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    Of the three, RADs top the improper payment rate at 63%
    04/20/2018
    Theresa Flaherty

    WASHINGTON – CMS unveiled the first drafts of clinical templates for respiratory-related items at a Special Open Door Forum April 19.

    The templates, as well as suggested clinical data elements, are for respiratory assist devices (order, face-to-face encounter and lab results); positive airway pressure devices (order and face-to-face encounter); and ventilators (order and face-to-face encounter).

    The templates, which are strictly voluntary, are designed to assist providers with medical documentation requirements and data collection, in an effort to reduce denials.

    CMS has targeted RADs, PAPs and vents because of their high improper payment rates. A 2017 report on Comprehensive Error Rate Testing reported PAP has an improper payment rate of 59%, with 88% due to incomplete documentation; RADs have an improper payment rate of 63%, with 98% due to improper or incomplete documentation; and ventilators have an improper payment rate of 57%, with 25% due to incomplete documentation and 58% due to medical necessity.

    CMS officials say they welcome feedback on the drafts as they work to fine tune them. Feedback and questions can be sent to clinicaltemplates@cms.hhs.gov.

    CMS also continues to develop templates and CDEs for oxygen, which had an improper payment rate of 48% in 2015, with 86.2% due to incomplete documentation. A third draft of the templates and CDEs was discussed at a Special Open Door Forum in January 2017.

    The downloadable drafts are available on the CMS.gov website.

     


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  • 04/20/18--11:27: Stakeholders fear QIC switch
  • ‘It could exacerbate the situation at the ALJ, which is already untenable’
    04/20/2018
    Liz Beaulieu

    YARMOUTH, Maine – Stakeholders are not happy that C2C Innovative Solutions appears to be losing its gig as the Qualified Independent Contractor for HME.

    Jacksonville, Fla.-based C2C has popularized a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases. In 2017, 64% of claims that were involved in the demo were found fully favorable and 3% were found partially favorable, AAHomecare recently reported.

    “C2C has been great to work with,” said Ronda Buhrmester, a reimbursement specialist with the VGM Group. “They’re following CMS’s directives, but they see the issues, and they want to help.”

    AAH also reported that, in 2017, the demo had reopened 54,128 claims and withdrew 27,132 claims from the backlog at the administrative law judge level.

    The word on the street is that CMS is switching the QIC contract from C2C to Reston, Va.-based Maximus to save money.

    “When you provide excellent customer service and tools like C2C does, it costs money,” said Mary Stoner, president of Electronic Billing Services Inc. “It’s all about the money, and it’s too bad.”

    Stakeholders say C2C is protesting the decision, and they’re crossing their fingers.

    “They’re trying to get their expenses down to come up with a better price,” Buhrmester said. “We’re waiting to see what the outcome of that is.”

    If the contract stays with Maximus, stakeholders fear they’ll have a lot of work to do, as they say the company has little, if any, experience with DME. Maximus currently holds one QIC contract for the West Jurisdiction for Part A, while C2C currently holds five QIC contracts, including for HME and the DME Phone Demonstration.

    “We’re going to have to provide education (to Maximus) on how to process claims,” Stoner said. “We’ve notified CMS and we’ve been assured that they’re watching this.”

    Switching the contract to Maximus may also create instability in an already unstable audit and appeal environment, stakeholders fear.

    “It could exacerbate the situation at the ALJ, which is already untenable,” said Andrea Stark, a reimbursement consultant with MiraVista.


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    04/20/2018
    HME News Staff

    WASHINGTON – Office of Management and Budget Director Mick Mulvaney said last week that the agency is working to release an interim final rule that would provide relief from Medicare’s competitive bidding program, but he gave no timeline for when that might happen.

    “I will say this: I have probably received more calls about this than any other rule put together,” he said during a hearing for the fiscal year 2019 budget on April 18. “Since we’re aware of the urgency to members of both parties, I’m interested in getting it out as quickly as we possibly can. That being said, it’s a fairly complex rule, and it’s absolutely critical that we get it right because of the scope of this rule, so I won’t be able to comment.”

    Mulvaney’s comments were made in response to Rep. Kevin Yoder, R-Kan., who asked, “Can you share an update where the rule is in this process, and how far away from finalization that might be, and what steps is OMB taking right now to review the rule in a timely manner?”

    Mulvaney stated that IFR is currently under review at the Office of Information & Regulatory Affairs and said he couldn’t comment further.

    The industry has kept the pressure on lawmakers, urging them to contact Mulvaney about the IFR, which has been stuck at the OMB since August. In March, they included language in the omnibus bill encouraging CMS to implement the IFR.

    AAHomecare plans response to tariff proposal

    WASHINGTON – AAHomecare plans to submit comments to the U.S. Trade Representative in response to a proposed tariff of 25% on medical equipment from China. The association and representatives from several manufacturer members have met to discuss the response. A sudden increase in costs for equipment made in China would cause significant hardship and disruption for HME providers and patients, says AAHomecare.

    Quantum Rehab offers peek at manufacturing

    DURYEA, Pa. – Quantum Rehab has released “Quantum Experiences are Made in America,” a new video offering an inside look at its U.S.-based manufacturing facility, process and products. Quantum’s complex rehab power wheelchairs are custom built to each user’s needs in a state-of-the-art, vertically integrated manufacturing facility in Duryea, Pa., along with an additional production facility in Las Vegas, the company says. “We’re immensely proud of the made-in-the-USA foundation we’ve created with Quantum to best serve our customers and engage the tremendous local workforce,” said Joe O’Brien, senior vice president of global operations in a press release.

    Wisconsin recognizes complex rehab

    NASHVILLE, Tenn. – Legislation recognizing complex rehab as a separate benefit category has been passed in Wisconsin and signed into law by Gov. Scott Walker, according to a press release from National Seating & Mobility. “We were honored to stand alongside Gov. Walker to witness the adoption of CRT legislation protecting individuals with disabilities in Wisconsin,” said Ryan Peebles, NSM’s director of government affairs. “Our coalition has worked tirelessly for more than 18 months to advance education about the complexity of CRT solutions and the unique needs of individuals with disabilities who are in need of those services and products.” NSM has worked on getting AB-462 passed in the House and SB-381 in the Senate with NCART, Ki Mobility and Comfort Company for 18 months. The legislation helps to protect access to critical products and related services for individuals with significant disabilities by recognizing the specialized nature of complex rehab; and by establishing supplier standards that incorporate beneficiary and program safeguards already in place for Medicare.

    Inolife primes ADW to distribute Inojex

    TORONTO – Inolife R&D has entered into a letter of intent with ADW Diabetes for the distribution of its Inojex, a patented and FDA-cleared needle-free injection device. With ADW as a new partner, Inolife will have strategic access to one of the biggest insulin markets in the world, according to a press release. “By connecting innovative needle-free insulin delivery technologies to ADW’s diabetic community, we will create new opportunities and synergies that otherwise would not have been available to our companies,” said Michael Wright, president and CEO of Inolife. “Partnering with ADW fits perfectly into our vision that every individual should have the opportunity to receive healthcare that is empowering, safe and respectful.” Company officials say the fear of needles is a leading reason why people with diabetes do not stay on track with their care team’s recommendations for optimum blood glucose management. “Inolife solves that problem,” said Michael Maguire, president and CEO of ADW. “ADW is excited to team up with Inolife so we can delivery comfort and ease to anyone with diabetes.”

