept. 21, with AeroCare serving those patients from its office in Galesburg, the newspaper reported. First Choice’s office in Galesburg has been consolidated into Kelly’s Medical’s office in the same town, it reported. Kimberly Angotti, a sales rep for AeroCare, told the newspaper that the acquisition has been a “good deal for everybody,” with no one losing jobs. “We’ve had some transitions, people’s own decisions,” she said, “but nobody’s been let go because of it.”

    Howard’s Medical Supply buys Keeler’s Medical Supply

    YAKIMA, Wash. – Howard’s Medical Supply will purchase the inventory of Keeler’s Medical Supply under a pending sale approved Aug. 28 by a U.S. Bankruptcy Court, according to the Yakima Herald. Keeler’s Medical Supply filed for Chapter 11 bankruptcy in June, citing drastic reductions in Medicare and Medicaid reimbursement, the newspaper reported. Company officials at Howard Medical Supply told the newspaper they have handled the same cuts by being debt free and by improving operational efficiency. They will pay $600,000 in cash for Keeler’s Medical Supply’s inventory, the newspaper reported. Keeler’s Medical Supply’s co-owner Chuck Vetsch and employee Brad Vetsch will have a five-year non-compete agreement, it reported.

    Numotion website shares customer stories

    BRENTWOOD, Tenn. – Numotion has relaunched its website, www.numotion.com, with a heavy emphasis on showcasing its customers.

    The new website features a section called “Customer Stories” where 20 customers share their mobility journey and why they chose Numotion for their complex rehab technology. For example, Kierra, a pre-teen with muscular dystrophy, shares how her power wheelchair has made her more independent at school and at home.

    “Our mission is to help customers live active and independent lives and these stories showcase how we do just that,” said Mike Swinford, CEO. “As customers turn to the web more frequently to learn about their mobility options, it’s important that we offer them not only inspiration, but the information they need to make decisions related to their health.”

    The website also features a timeline that outlines the steps involved in the ordering process and a glossary that clarifies acronyms.

    Additionally, the website features new blogs, including “Nu Digest,” which provides tips like how to fly with a wheelchair; and “Wheeltime with Daniel and Shea,” which offers service advice and tips.

    “While our website serves as the first touchpoint for many new customers, we also want it to be a helpful resource for anyone with mobility needs,” Swinford said. “Our team has a vast wealth of collective expertise in our industry—the website is an opportunity for us to extend their knowledge beyond their day-to-day interactions to even more customers who can benefit.”

    Numotion, which has 125 locations across the country, says it serves more than 250,000 customers annually.

    NSM promotes two

    NASHVILLE, Tenn. – National Seating & Mobility has named Charles Sargeant as senior vice president, it announced Aug. 30. Previously, Sargeant served as regional vice president driving business for NSM in the west. The provider has named Katie Stevens as regional vice president. She has served I business development and operations roles at NSM for the past decade. “NSM is committed to invest in key talent as the company continues to grow,” said Bill Mixon, CEO. “I am pleased to announce the promotions of Charles Sargeant and Katie Stevens.”

    Good works: AvaCare Medical, Lofta support Hurricane Harvey victims

    LAKEWOOD, N.J. – A truck loaded with supplies left for New Jersey for Houston Aug. 30. AvaCare Medical, an online medical supply store, donated thousands of dollars worth of supplies and equipment for flooded nursing home and other victims of devastating Hurricane Harvey. Donations included first aid supplies, gauze, bandages walkers, adult diapers, wipes, reusable and disposable underpads, medical gloves, creams, mouthwash and shampoo.“With more and more news pouring in about Harvey's victims, we realized that as a medical supply company, we are uniquely positioned to offer support to Houston even from our location in New Jersey,” said CEO Steven Zeldes. “Since we have the resources to help, we feel like it is not only an opportunity but an obligation to pitch in when so many people need help so badly."

    Lofta donates to relief fund

    SAN DIEGO – Lofta will donate of portion of its proceeds to the Hurricane Harvey Relief Fund, established by Houston mayor Sylvester Turner.

    “Lofta is part of a personal commitment to help improve quality of life for the millions of people nationwide who suffer from sleep apnea,” said Jay Levitt, principal. “Our company’s mission has always been to help people feel better, so naturally, in the wake of this natural disaster we want to be able to support relief efforts in any way we can.”