    Viemed launches new corporate website

    LAFAYETTE, La. – Viemed Healthcare has launched a new corporate website to offer quick and easy access to essential information about the company’s medical equipment and respiratory therapist service business. The website, www.viemed.com, also has an investor section with updated company news and events, financial and stock information, regulatory filings and corporate governance information. “We are excited about our new website launch and the robust information it provides customers, investors, partners and media to better understand the Viemed business,” said Casey Hoyt, CEO. “We believe that this new site will allow our visitors to have a very informative experience as we continue to grow and increase our market presence across the United States.” The website will be updated on a regular basis with news of product launches, business activity, corporate milestones, events, and investor and financial information. Viemed operates through two indirect wholly owned subsidiaries: Sleep Management, which focuses on disease management; and Home Sleep Delivered, which focuses on in-home sleep testing.

    Research backs use of myAirvo device, F&P says

    AUCKLAND, New Zealand – Fisher & Paykel Healthcare says new research that has been published in the International Journal of COPD shows significant benefits of nasal high flow therapy for COPD patients using its myAirvo device. A randomized controlled trial in Denmark investigated the long-term effects of nasal high flow therapy for COPD patients already being treated with long-term oxygen therapy. The trial showed statistically significant results, including a significant reduction in the exacerbation rate of patients. It also showed a reduction in hospitalization rates, less breathlessness, better mobility and lower carbon dioxide retention levels for chronic patients. The trial followed 200 patients with COPD on long-term oxygen for 16 hours or more per day over a year. As a result of the positive outcomes of the trial, a larger multi-center trial has begun.

    Stratice Healthcare strengthens board of advisors

    CARMEL, Ind. – Stratice Healthcare, the company behind the e-prescribing solution suite eOrdersPlus, has tapped Renee Picard Walsh to join its board of advisors. Stratice says Picard Walsh will help the company make inroads in the home health market. “I was completely engaged when I became aware Stratice had achieved universal accessibility to eOrdersPlus via its web-based applications and completed direct EHR integrations offering suppliers direct connectivity to 30% of physician prescribers,” said Picard Walsh. “There is such a need for this solution within home health. Stratice’s technology has revolutionized DME ordering for physicians and it will fill the remaining gaps in home care.” Stratice also has Chad Hammerstrom, executive vice president of business development, championing the company’s e-prescribing solution.


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    04/23/2018
    Liz Beaulieu

    Because the response to a recent HME Newspoll was so paltry (See “Goal for 2018: ‘Make money, not lose it,’ March 2018), I called Miriam Lieber to find out what providers could be doing differently with their businesses this year.
    Willing to take risks
    Lieber, president of Lieber Consulting LLC, says the majority of her client base has experienced some level of success, despite the difficult climate. In the upcoming year, they’re looking for ways to stay that way.
    “They’re scrambling a little bit right now, trying to find new ways to define themselves to ensure that their profitability continues to grow,” she said. “They’re looking to expand what they do well, because they know they can’t be everything to everybody. If there’s an opportunity related to their core competencies, they’re exploring it unabashedly. They’re unafraid to take risks.”
    Developing business
    Lieber says her coaching business, which she started just for fun, has kept her “really, really busy,” an indication that providers are making leadership a focal point in the upcoming year in a way that they haven’t in the past. Her clients are boosting their corporate culture, and hiring people with higher-level skillsets to focus on payer relations and business development.
    “They’re realizing if they don’t run their business like a business, and don’t have good leadership, they’re going to wobble,” she said.
    Mining technology
    Lieber says providers will be mining technology in the upcoming year to find ways to make themselves even more instrumental and relevant to the healthcare process.
    “There are more and more software solutions that wed the referral, the patient, the payer and them,” she said. “This helps to make the case, ‘There’s no way for them to go around us.’”  
     


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    ‘I need to decide what my next move is,’ says one contract provider
    04/27/2018
    Theresa Flaherty

    WASHINGTON – With only seven months to go until the current competitive bidding contracts expire across the country, HME providers are getting antsy for information on Round 2019.

    “We’ve heard nothing,” said Josh Eckstein, vice president of Complete Home Care in Buffalo, N.Y., which holds a respiratory contract. “I need to decide what my next move is. There’s no chance there is enough time to evaluate my bid then figure out whether to accept a new contract.”

    CMS has typically given the bidding process—from bid window opening to contract implementation—about 16 months. However, a new requirement that bidders obtain surety bonds for each CBA in which they bid means providers could need even more time.

    Some providers are anxious to get on with it.

    “I have been looking forward to a raise (in reimbursement) in Round 2109,” said Andrew Trammell, president of Carolina’s HME in Charlotte, N.C., which holds contracts for general DME and standard mobility. “There will be fewer bidders and the bidders will be far more reasonable.”

    CMS could buy itself more time by extending the current contracts for another six months beyond Dec. 31, 2018. If a current contract provider refuses to re-up, the agency could offer contracts to the next bidder.

    That could be easier said than done, says Eckstein.

    “I don’t think there’s enough providers left in our market,” he said. “Out of 23 companies, only four of them actually operate locally. Patients are waiting weeks and weeks for tanks.”

    Ecsktein isn’t sure, if it comes right down to it, whether or not he would extend his contract.

    “Because of the hoops that Medicare makes us jump through to get oxygen covered, it’s not worth it—it costs too much,” he said.

    For Trammell, extending the contracts would be a survival tactic.

    “The only benefit (to participating in the bid program) was maintaining our patient base until reimbursement improves,” he said. “And to be a one-stop shop for our referrals.”

    On the bright side, the long delay could mean an improved bid program, say stakeholders.

    “We’d all prefer a better program with more sustainable pricing,” said Cara Bachenheimer, vice president of government relations for Invacare. “The question is, how long can you muddle through from a business perspective?”

    Department of Health and Human Services Secretary Alex Azar has said any changes to the bidding program would go through a full rulemaking process.

    “I think for Round 2019, they are going to do a proposed rule with comment period and then a final rule,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “We’re going to keep meeting with the folks at HHS and CMS, and push our recommendations for changes.”


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    04/27/2018
    HME News Staff

    YARMOUTH, Maine – Nine out of 10 wheelchair users in the U.S. experience pain as a result of their device, according to a new study.

    The study, conducted by ComRes for the Toyota Mobility Foundation, polled wheelchair users in five countries.

    In November, the foundation launched the $4 million Mobility Unlimited Challenge to change the lives of people with lower-limb paralysis with “game-changing” technology.

    "This research expresses the urgent need for innovation in this area,” said Julie Ann Burandt, global strategy and communications manager, Toyota Mobility Foundation. “It's surprising that with all of the technology we have today, we still have people in constant pain as a result of their mobility devices. The comments we are receiving through social media show the kinds of developments that people want to see and we hope the Challenge will result in genuinely life-changing technologies."

    According to the study, 50% of users experience back pain at least once a day, 29% experience shoulder pain at least once a day, and 28% say they constantly experience back pain.

    Getting around

    The study also found that 39% of U.S. wheelchair users report needing assistance travelling to destinations, and 31% have been unable to find an accessible toilet.

    NSM makes ‘special’ buy

    NASHVILLE, Tenn. – National Seating & Mobility has acquired Chattanooga-based Professional Rehab & Mobility. The deal, which also includes locations in Knoxville and Kingsport, allows NSM to expand its reach throughout Tennessee. “Tennessee is home to both our corporate headquarters in Franklin, and our operations center in Chattanooga, making this acquisition particularly special to NSM,” said Bill Mixon, NSM CEO, in a press release. Professional Rehab was launched in 2003 by respiratory therapists Theresa Crump and Vickie Jarrell. It sold its respiratory and DME segments and rebranded as a mobility focused company in 2017. “NSM’s client-focused approach was a good match for our team,” said Crump, co-owner. “We are excited to bring our community of clients the industry-leading resources NSM can provide.”

    Inspire Medical Systems sets terms for IPO

    MINNEAPOLIS ­– Inspire Medical Systems plans to raise $75 million by offering 5 million shares at a price range of $14 to $16 as part of an initial public offering that it announced earlier this month. Insiders plan to purchase $15 million worth of shares in the IPO, according to Nasdaq. Inspire Medical Systems, which plans to list on the New York Stock Exchange under the symbol INSP, makes FDA-approved neurostimulation technology that provides treatment for moderate to severe obstructive sleep apnea. It generated $29 million in sales for the 12 months ended Dec. 31, 2017.

    Aeroflow earns local honor

    ASHEVILLE, N.C. – Aeroflow Healthcare has received the Asheville Area of Commerce Sky High Growth Award. The award is given to 28 local businesses in recognition of their contribution to the local economy. “Aeroflow’s ongoing commitment centers around the three Cs: customers, coworkers, and community,” said Casey Hite, Aeroflow president and CEO, in a press release. “By investing in our staff, we’ve seen substantial growth from motivated individuals who are happy to be here to provide the highest quality of care possible. This award is completely in line with our corporate objectives to give back to the local community in the flourishing city we love.” Aeroflow employs more than 200 people and regularly gives back to the community, including through donations to the local foodbank.

    Tandem targets Australasia

    SAN DIEGO – Medical Device maker Tandem Diabetes Care has inked distribution agreements with Australasian Medical & Scientific Ltd (AMSL) and New Zealand Medical & Scientific Ltd (NZMS) to distribute Tandem’s t:slim X2 Insulin Pump in Australia and New Zealand, respectively. “Partnering with key international distributors furthers our mission to expand available insulin pump choices for people with diabetes worldwide,” said Kim Blickenstaff, president and CEO of Tandem Diabetes Care. “AMSL and NZMS have significant experience introducing a variety of diabetes-specific products to patients and healthcare providers in Australia and New Zealand, and we look forward to working with them to bring the t:slim X2 Insulin Pump to the communities they serve.”

    In February, Tandem submitted a medical device license application to health Canada to market its t:slim X2 Insulin Pump with Dexcom G5 Mobile continuous glucose monitoring integration.

    Sleep patients have their say

    WASHINGTON – Sleep apnea patients and their family members will share perspectives on living with the condition with Food and Drug Administration regulators, drug and medical device developers, and researchers, according to a release from the American Sleep Apnea Association. The AWAKE Sleep Apnea Initiative will collect patient and caregiver experiences as they relate to diagnosis, impact on daily life, symptom management, and treatment expectations through an online survey. A meeting with FDA officials is scheduled for June 8.

    Home Oxygen Company clears TPE

    MODESTO, Calif. – Home Oxygen Company has cleared the first round of review for the Targeted Probe and Educate program, the company announced April 25. “This is a collaborative effort between internal and external teams, resulting in compliant files,” said Andrea Ewert, CEO. “We continue our process for success despite the obvious burden.” Noridian Healthcare Solutions, the DME MAC for jurisdictions A and D, selected Home Oxygen Company’s CPAP claims for the TPE program earlier this year. As part of the program, the MACs review 20 to 40 claims per provider, per item or service, per round, for a total of up to three rounds of review. Previously, Home Oxygen Company had received a 12-month reprieve from Noridian for widespread pre-pay reviews for CPAP and oxygen. “I have 100% confidence in our abilities to process orders in the manner Medicare requires,” Ewert said.

    ATS, ResMed launch fellowship

    NEW YORK – The ATS Foundation and ResMed have partnered on a new fellowship in sleep-disordered breathing and PAP therapy. The ATS Foundation/ResMed Research Fellowship is made possible through a $100,000 contribution from ResMed. “This award can help shine a brighter light on sleep apnea—a public health crisis—and PAP therapy’s role in addressing it worldwide,” said Carlos M. Nunez, MD, ResMed’s chief medical officer. “When 85% of people with sleep apnea still aren’t diagnosed, ResMed is proud to support high-quality research efforts to accelerate finding, testing and treating them so they can enjoy a full night’s rest, better overall health and a significant reduction of life-threatening risks.” The fellowship application process will open April 26. The ATS Scientific Advisory Committee will review applications for their scientific merit, innovation, feasibility and relevance to sleep-disordered breathing and PAP therapy. The $100,000 in funding will span a two-year period, from December 2018 through December 2020.

    ACHC launches nutrition distinction

    CARY, N.C. – The Accreditation Commission for Health Care has launched a Distinction in Nutrition Support (NTS), the industry’s first, it says. The distinction augments the company’s infusion pharmacy accreditation, allowing providers to demonstrate their expertise in the provision of nutrition products and formulas, as well as their commitment to optimal patient care, according to a press release. “The Distinction in Nutrition Support focuses on nutrition-specific pharmacy operations and the provision of care, allowing infusion providers to differentiate themselves among their competitors,” said Tim Safley, director of DMEPOS, pharmacy and sleep. Pharmacies seeking to achieve a Distinction in NTS must do so in combination with ACHC Infusion Pharmacy Accreditation. The Nutrition Distinction joins ACHC's other distinctions in oncology, infectious disease specific to HIV, and hazardous drug handling.

     

     


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    04/30/2018
    HME News Staff

    WASHINGTON – The DME MACs have rescinded part of their updated guidance for the oxygen CMN.

    Back on Feb. 15, the MACs published an article with new supplier guidance on how to use new Q modifiers on the certificate of medical necessity form. They instructed providers to report the calculated average flow rate for Question 5 on the CMN when a patient has differing daytime and nighttime prescribed flow rates. They also instructed providers to submit revised CMNs in this situation.

    In an article on April 26, however, the MACs rescinded the instructions related to submitting a revised CMN.

    AAHomecare applauded the change, saying requiring suppliers to create tens of thousands of revised CMNs would have created significant burdens.

    “AAHomecare appreciates CMS and the DME MACs listening to concerns and rescinding the requirement,” it stated in a bulletin. “This is an example of the excellence working relations the industry has built with CMS and contractors to resolve issues that significantly impact suppliers.”

    Three new Q modifiers went into effect April 1:

    • QA (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute);
    • QB (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute and portable oxygen is prescribed); and
    • QR (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute).

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    05/04/2018
    Theresa Flaherty

    WASHINGTON – Industry stakeholders say an upcoming rule could be a potential vehicle for changes to Medicare’s competitive bidding program.

    Last week, the Office of Management and Budget indicated that the proposed rule, CY 2019 Changes to the End-Stage Renal Disease Prospective Payment System, is under review.

    “We talk to the Health and Human Services folks all the time and they have assured us they are working on all of our issues,” said Jay Witter, senior vice president of public policy for AAHomecare. “The ESRD would be the easiest vehicle for them to do it.”

    However, like the interim final rule that has been stuck at the OMB since August, there is simply no way to know what’s in the proposed rule for ESRD until it’s published, something that probably won’t happen until the end of June. In previous years, the rule has contained items related to future rounds of competitive bidding, although the most recent iteration of the rule did not.