    Those wishing to have a portion of their own CPAP purchase benefit the fund, or to make a direct donation to the Hurricane Harvey Relief Fund can do so at Lofta’s online shop: buyminicpap.com.

    Diabetes supplies en route to Texas

    ARLINGTON, Va. – The American Diabetes Association, JDRF and Insulin for Life have secured and shipped more than 3,750 pounds of donated diabetes supplies to people with diabetes affected by Hurricane Harvey, they announced Aug. 29. Five pallets, each of which includes 200,000 syringes, 50,000 pen needles and 20,000 alcohol pads, are already en route to the Houston area. Accompanying each pallet are separate packages containing dozens of blood glucose meters along with thousands of glucose test strips and lancets, which will allow an individual to test his or her blood glucose three times per day for nearly two months. More than 25,000 units of analogue and human insulin, in both vial and pen forms, will also be delivered for each pallet, pending safe delivery and temperature control conditions at the locations. One pallet is for immediate distribution by the Houston Health Department to evacuees with diabetes who are sheltered at the George R. Brown Convention Center. The second pallet will be distributed by Sen. Larry Taylor's office to the Galveston communities of Clear Creek, Friendswood, League City and Victory Lakes. Two pallets are being delivered to the Harris County Health Department. The fifth pallet is going to the City of Corpus Christi Health Department. The organizations have also launched a website, diabetes.org/hurricaneharvey, for updated information and resources.

    Accredo passes muster with OIG

    WASHINGTON – Accredo Health Group has properly billed Medicare for inhalation drugs, according to a report from the Office of Inspector General. The review follows the inclusion of inhalation drugs in the top 20 DME products with the highest improper payment rates for calendar years 2014-15. Accredo is the first of three providers that will undergo reviews by the OIG. Medicare paid about $1.3 billion for inhalation drugs during 2014-15, with Accredo receiving 26% of payments. The OIG reviewed a random sample of 100 claim lines from a pool of 28,718 claim lines for inhalation drugs. For each sample, the OIG provided copies of the supporting documentation to a medical review contractor to determine whether or not inhalation drugs were properly billed.

    Quantum Rehab’s iLevel hits 10K users

    EXETER, Pa. – Quantum Rehab now has more than 10,000 iLevel users, the company announced Aug. 25. Launched in July 2015, iLevel elevates the seat of a power wheelchair up to 12 inches, while stabilizing it using Extra Stability Technology. It allows full functionality at walking height and speeds up to 3.5 mph for increased independence and social inclusion. Quantum Rehab credits the increasing number of iLevel users to consumer demand and payer coverage. “As we pass the two-year mark with iLevel, third-party payers across the country are covering and providing reimbursement for this feature almost daily,” said Julie Piriano, vice president of clinical education and rehab industry affairs, and compliance officer.

    EarlySense, SleepMed synch up technologies

    WEST PALM BEACH, Fla., and WALTHAM, Mass. – EarlySense and SleepMed have partnered to improve the detection of and treatment for obstructive sleep apnea. EarlySense uses hospital-proven technology to, among other things, monitor disruptions throughout the night, including interrupted breathing. Now, when EarlySense captures interrupted breathing, its synched mobile app will send notifications to invite users to visit SleepMed’s website. There, users will find information on determining their level of sleep apnea and receive recommendations on next steps in treating their symptoms. "By collaborating with SleepMed, we are able to not only bring awareness to our users, but also offer an effective next step in identifying the extent of their sleep risk," said Avner Halperin, CEO of EarlySense. "Sleep disorders such as OSA affect over 20 million Americans each year. As this is such a significant health concern across the United States, it's a priority of ours to deliver to our users relevant and accurate data so they can be proactive in leading a healthier, more comfortable life."

    Audit Key deadline extended

    WASHINGTON – The HME Audit Key will stay open until Monday, Sept. 9 so providers can submit 2nd quarter data, AAHomecare announced. The survey is open to all providers, who can submit data even if they haven’t done so previously. “Additional participation will allow us to better demonstrate the effects of overly burdensome HME audits to regulatory agencies and Capitol Hill as we advocate for better audit policies,” said the association in a bulletin.