    In the meantime, stakeholders continue to press both HHS officials and lawmakers for the release of the IFR, as well as raise concerns that information and instructions related to Round 2019 are long overdue.

    “We’d like to work with them—we’d prefer them to fix the program rather than rush something out,” Witter said. “Lawmakers’ level of concern is growing about all these issues.”

    Senate Finance Committee Chairman Orrin Hatch, R-Utah, last week sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma, expressing concerns with the bid program and the national mail-order program for diabetes testing supplies.

    One thing providers may not have to worry about: the expansion of the bidding process to all areas of the country, a proposal that was included the 2019 HHS budget. Witter says he has spoken with both Azar and Deputy Secretary Eric Hargan about the proposal.

    “It’s in the budget, so they support it, but I got the sense that it’s a proposal that’s not moving forward,” he said.


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    05/04/2018
    HME News Staff

    WASHINGTON – The Medicaid programs of 11 states have indicated that they will be changing their fee schedules to match Medicare’s, AAHomecare reports.

    Twelve states say they will not be changing their fee schedules at this time, and 10 states say they are still analyzing data with AAHomecare and/or CMS.

    “It’s gratifying to work alongside so many dedicated individuals across the country to encourage state Medicaid officials to take a careful look at their options for complying with the Cures Medicaid provisions,” said Laura Williard, AAHomecare’s vice president for payer relations. “The persistence and a team-approach exhibited by these leaders has made all the difference in our successes thus far."

    A provision in the Cures Act required CMS to cap its contribution to Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018. Industry stakeholders, including AAHomecare and state associations, have been doggedly working to educate state Medicaid programs that they have options other than just adopting Medicare’s fee schedules.

    The states that will be changing their fee schedules: Vermont, Montana, Washington, Colorado, Iowa, Kentucky, North Dakota, Connecticut, Maine, Massachusetts and Alabama

    The states that won’t be changing their fee schedules: Florida, Georgia, Hawaii, Michigan, Minnesota, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Indiana. 

    The states that are still analyzing data: New Hampshire, Illinois, New York, Kansas, Missouri, Oklahoma, Rhode Island, Wisconsin, Nebraska and South Dakota.

    AAH and state associations are working with Iowa, Kentucky, Connecticut and Alabama to convince them to reverse their decisions to adopt Medicare’s fee schedules, or to limit their reductions in reimbursement using HCPCS-based utilization.

    DME MACs: Revised CMNs aren’t necessary

    WASHINGTON – The DME MACs have rescinded part of their updated guidance for the oxygen CMN.

    Back on Feb. 15, the MACs published an article with new supplier guidance on how to use new Q modifiers on the certificate of medical necessity form. They instructed providers to report the calculated average flow rate for Question 5 on the CMN when a patient has differing daytime and nighttime prescribed flow rates. They also instructed providers to submit revised CMNs in this situation.

    In an article on April 26, however, the MACs rescinded the instructions related to submitting a revised CMN.

    AAHomecare applauded the change, saying requiring suppliers to create tens of thousands of revised CMNs would have created significant burdens.

    “AAHomecare appreciates CMS and the DME MACs listening to concerns and rescinding the requirement,” it stated in a bulletin. “This is an example of the excellence working relations the industry has built with CMS and contractors to resolve issues that significantly impact suppliers.”

    Three new Q modifiers went into effect April 1:

    QA (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute);

    QB (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute and portable oxygen is prescribed); and

    QR (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute).

    Ally Medical, Preston Wound Care merge under Acentus

    TAMPA, Fla. – Principles from Tampa, Fla.-based Ally Medical Services and McKinney, Texas-based Preston Mobility Plus, dba Preston Wound Care, have merged. They’re now wholly owned subsidiaries of Acentus, also based in Tampa. Ally Medical is one of Florida’s larges providers of incontinence and medical nutritional supplies to children with special healthcare needs, and urological catheters to the neurogenic bladder patient population. Preston Wound Care is one of Texas’ largest wound care providers to patients living at home with diabetic ulcers and chronic wounds. Together, they give Acentus a robust platform that includes 24 state Medicaid licenses and a broad portfolio of commercial and managed care insurance contracts. “We believe the Acentus platform represents the future for medical supply entrepreneurs,” Ally Medical Co-founder and CEO Todd Cianfrocca said. “It allows successful, independent owners to band together and focus on building their patient revenue base quicker, more profitably and with a clear path to optimize the enterprise value of their business.”

    PromptCare expands south

    CLARK, N.J. – PromptCare, a regional provider of respiratory and infusion services, has acquired Hometown Oxygen, it announced today. The Charlotte, N.C.-based Hometown Oxygen specializes primarily in pediatric vent patients, serving nearly 1,100 from eight locations throughout the Carolinas. “Bringing the Hometown team on board will allow us to expand our footprint to the Southeast, an integral part of our strategy,” said PromptCare CEO Tom Voorhees. “(CEO) Scott Dinning and the Hometown team share our strong commitment to providing exemplary patient care to those we care for, and we are excited to partner with them as we continue building our platform.” Dinning will stay on as an executive. PromptCare serves more than 3,400 pediatric and adult patients through 23 locations across the Mid-Atlantic and the Northeast.

    Stakeholders publish ostomy white paper

    WASHINGTON – AAHomecare has partnered with several patient organizations, including the United Spinal Association, the United Ostomy Associations of America and the Spina Bifida Association, to produce a white paper on why the competitive bidding program should not be expanded to include urologicals and ostomy supplies. Both the president’s budget and the Medicare Payment and Advisory Committee have referenced such a possibility. “The danger of expanding the competitive bidding program to ostomy and urological supplies is that the minimal function of the product can take precedent over patient choice and advanced technologies, which often, and necessarily, enhances quality of life,” said contributor Anna Markiewicz of Hollister, in a bulletin.

    Cork Medical inks ‘winning’ deal with GPO

    INDIANAPOLIS – Medical device maker Cork Medical has signed a deal to serve as the sole provider of negative pressure wound therapy products for HPS, a group purchasing organization for 4,000 organizations in 22 states. “HPS is proud to offer Cork Medical’s Nisus negative pressure system to our members,” said Benjamin Long, contract portfolio analyst for HPS, in a release. “The exceptional pricing available through this contract, coupled with Cork Medical’s infrastructure of service centers throughout our member base, is a winning combination.” Cork Medical manufactures the Nisus NPWT system for use in hospitals, nursing homes and homecare settings.

    VGM Fulfillment launches compression resupply program

    WATERLOO, Iowa – VGM Fulfillment has launched a compression stocking resupply program. The new program complements its existing CPAP resupply program, which ships more than 2 million orders annually, according to a press release. “We are excited to expand our offering of services outside of CPAP fulfillment to include compression stocking fulfillment,” said Jeremy Stolz, president of VGM Fulfillment. “Similar to CPAP, the compression market is growing. This new service allows the opportunity for seamless delivery or resupply of compression stockings directly to patients or to a provider’s store.” 

    Aeroflow springs into volunteering

    ASHEVILLE, N.C. – Aeroflow Healthcare kicked off its spring volunteering with its employees participating in several community events. “Volunteering our time and resources to help those in need encompasses the three Cs that define Aeroflow’s culture: customers, co-workers and community,” said Ashlie Groff, director of accounting and head of Aeroflow’s Community Involvement Committee. “Along with helping others, we’re able to combine the rewarding experience of making a difference for others with the opportunity to grow stronger as a team.” So far, employees have participated in events for the Special Olympics, senior bingo and a community garden day.