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    09/01/2017
    HME News Staff

    LAKEWOOD, N.J. – A truck loaded with supplies left for New Jersey for Houston Aug. 30. AvaCare Medical, an online medical supply store, donated thousands of dollars worth of supplies and equipment for flooded nursing home and other victims of devastating Hurricane Harvey. Donations included first aid supplies, gauze, bandages walkers, adult diapers, wipes, reusable and disposable underpads, medical gloves, creams, mouthwash and shampoo.“With more and more news pouring in about Harvey's victims, we realized that as a medical supply company, we are uniquely positioned to offer support to Houston even from our location in New Jersey,” said CEO Steven Zeldes. “Since we have the resources to help, we feel like it is not only an opportunity but an obligation to pitch in when so many people need help so badly."

    Lofta donates to relief fund

    SAN DIEGO – Lofta will donate of portion of its proceeds to the Hurricane Harvey Relief Fund, established by Houston mayor Sylvester Turner.

    “Lofta is part of a personal commitment to help improve quality of life for the millions of people nationwide who suffer from sleep apnea,” said Jay Levitt, principal. “Our company’s mission has always been to help people feel better, so naturally, in the wake of this natural disaster we want to be able to support relief efforts in any way we can.”

    Those wishing to have a portion of their own CPAP purchase benefit the fund, or to make a direct donation to the Hurricane Harvey Relief Fund can do so at Lofta’s online shop: buyminicpap.com.


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    09/07/2017
    HME News Staff

    WASHINGTON – Medicare will pay for beneficiary-owned DME that has been damaged or destroyed in circumstances related to a declared emergency like Hurricane Harvey.

    Guidance issued today also:

    • Establishes that a new physician order, face-to-face requirements, and new medical necessity documentation are not needed for the replacement.
    • Still requires a narrative description, explaining why the equipment must be replaced.
    • Extends the notification deadline for subcontracting agreements to 30 days.

    The announcement comes in the wake of Hurricane Harvey, which made landfall on the Texas Gulf Coast on Aug. 25, eventually dumping nearly 50 inches of rain in some places, and ahead of Hurricane Irma, which is bearing down on Southern Florida.

    CMS has also shared with AAHomecare that the rental cycle will start over for capped rental and oxygen equipment that is replaced due to disaster, according to a bulletin from the association today.


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    09/08/2017
    Theresa Flaherty

    WASHINGTON – As Hurricane Irma barreled toward Florida last week, industry stakeholders met with CMS officials to discuss serious issues that arise in disaster situations.

    One thing being discussed: Whether there is a possibility of getting the Federal Emergency Management Agency to pay for oxygen tanks in such situations, says Tom Ryan, president and CEO of AAHomecare.

    “If CMS indicates (there could be) a gap in coverage—and Laurence Wilson seems willing to do that—it’ll notify FEMA,” he said. “I am also reaching out to FEMA. We have to quickly determine how we can get a funding stream and get ourselves teed up.”

    CMS on Thursday did provide some relief in the wake of Hurricane Harvey, issuing guidance stating that it will pay for beneficiary-owned DME that has been damaged or destroyed in circumstances related to a declared emergency.

    Stakeholders say that storm, which made landfall on the Texas Gulf Coast on Aug. 25, made it quickly apparent that Medicare rules limiting the provision of HME to only contract suppliers in competitive bidding areas like Houston, and the inability to get replacement tanks paid for, are shortsighted.

    “There is a possibility that there are going to be access issues, that the contracted suppliers will not be able to handle the increased capacity during this emergent situation,” said Ryan.

    Stakeholders say it’s also time to revisit longstanding policy that providers cannot be paid for the back-up tanks they put out in such situations. While in the past, providers absorbed the hit, today’s reimbursement rates make that unfeasible, says Ryan who, as a former provider, speaks from experience.

    “I lost tens of thousands of dollars back when Sandy hit,” he said. “But I was at least getting reimbursed at a reasonable amount. I don ‘t know how a provider who is financially restrained today can go out for four to six weeks and deliver oxygen.”

    CMS’s guidance last week also extends the notification deadline for subcontracting agreements to 30 days; and waives the requirements for a new physician order, face-to-face visit, and new medical necessity documentation for replacement equipment.

    “Basically, suppliers are to put a narrative on the claim when they submit it,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “One thing we want to be sure of is that they issue very clear guidance on this that those claims aren’t exposed to audits (for these things).”

    Stakeholders are also looking ahead to a longer-term fix that ensures beneficiary access to care when disaster strikes.

    “We have to find out where they are legally prevented from making changes and determine how we can give them more flexibility,” said Ryan. “We want to follow up and see if we can get some legislative language that might unencumber them a little.”


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  • 09/08/17--10:57: Case analysis by Jeff Baird
  • ‘That ruling affects us equally as much as it does hospitals and labs and physicians—we are all in this together’
    09/08/2017
    Theresa Flaherty

    YARMOUTH, Maine – The American Hospital Association’s lawsuit against the Department of Health and Human Services over a massive appeals backlog has been ping-ponging between the U.S. District Court for the District of Columbia and the D.C. Circuit Court since it was first filed in 2014.

    The latest ruling, issued Aug. 11, directed a federal judge to take a closer look at whether it’s actually feasible for HHS to clear the backlog by 2021, as previously ordered.

    “I think the D.C. Circuit Court is saying, while we here are not opposed to a court ruling that addresses this appeals backlog, we do think what you did come up with was unworkable, where HHS just physically can’t do it,” says attorney Jeff Baird, chairman of the Health Care Group at Brown & Fortunato.“It’s a setback for AHA, but not a severe setback.”

    Baird spoke with HME News recently to offers his thoughts on the case.

    HME News: Is it typical for a case like this to drag on?

    Jeff Baird: No, this is abnormal. In a sense, it is more academic, more of a policy lawsuit. They are going back and forth, basically going through the discussions and decision-making that you would normally think that HHS would go through or Capitol Hill. But Capitol Hill is not addressing this and, up to this point, HHS is not addressing this, so it’s a complete mess, so now the courts are saying, we have to address it.

    HME: Whatever the final verdict, would you consider it a short-term or a long-term fix?

    Baird: Both. Longer-term in the sense that I believe the court ruling will be to clean it up, get rid of the backlog and stay current. But having said that, it’s easy to say but reality may set it where there’s not enough ALJs to go around. There needs to be more of a fundamental fix. There needs to be real regulatory fixes that will keep this from snowballing again.

    HME: What are the implications of this lawsuit for the HME industry?

    Baird: If, as expected, the trial judge says, OK, here’s how and when I want these claims cleaned up, it’s likely HHS is going to appeal. HHS is not going to want any type of hammer hanging over it. That ruling affects us equally as much as it does hospitals and labs and physicians—we are all in this together.


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    09/08/2017
    HME News Staff

    WAYNE, Pa. – Teleflex will buy NeoTract for $1.1 billion in a move that significantly expands its urological product offerings, the company announced Sept. 5.

    NeoTract, maker of the UroLift System, had revenues of about $51 million in 2016 compared to about $18 million in 2015, representing 178% year-over-year growth. For 2017, NeoTract expects revenues to be between $115 million and $120 million, and for 2018, it expects them to grow at least 40%.

    “This combination is expected to solidify Teleflex’s ability to generate mid-single digit constant currency revenue growth for the next several years, as well as enhance Teleflex’s margin profile,” said Benson Smith, chairman and CEO of Teleflex. “NeoTract is a truly unique company with a differentiated technology that targets a greater than $30 billion addressable market, and through their internally developed, patented UroLift System, have achieved sequential quarterly revenue growth of 20% or greater in 13 of the past 14 quarters. Importantly, while we believe NeoTract has compelling growth opportunities as they continue to penetrate the market.”

    Founded in 2004, NeoTract is a privately held medical device company that has developed and commercialized the FDA-cleared UroLift System, a minimally invasive technology for treating lower urinary tract symptoms due to benign prostatic hyperplasia or BPH.

    Under the terms of the agreement, Teleflex will acquire NeoTract for an upfront cash payment of $725 million at closing, and up to an additional $375 million upon the achievement of certain commercial milestones related to sales through the end of 2020. The boards of directors of both Teleflex and NeoTract have unanimously approved the transaction.