    MSD picked up by McKesson

    STOUGHTON, Mass. – Medical Specialties Distributors has entered into a definitive agreement to be acquired by McKesson Corp., the company announced April 25. McKesson will pay $800 million for the post-acute/non-hospital patient supply chain provider, according to news reports. “We believe McKesson is the ideal partner and view this transaction as a strategic fit that will generate many benefits for our customers and their patients,” said Tom Burke, CEO of MSD. “Combining our complementary businesses will allow us to collectively bring more value to the healthcare providers across the post-acute segments MSD serves.” MSD provides more than 9,700 healthcare providers at more than 11,000 sites nationwide with a broad portfolio of medical supplies, biomedical services and technology solutions. The company has been owned by investment firm New Mountain Capital since 2013. The deal is expected to close in the first half of McKesson’s fiscal year 2019.

    KCI: Data supports remote therapy monitoring

    SAN ANTONIO – KCI shared data at the recent 2018 Symposium of Advanced Wound Care Spring Conference that demonstrates increased patient therapy usage immediately after patient contact using its iOn Progress Remote Therapy Monitoring. The day following an adherence call, 73.5% of patients increased therapy use, with an average increase of eight hours, the company says. Additionally, as adherence increased, the rate of daily change in wound volume reduction also increased, it says. “Patient adherence to treatment is an ever-present concern for clinicians, and we have successfully harnessed technology to alleviate that concern for more effective home care, and to provide smarter solutions for our customers and their patients,” said Ron Silverman, MD, chief medical officer, KCI. iOn Progress delivers continuous at-home monitoring for patients prescribed NPWT at home. It works in conjunction with the ACTIV.A.C system to monitor adherence and securely transmit data to the KCI iOn Progress Care Network, a group of highly trained individuals who interact with patients to driver proper utilization. The presentation is an extension of a recently published study in WOUNDS.

    Short takes: VGM, Cure Medical

    Waterloo, Iowa-based VGM Group has released its second playbook: “Industry Insights: How to Capitalize on Opportunities in Post-Acute Health.” The playbooks serve as a resource for HME providers adjusting to an ever-changing business climate, VGM says. This latest playbook covers a number of areas, including people, processes and business diversification…Newport Beach, Calif.-based Cure Medical has announced that its full line of ready-to-use, 16-inch hydrophilic catheters are now approved for sale in Canada. In March, the company announced that its Ultra Ready-to-Use Catheters were approved for sale in Canada.

    People news: NSM, Vitalus Health

    Nashville, Tenn.-based National Seating & Mobility has named Jim Noland director of clinical development. He will be responsible for developing clinical and professional relationships to support continued growth at the company. Prior to joining NSM, Noland founded Presque Isle Medical Technologies and Conduit Technology. He is also a former SMS and owner/operator of an HME, complex rehab and O&P practice in Erie, Pa…Houston-based Vitalus Health has named Karen DeJean, MSN-NI, RN, CCM, vice president of health services. She will be responsible for developing a technology based airway and heart home health program to bridge the gap between inpatient and outpatient care. DeJean has been practicing nursing for more than 30 years in Texas. Vitalus Health provides specialty lung disease management, comprehensive sleep diagnostic solutions, PAP therapy, EEG testing and home health care.


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    05/04/2018
    HME News Staff

    WASHINGTON – Sen. Orrin Hatch, R-Utah, who is chairman of the influential Senate Finance Committee, has written a letter to HHS and CMS urging them to provide relief from Medicare’s competitive bidding program, the VGM Group reports.

    In the May 1 letter, Hatch urges HHS to submit a mandated report on the impact of the application of competitive bidding rates in non-bid areas, and to take appropriate action to ensure access to DME in those areas.

    Hatch also urged the agencies to address a number of concerns with the national mail-order program for diabetes testing supplies, including the decrease in the number of contract providers for these supplies.

    The letter follows a meeting between members of the Utah Medical Equipment Dealers and the offices of Hatch and Sen. Mike Lee, R-Utah. Among the topics discussed at the meeting: H.R. 4229 and an interim final rule stuck at the Office of Management and Budget, both of which would provide relief from the bid program in rural areas.

    “This is a great example of the importance of grassroots activities,” VGM stated in a bulletin.


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    05/04/2018
    HME News Staff

    WASHINGTON – The Medicaid programs of 11 states have indicated that they will be changing their fee schedules to match Medicare’s, AAHomecare reports.

    Twelve states say they will not be changing their fee schedules at this time, and 10 states say they are still analyzing data with AAHomecare and/or CMS.

    “It’s gratifying to work alongside so many dedicated individuals across the country to encourage state Medicaid officials to take a careful look at their options for complying with the Cures Medicaid provisions,” said Laura Williard, AAHomecare’s vice president for payer relations. “The persistence and a team-approach exhibited by these leaders has made all the difference in our successes thus far."

    A provision in the Cures Act required CMS to cap its contribution to Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018. Industry stakeholders, including AAHomecare and state associations, have been doggedly working to educate state Medicaid programs that they have options other than just adopting Medicare’s fee schedules.

    The states that will be changing their fee schedules: Vermont, Montana, Washington, Colorado, Iowa, Kentucky, North Dakota, Connecticut, Maine, Massachusetts and Alabama

    The states that won’t be changing their fee schedules: Florida, Georgia, Hawaii, Michigan, Minnesota, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Indiana. 

    The states that are still analyzing data: New Hampshire, Illinois, New York, Kansas, Missouri, Oklahoma, Rhode Island, Wisconsin, Nebraska and South Dakota.

    AAH and state associations are working with Iowa, Kentucky, Connecticut and Alabama to convince them to reverse their decisions to adopt Medicare’s fee schedules, or to limit their reductions in reimbursement using HCPCS-based utilization.


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    05/09/2018
    HME News Staff

    WASHINGTON – CMS will publish an interim final rule in the Federal Register on May 11 that resumes reimbursement rates for DME included in the competitive bidding program to the 50/50 blended rates from June 1, 2018, to Dec. 31, 2018.

    “This action will help Medicare beneficiaries in rural areas continue to access life-sustaining DME, like oxygen equipment,” said CMS Administrator Seema Verma.

    In 2016 and 2017, information from the bid program was used to adjust Medicare payments for certain DME and enteral nutrition in non-bid areas. Beginning Jan. 1, 2017, the fully adjusted fee schedule rates were, on average, 50% lower than the unadjusted rates in these non-bid areas based on the average reduction in payment for all of the items and services subject to the adjustments, weighted by volume. In 2016, prior to the fully adjusted fee schedule rates going into effect, blended rates of 50% of the amount based on the competitive bid rates and 50% of the traditional fee schedule amounts were implemented for the transitional year period. The rule would resume those blended rates from June 1, 2018, to Dec. 31, 2018.

    CMS says it is continuing to engage with stakeholders regarding the bid program and payment for items and services furnished in non-bid areas.

    “Going forward, CMS will continue to review data and information about rates for DMEPOS items and services, as required under section 16008 of the 21st Century Cures Act,” the agency states. “CMS intends to undertake subsequent notice-and-comment rulemaking to address the rates for durable medical equipment and enteral nutrition furnished in 2019 and beyond.”