    Numotion buys Academy Medical Equipment

    BRENTWOOD, Tenn. – Numotion has expanded its footprint in Southern and Central California, as well as Nevada, with its acquisition of Academy Medical Equipment. Las Vegas-based Academy Medical Equipment, which has been in business for more than 17 years, has seven locations—six in California and one in Las Vegas. Fifty-nine employees at Academy Medical Equipment will transition to the Numotion team, including ATPs, as well as professionals in customer care, service and repair, payer relations, medical documentation and order processing. Also this year, Numotion acquired the complex rehab division of CVC Home Medical in Wilmington, N.C.; Horns Medical Supply in Athens, Texas; the complex rehab division of BlueDot Medical in Charlotte, N.C.; and the complex rehab division of the Ability Center in San Diego. Numotion says it has more than 130 locations across the country and serves more than 250,000 people annually.

    NSM hits five locations in Pennsylvania

    NASHVILLE, Tenn. – National Seating & Mobility has acquired the rehab division of Harrisburg, Pa.-based Dynamic Healthcare Services. NSM now has five locations in Pennsylvania, according to a press release. Two of Dynamic Healthcare’s ATPs will join the NSM team. “This acquisition strengthens NSM’s presence in Pennsylvania, allowing our teams to serve clients across the state,” said Bill Mixon, NSM CEO. “We are pleased to add this location to our growing national network of branches.” Earlier this summer, NSM bought Mobility Healthcare in Texas.

    Golden Technologies lines up consumer financing

    OLD FORGE, Pa. – Golden Technologies has partnered with CareCredit to offer its dealers a new financing solution, the lift chair manufacturer announced Sept. 6. Through the partnership, dealers can now offer their customers a dedicated line of credit to pay for costs not covered by insurance. Financing offered through CareCredit can span six, 12 or 18 months, with dealers receiving payment in just two days, according to a press release. “We are excited about this strategic relationship with CareCredit and how it can best help our retailers,” said C.J. Copley, Golden’s executive vice president of sales and marketing. “Durable medical equipment retailers often face challenges in helping consumers get an ideal product while working under the constraints of increasing deductibles and rising insurance premiums. CareCredit’s financing solution program will help consumers cover the costs for retail-cash purchases at a time in their life when they need it most.” CareCredit works with more than 200,000 enrolled healthcare providers and select health-focused retailers across the country.

    Alliqua sells TheraBond line

    YARDLEY, Pa. – Alliqua BioMedical has sold its TheraBond 3D Antimicrobial Barrier Systems product line to Argentum Medical, a manufacturer of metallic silver-based, antimicrobial wound dressings, for approximately $.38 million, it announced Sept. 5. Alliqua will use sale proceeds for working capital purposes and to reduce its outstanding debt balance. Argentum is a portfolio company of Shore Capital Partners, a private equity firm.

    Rotech employee sentenced in identify theft

    PLANT CITY, Fla. – Sharmekia Young, a former employee of Rotech Healthcare, was sentenced to three years in prison for conspiracy and aggravated identity theft, according to the U.S. Attorney’s Office for the Middle District of Florida in Tampa and as reported in The Ledger. Young worked at Rotech’s Lakeland billing center, where she allegedly used her access to the provider’s secure databases to obtain the personal information of 957 people. The information was sold and used to create fake credit cards and Florida driver’s licenses. She conspired with another Rotech employee, Fontella James, who was sentenced in June to 32 months in prison.

    Study refines link between sleep apnea, other diseases

    BALTIMORE – Untreated sleep apnea can contribute to a range of conditions associated with heart disease and diabetes, according to a new study conducted by Johns Hopkins Medicine researchers. The study found increases in blood sugar, fat levels, stress hormones, and blood pressure in patients with obstructive sleep apnea. The findings, published in The Journal of Clinical Endocrinology & Metabolism, may help to refine the scientific debate over whether sleep apnea is just a manifestation of obesity, or an active contributor to associated health problems like diabetes and heart disease, researchers say. The study also emphasizes the importance of CPAP as a treatment solution: Researchers found that withdrawing CPAP in sleeping patients increased levels of free fatty acids, glucose and cortisol—all conditions linked to diabetes.

    CareMotion adds virtual assistant to website

    CLEVELAND  – CareMotion, a growing online retailer of home medical equipment, has launched a virtual shopping assistant designed to eliminate the pain points associated with online purchases. The assistant asks customers to enter basic health and fitness information, allowing it to recommend the best products to fit their needs. “All of us at Care Motion are advocates for helping seniors enjoy a higher quality of life while living at home, independently," said Aaron Cavano, president. "We developed the shopping assistant to ensure customers find the right products at the lowest prices, and we believe this technology will revolutionize how home medical equipment is purchased." CareMotion, which prioritizes cash-paying customers over third-party insurance, offers same-day shipping, a 30-day money back guarantee, and at-home repairs and installations. Its website carries brands like Drive Medical, EZ-Access, Inogen, Invacare, Pride Mobility Products and more.

    Date stamp requirement updated

    WASHINGTON – The DME MACs have updated the Dear Physician letter to remove the requirement for a date stamp or similar to prove a supplier has received a written order prior to delivery of an item, according to a bulletin from AAHomecare. Now, the date of the physician signature must be on or before the date of delivery. The requirement is mandated by the Affordable Care Act.

    Short takes: Option Care, Medicine Shoppe, ACHC, Abilene CPAP Sales & Supplies

    Bannockburn, Ill.-based Option Care, an independent provider of home and alternate treatment site infusion services, has signed an agreement to become a national contracted provider of Radicava, an IV infusion treatment for ALS. Radicava is the first ALS treatment option approved by the U.S. Food and Drug Administration in more than 20 years. Option Care says its national payer network includes contracts with more than 800 health plans, ensuring broad access to the treatment…After more than two years of planning, the new Medicine Shoppe Pharmacy in DuQuoin, Ill., is near completion, according to the Harrisburg Register. The 3,000-square-foot pharmacy, which will also carry DME, is expected to open in the next two months with added features like drive-up windows and better parking…Cary, N.C.-based The Accreditation Commission for Health Care has been approved by the New Mexico Department of Health as the first accreditation organization permitted to perform accreditation surveys in lieu of an initial state licensure survey for home health and hospice facilities…Speaking of accreditation, Abilene, Kan.-based Abilene CPAP Sales & Supplies was recently accredited by the Healthcare Quality Association on Accreditation. The company was started by husband-and-wife team Curtis and Sheree Osland, CPAP users themselves, about three years ago.


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    ‘Transportation workers should be screened, but (it shouldn’t be a) carte blanche,’ said one respondent
    09/15/2017
    Theresa Flaherty

    YARMOUTH, Maine – Requiring transportation workers to get screened for sleep apnea is a “no brainer,” say respondents to a recent HME Newspoll.

    “Anyone who drives on an interstate highway can only hope that the long-haul truckers around them don’t have OSA,” wrote one respondent. “This is a no-brainer question.”

    In line with a Trump administration that has pledged to slash regulations, the Federal Railroad Administration and the Federal Motor Carrier Safety Administration said in August that they would scrap a regulation to require testing for certain commercial drivers and rail workers.

    That’s short sighted, say 87% of poll respondents.

    “The prevalence of OSA in the general population indicates significant risk factors for professional driers, pilots, heavy equipment operators, etc.,” said Steven DeYoung of Elliot Hospital Home Medical Equipment in Manchester, N.H. “An analysis of accident data by the NTSB (which under-reports sleep reported accidents) shows somnolence as a significant contributor to a high number of accidents with this cohort.”

    At the same time, poll respondents say it’s important not to paint too broad a brush.

    “I believe that any transportation workers that spends most of their time driving on highways and has signs or symptoms of sleep issues should be screened, but (it shouldn’t be a) carte blanche,” wrote Rich Waltman of HealthCare Plus in Polson, Mont.

    Other respondents don’t think a federal regulation, which they worry could be burdensome for drivers and the companies that employ them, is the answer.

    “I think that requiring transportation workers to get regular physicals and to be compliant with any subsequent physician orders should be adequate, as long as the physicians don’t rubber stamp the form,” wrote Lori Sears of Active Home Medical Supply in Lapeer, Mich. “Advocate that physicians become more proactive at screening all of their patients for risk factors—don’t single out a single group and force it.”

    Fortunately, awareness of sleep disorders is on the rise, say 91% of poll respondents.

    “More primary care physicians are screening their patients,” wrote one poll respondent. “And, just as important, as more people are diagnosed and treated, they talk about it with friends and family, as well as via social media and the Internet.”

     


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