    CMS will collect comments on the rule through July 9.
     


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    05/09/2018
    HME News Staff

    WASHINGTON – The status of an interim final rule that would provide relief from Medicare’s competitive bidding program was changed to “concluded” on May 8.

    Previously, the status of the IFR, which has been sitting at the Office of Management and Budget since August, was “pending.”

    An abstract for the IFR states that it would extend a phase-in period for a second round of reimbursement cuts for DME and enteral nutrition in non-bid areas from June 30, 2016, to Dec. 31, 2016. It would also amend the regulation to resume the transition period for items furnished from Aug. 1, 2017, through Dec. 31, 2018.

    According to the abstract, the IFR would also:

    • Make technical amendments to existing regulations for DMEPOS items and services to exclude infusion drugs used with DME from the bid program; and
    • Request information on issues related to adjustments to DMEPOS fee schedules, alternatives for ensuring budget neutrality of oxygen payment classes and current rules under the bid program.

     

    AAHomecare says it is working with sources to find out more about the new status of the IFR and expects additional details to be published in the next few days.


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    ‘We have to go back to Congress and tell them, you have to fix it’
    05/11/2018
    Theresa Flaherty

    WASHINGTON – The long-anticipated interim final rule landed with a thud last week, when it became apparent that it offered little in the way of bid relief, say industry stakeholders.

    “It’s not the IFR we were expecting,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “They didn’t even do half of what were anticipating and, more importantly, what folks on Capitol Hill were anticipating.”

    The IFR, published in the May 11 Federal Register, applies the 50/50 blended rates, but only from June 1, 2018, to Dec. 31, 2018, instead of retroactively to Jan. 1, 2017, as the industry had sought.

    Furthermore, those seven months of relief will only apply to rural and non-contiguous CBAs. That’s in stark contrast to what lawmakers intended and to a provision in the 21st Century Cures Act that called for a roll back of reimbursement cuts in all non-bid areas.

    “The (IFR says it) is a continuation of the Cures Act payment relief, but then it’s limited to Hawaii, Alaska and these super-rural areas,” said Bachenheimer. “It is really very limited.”

    That means, even when the IFR goes into effect, a lot of beneficiaries will continue to be vulnerable to access issues, says John Gallagher, vice president of government relations for VGM.

    “The majority of the population outside the CBAs are not going to be covered,” he said. “If you’ve got a hospital in Butte, Mont., that wants to discharge a patient to a small town that’s considered not rural, providers are going to say, ‘I don’t go there.’ It’s sheer incompetence by CMS.”

    CMS did acknowledge that there are many issues with the bid program—like the oxygen “double-dip”—that need to be fixed, say stakeholders.

    “This is the first time, in my experience, that CMS has acknowledged major problems,” said Jay Witter, senior vice president of public policy for AAHomecare. “We’re seeing through the disappointment.”

    At press time on Friday, AAHomecare was still analyzing the impact before determining next steps.

    “We need for all bid areas to get relief, but we need to get an accurate read of this to give lawmakers further recommendations,” Witter said. “We’ve been communicating with folks on the Hill and will probably go back to them with a request for legislation to fulfill the rest of the relief that’s needed.”

    Gallagher already had a meeting planned with Sen. Chuck Grassley’s office on Friday afternoon.

    “We want to point out the stupidity of this,” he said. “CMS said yes, there are problems, but they didn’t fix them. We have to go back to Congress and tell them, you have to fix it.”


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  • 05/11/18--11:22: AAH pushes e-prescribing
  • ‘It’s time for paper to go,’ says Kim Brummett
    05/11/2018
    Liz Beaulieu

    WASHINGTON – AAHomecare’s goal for a new project evaluating e-prescribing platforms isn’t to provide a Good Housekeeping seal of approval, per se, but to raise the level of awareness and comfort surrounding the technology, says Kim Brummett.

    “Providers can be leery, so we’re trying to help drive adoption,” said Brummett, vice president of regulatory affairs, who is spearheading the project for the association. “I hope we succeed. It’s time for paper to go.”

    As part of the project, Brummett and other members of AAHomecare’s Regulatory Council have been on calls with senior leadership from Stratice Healthcare, Parachute Health, GoScripts and DMEhub to familiarize themselves with each company’s platform.

    While similar, the four platforms are different enough in form and function that having AAHomecare step in to “vet” them was necessary, Brummett says.

    “At the end of the day, I’m sure we’ll be comfortable with all the platforms,” she said. “But having us go through this process and making sure all the platforms meet compliance requirements, for example, will help. Then it’s up to the supplier to choose which one to adopt.”

    The project also aims to address several challenges to adopting e-prescribing platforms, like getting buy-in from prescribers and/or having prescribers that use multiple platforms, Brummett says.

    “A supplier may say, ‘I choose this one,’ but then find their prescribers use more than one platform,” she said. “It can get confusing.”

    Joining AAHomecare in pushing providers toward e-prescribing: CMS, says Wayne van Halem, president of The van Halem Group, who’s involved in the project. The agency is exploring an increasing number of e-templates, most recently for RADs, PAPs and vents.

    “They understand that DME claims are what’s clogging up the appeals system, and more than ever before they’re listening to the provider community and coming up with ways to make the process easier,” he said. “Technology is a big part of that.”


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    05/11/2018
    Liz Beaulieu

    FARGO, N.D. – Noridian Healthcare Solutions has taken over yet another CMS contract.

    The company, which is already the Medicare Administrative Contractor for jurisdictions A and D, and the Pricing Data Analysis and Coding contractor, among other things, has been awarded a $227 million contract to be the new Supplemental Medical Review Contractor.

    “Noridian has extensive DME experience in the field, so this is definitely in their wheelhouse,” said Andrea Stark, a reimbursement consultant with MiraVista. “I think this is a good thing for the HME industry going forward.”

    CMS previously contracted with Omaha, Neb.-based StrategicHealthSolutions to conduct post-pay review audits as the SMRC.

    Reimbursement consultant Mary Stoner also believes Noridian is a good pick to be the SMRC. She has worked closely with the company in her work on the DMERC Advisory Committee for Jurisdiction D.

    “They’re a go-to for us on that committee,” said Stoner, president of Electric Billing Service Inc. “When we’ve had questions for the SMRC that we’ve sent over and over and over, and never received a response. We already have a relationship with Noridian, so we know they’re going to be taking and answering those questions.”

    There are some, however, that take pause with giving Noridian the power to conduct not only pre-pay reviews as a MAC but also post-pay reviews as the SMRC.

    “People are a little uneasy with that,” said Ronda Buhrmester, a reimbursement specialist with The VGM Group. “So they’re not sure about it yet.”


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    05/11/2018
    HME News Staff

    WASHINGTON – The DME MACs are adding modifiers that will allow HME providers to provide additional information related to the coverage and/or liability when the policy criteria are not met for oxygen patients.

    “The benefit of this change is that suppliers can now file an oxygen claim when a patient doesn’t qualify and get an accurate PR (patient responsibility) denial,” AAHomecare wrote in a bulletin.

    Effective for claims with dates of service on or after Aug. 1, providers should use:

    • the KX modifier when the requirements specified in the medical policy have been met;
    • GA for a waiver of liability (expected to be denied as not reasonable and necessary, ABN on file);
    • GY for item or service statutorily excluded or does not meet the definition of any Medicare benefit;
    • or GZ for item or service not reasonable or necessary (expected to be denied as not reasonable or necessary, no ABN on file).

    AAHomecare says stakeholders have been requesting these changes for “many years.”

    Philips buys NightBalance

    AMSTERDAM, the Netherlands – Royal Philips has expanded its sleep and respiratory care portfolio with the acquisition of NightBalance, the Delft, Netherlands-based maker of the Sleep Position Trainer. The SPT is a device worn around the upper body that, once users turn onto their backs, gives them a gentle vibration, reminding them to change sleeping positions.

    “NightBalance offers a unique, patient friendly solution to treat positional obstructive sleep apnea and positional snoring that is highly complementary to our current offerings," said John Frank, business leader, Sleep & Respiratory Care, Philips. "This acquisition will help us further expand our leadership position in the growing home care market, and our ability to deliver integrated solutions that drive efficiencies and improved outcomes.”The SPT is CE marked and currently available in select countries in Europe, but not in the U.S. Terms of the deal were not disclosed.

    MSC buys assets, opens three sleep centers

    CLEVELAND – Medical Service Co. has acquired the assets of St. Vincent Home Medical, which serves the greater Indianapolis market and supports St. Vincent Health System. MSC is already the preferred provider for HME throughout the area for St. Vincent Health System, part of Ascension Health. “As a result of this partnership, we are opening three CPAP Therapy Centers and a central distribution center to support our new patients and partners in the region,” MSC stated in a press release. MSC recently launched a new division, MSC Sleep, and opened five centers in Ohio, New York and Kentucky. 

    Degen Berglund closes store dues to industry challenges

    LA CROSSE, Wis. – Degen Berglund plans to close its home medical services store, laying off 30 employees, according to a local TV station. The company says it is selling its CPAP business to Family Medical Supply and CPAP, also located in La Crosse, and will now focus on its pharmacy and retail businesses. In a statement, the company told the station that industry challenges have made it more difficult to provide service to people needing DME and CPAP. The layoffs will begin in phases, starting July 8 and continuing through Aug. 31.

    MACs retire ‘Dear Physician’ letter for limbs

    WASHINGTON – The DME MACs are retiring the “Dear Physician” letter for artificial limbs, according to a bulletin from the American Orthotics & Prosthetics Association. The letter is being retired following recently passed legislation that requires the recognition of the prosthetists’ notes as part of the patient’s medical record. The letter, originally published in 2011, dramatically changed the standards for approving a prosthetic claim by disregarding the prosthetist’s notes as part of the medical record, leading to higher claim denial rates, according to AOPA. The association in 2013 *sued CMS over its auditing practices.

    Sign-on letter circulates to protect complex rehab

    WASHINGTON – Complex rehab stakeholders seek signatures for a letter to CMS asking the agency not to apply a provision in the 21st Century Cures Act to complex rehab technology. Stakeholders are collecting signatures for the letter, spearheaded by Reps. Bill Johnson, R-Ohio, and Robert Latta, R-Ohio, until May 17. A provision in the Cures Act requires CMS to limit federal contributions to Medicaid reimbursement to competitive bidding-influenced Medicare reimbursement. Stakeholders argue that, because complex rehab has been exempted from the bid program, the provision should not apply to that technology.

    Golden adds ‘human touch’ to website

    OLD FORGE, Pa. – Golden Technologies has officially launched a live web chat service to assist retailers and consumers with their questions. The company has chosen Facebook Messenger as its platform for the service, due to its familiarity to the general public and its user-friendliness. Users of the service, which had its soft launch in January, say it provides a much appreciated “human touch” to the website. “I’ve found that there are all kinds of reasons people use the chat,” said Sarah Market, a customer service representative at Golden. “It is a useful tool for our hearing impaired customers and customers who are constrained by mobility issues, apart from customers who just don’t have time to get into a discussion on the phone. I feel like it puts us within reach of the customer.” For retailers, the service allows them to, among other things, quickly find out what products are in stock and get answers to not-so-frequently-asked questions.

    Numotion adds financing option

    BRENTWOOD, Tenn. – Numotion has partnered with CareCredit to offer customers a solution for any out-of-pocket expenses. CareCredit, a healthcare credit card that is accepted at more than 200,000 provider and merchant locations, offers promotional financing for transactions greater than or equal to $200 that includes no interest if paid in full within 12 months, or an additional option for reduced APR with equal monthly payments for up to 24 months. “We need to ensure our customers have options when it comes to financing,” said Tamas Feitel, CFO at Numotion. “We are excited about our partnership with CareCredit because it offers our customers flexibility in obtaining high impact mobility solutions to meet their needs.” Other CareCredit partners include Golden Technologies and Applied Home Healthcare Equipment.

    AAH taps Bachenheimer for general counsel

    WASHINGTON – AAHomecare has retained Brown & Fortunato to provide a range of legal and advisory services. Long-time HME industry advocate Cara Bachenheimer, who is set to open a Washington, D.C., lobbying office for the Amarillo, Texas-based law firm in June, will take the lead role representing the association’s regulatory and legislative priorities. “I have had a front-row view of Cara’s work on HME public policy issues over the years, and I have always come away impressed by her depth of knowledge and strategic thinking,” said Tom Ryan, president and CEO of AAHomecare. “She has a great sense of what can practically be accomplished on Capitol Hill and at regulatory agencies, and has a clear view of the best path forward to achieve it.”Bachenheimer has served as senior vice president of government relations for Invacare for the past 14 years.

    NSM strengthens presence in NorCal

    NASHVILLE, Tenn. – National Seating & Mobility has acquired Western Rehab in California. The acquisition adds locations in Santa Rosa and Paradise/Chico to NSM’s growing national network of locations. “Expanding our service reach in Northern California allows us to impact more lives with mobility solutions that drive independence,” said CEO Bill Mixon. Mark Hawkins, the former owner of Western Rehab, along with his field team, including three experienced ATPs, will stay on board to serve clients from both locations. The company, whose focus has been on pediatric complex rehab, has been in business since 1993.

    Pride highlights growth at Pride Mississippi

    EXETER, Pa. – Pride Mobility Products reports that its power lift recliner plant in Pontotoc, Miss., has grown to 156 employees and 240,000 square feet, making it a notable employer in the region. “When we opened Pride Mississippi, we made an investment not just in manufacturing the highest-quality power lift recliners, but also to invest in the local people of generational craftsmen who make it all possible,” said Micah Swick, director of Pride sales. “The response from our customers has been tremendous, with growth and product demand that proves the strength of made-in-the-USA manufacturing in the PLR market.” Pride Mississippi, founded in 2016, is a vertically integrated, wholly owned manufacturing facility that features sub-frame construction and hand upholstered finished work.

    Soleo Health wins three Stevies

    MCKINNEY, Texas – Soleo Health was named the winner of one gold and two silver Stevie Awards in the 16th Annual American Business Awards. The home infusion provider was recognized in the following categories: Gold Winner - Management Team of the Year - Business Services; Silver Winner - Company of the Year - Health Products & Services - Large; and Silver Winner – Innovation of the Year – Business Services. “We appreciate that they took the time to notice the difference Soleo Health is making in the marketplace and were able to ascertain from our entries the benefits we bring through our distinctive specialty pharmacy and home infusion services offering,” said Drew Walk, CEO of Soleo. Soleo was recognized for, among other things, navigating changes in reimbursement due to new government regulations. The winners will be honored at a ceremony on June 11.

    Viemed expects to hit the TSX

    LAFAYETTE, La. – Viemed Healthcare has received conditional approval from the Toronto Stock Exchange to graduate from the TSX Venture Exchange to the TSX. Final approval of the listing is subject to the company meeting certain standard and customary conditions required by the TSX by Aug. 2. Viemed expects to satisfy all requirements. “We are pleased to continue the evolution of the Viemed stand-alone entity and feel that the graduation to the TSX is an important step in that process,” said Casey Hoyt, CEO at Viemed. “As our company grows we feel that it is important to position ourselves to attract as many investors as possible, and the TSX listing should open up the doors to a brand new conversation with funds whom had prior restrictions.”

    …reports ‘record’ growth

    LAFAYETTE, La. – Viemed Healthcare reported revenues of $14.1 million and gross margin of $10.6 million for the quarter ended March 31, 2018, increases of 41% and 45%, respectively. The company had a working capital balance of $5.2 million and a $5 million line of credit. Adjusted EBITDA for the quarter totaled approximately $3.8 million or 27%. Viemed grew its ventilator patient count by approximately 38% compared to the same quarter in 2017. The company also completed an ongoing CMS audit. “Our patient centric company culture of always putting the patients’ needs first should lead to continuing organic growth, and this growth will ultimately lead to our company continuing to post records in both the top and bottom lines,” said Casey Hoyt, Viemed CEO, in a press release.

    Compass Health snags exclusive rights to Lumin

    CLEVELAND – Compass Health Brands has been tapped by 3B Medical as the exclusive distribution partner for the Lumin, a CPAP disinfection device. “The Lumin is the perfect complement to our growing line of CPAP masks, tubing, filters and other supplies, and in line with our goal of providing our dealers with a one-stop for all their product needs,” said Stuart Straus, president and CEO of Compass Health Brands. The Lumin uses high-powered, germicidal ultra violet light to neutralize and kill harmful bacteria, mold and fungus—the same disinfecting method used in operating and surgical centers around the world. It does not use harmful ozone. The device can also be used as a general-purpose disinfection system for hearing aids, dentures and even toothbrushes.

    NRRTS honors CRT professionals

    WASHINGTON – NRRTS recognized John Zona, ATP/SMS, as the 2018 Simon Margolis Fellow at the National CRT Leadership and Advocacy Conference in April. Zona, who has been a long-time NRRTS board member and once served as president, was honored for his significant contributions to NRRTS, the complex rehab profession and the seating and wheeled mobility community as a whole. For their support of NRRTS’s mission, the organization also recognized Julie Piriano of Pride Mobility Products for her work promoting the professional RTS through her NRRTS webinars and CEU articles; Lew Shomer, the creator and producer of the Abilities Expo, for his work advocating for people with disabilities; Angie Kiger, also for her work on NRRTS webinars and CEU articles; and Dave McCausland of Permobil for his work in government affairs.


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    05/11/2018
    HME News Staff

    WASHINGTON – The DME MACs are adding modifiers that will allow HME providers to provide additional information related to the coverage and/or liability when the policy criteria are not met for oxygen patients.

    “The benefit of this change is that suppliers can now file an oxygen claim when a patient doesn’t qualify and get an accurate PR (patient responsibility) denial,” AAHomecare wrote in a bulletin.

    Effective for claims with dates of service on or after Aug. 1, providers should use:

    • the KX modifier when the requirements specified in the medical policy have been met;
    • GA for a waiver of liability (expected to be denied as not reasonable and necessary, ABN on file);
    • GY for item or service statutorily excluded or does not meet the definition of any Medicare benefit;
    • or GZ for item or service not reasonable or necessary (expected to be denied as not reasonable or necessary, no ABN on file).

    AAHomecare says stakeholders have been requesting these changes for “many years.”


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    05/15/2018
    HME News Staff

    WASHINGTON – Enteral nutrition had the highest error rate (87%) from Targeted Probe and Educate audits in Jurisdiction D.

    Noridian Healthcare Services, the DME MAC for Jurisdiction D, posted the error rates from TPE audits (see below) from Oct. 1 to Dec. 31, 2017.

    AAHomecare has requested that all the DME MACs publish the error rates.

    The error rates in Jurisdiction D are:

    • 19%, ankle-foot/knee-ankle-foot orthosis (L4360, L4362, L4386, L4387)
    • 87%, enteral nutrition (B4150, B4152, B4154)
    • 35%, external infusion pumps (E0781, E0784)
    • 76%, glucose monitors (A4253)
    • 14%, hospital beds (E0250, E0260)
    • 9%, immunosuppressive drugs (J7507, J7517, J7518, J7520)
    • 77%, knee orthosis (L1810, L1812, L1832, L1833, L1843)
    • 57%, manual wheelchairs (K000, K0003)
    • 3%, nebulizers (J7605, J7626)
    • 32%, oxygen and oxygen equipment (E1390, E0431)
    • 3%, positive airway pressure (E0601)
    • 34%, spinal orthoses (L0627, L0630, L0631, L0637, L0642, L0643, L0648, L0650)
    • 80%, surgical dressings (A6196, A6197)
    • 13%, therapeutic shoes (A5500)
    • 21%, urological supplies (A4351, A4353, A4358)

     


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    05/18/2018
    Liz Beaulieu

    WASHINGTON – With the fate and details of the interim final rule no longer a mystery, stakeholders and their champions in Congress are putting their full weight behind H.R. 4229, a bill that would provide more broad-based relief in non-competitive bidding areas.

    The IFR, published in the Federal Register on May 11, will apply 50/50 blended reimbursement rates, but just in rural and non-contiguous bid areas, and only from June 1, 2018, through Dec. 31, 2018.

    “The IFR was holding back H.R. 4229,” said Jay Witter, senior vice president of public policy for AAHomecare. “Now that we know what’s in the IFR, it’s no longer holding us back.”

    H.R. 4229, which has 145 co-sponsors, would apply the blended rates from Jan. 1, 2017, to Jan. 1, 2019. A provision in the 21st Century Cures Act has already applied the blended rates retroactively from July 1, 2017, to Jan. 1, 2017.

    That provision in the Cures Act is proof that Congress is ready and willing to provide more broad-based relief in non-bid areas, stakeholders say.

    “They know how to do it,” Witter said. “They’ve already done it.”

    The job of stakeholders now: Educating lawmakers that, while it provides relief, the IFR doesn’t go far enough and legislative relief is needed, they say.

    “A number of offices forwarded me the IFR when it was released, saying, ‘Isn’t this the IFR you were looking for!’” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The first impression was, ‘This is it; this is great.’ So we’re going through the painful analysis of spelling out everything for everyone state by state.”

    In what’s becoming a constant balancing act, stakeholders are also continuing to have conversations with CMS in an attempt to help shape changes to the program for Round 2019, something the agency acknowledges in the IFR must happen. The details of those changes, however, much like the IFR, won’t be known until CMS publishes its “CY 2019 Changes to the End-Stage Renal Diseases Prospective Payment System,” likely in late June.

    “We’re an industry living in crisis and that’s a story we continue to bring to them,” said Tom Ryan, president and CEO of AAHomecare. “We need relief and we need a long-term fix. We’ve heard from CMS that they’re working on it.”

    Stakeholders will use this week’s AAHomecare Washington Legislative Conference to turn disappointment on the IFR into action on H.R. 4229.

    “Absolutely, it still has legs,” said John Gallagher, vice president of government relations for the VGM Group.


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