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    08/28/2013
    HME News Staff

    WASHINGTON – The Office of Inspector General (OIG) said this week that it plans to review problems with Medicare’s competitive bidding program.

    The review is in response to a request from Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa.

    “The Inspector General’s decision to investigate CMS’s implementation of competitive bidding is a step in the right direction for the many small healthcare providers in rural America concerned about the impact of this program,” Braley stated in a release. “When the government picks winners in a flawed bidding system, seniors on Medicare and the small businesses that serve them lose. I look forward to reading the conclusions of the coming investigation.”

    In a June 20 letter, Thompson and Braley asked that the OIG investigate competitive bidding after it came to light that CMS awarded a number of contracts to providers that did not meet licensure requirements, as required by program rules. States where contract suppliers did not meet requirements include Tennessee, Maryland, Michigan and Ohio.

    The OIG will conduct a review of the implementation of both Rounds 1 and 2 of the program to determine whether CMS complied with federal guidelines when it awarded the contracts.

    “We are relieved to see that the OIG is looking into the serious flaws in the competitive bidding program,” said John Gallagher, vice president of government relations for The VGM Group, in a statement. “This program is deeply flawed and, should it go unchanged, will have a severe and lasting impact on Medicare beneficiaries.”


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    08/29/2013
    HME News Staff

    WASHINGTON - Providing patients with orthotic and prosthetic devices saves taxpayers money in the long term, according to the findings of a new study released Aug. 27.

    The study, conducted by health economist Dr. Allen Dobson and commissioned by the Amputee Coalition, found that Medicare spent the same or a comparable amount on patients who received devices as it did on those who needed the devices but did not receive them.

    “This is a clear win for patients and a win for taxpayers,” stated Thomas F. Kirk, Ph.D, president of the American Orthotic & Prosthetic Association, in a press release. “Not only do patients who get full orthotic and prosthetic treatment benefit the most, but it also ends up costing taxpayers less, in most cases.” 

    The reason: The study suggests that the devices help patients not only rehabilitate, but also reduce hospitalizations and the use of costly live-in care facilities. Patients who received the devices had more physical therapy and rehabilitation, which kept them at home and out of facility-based care. Additionally, those who are more independent may have fewer emergency-room visits and hospitalizations.

    According to the study, which examined the claims of 42,000 paired sets of patients between 2007 and 2010, Medicare could experience 10% savings ($2,920 less) for those receiving lower extremity orthoses, and comparable amounts for patients receiving spinal orthoses and lower extremity prostheses.

    “Looking at full costs and other outcomes (including use of outpatient therapy, number of falls, ER admissions and acute hospitalizations) over a 12- to 18-month period, our study concludes that patients who received the orthotic and prosthetic services experienced greater independence than patients who do not, with better or comparable health outcomes and generally lower Medicare payments,” Dobson stated.

    The study is online at http://amputee-coalition.org/content/documents/dobson-davanzo-report.pdf.


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    08/30/2013
    Liz Beaulieu

    WASHINGTON – If an investigation by the Office of Inspector General (OIG) goes the HME industry’s way—and stakeholders believe it will—CMS will no longer be able to blow off concerns about competitive bidding.

    The OIG on Aug. 22 notified Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, that it will conduct a “limited scope review” in Tennessee, Maryland, Michigan and Ohio to address concerns that, as part of Round 2 of the program, CMS awarded contracts to providers that didn’t meet accreditation and state licensure requirements.

    “The OIG is very influential,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “We’re determined to be biased and CMS is determined to be biased, so they’re the objective arbiters.”

    Thompson and Braley requested the investigation in a June 20 letter to the OIG. The letter followed CMS’s decision to disqualify 30 contract suppliers for Tennessee because they didn’t meet requirements.

    Stakeholders have long argued that CMS has played fast and loose with the requirements. Per the agency’s own rules, providers had to meet requirements in the areas where they submitted bids by March 30, 2012, a deadline that was extended to May 1, 2012. But in Tennessee, for example, CMS gave contract suppliers until July 1, 2013, the day Round 2 went into effect, to meet a requirement that they have a physical location in the state that is enrolled with Medicare and licensed.

    “What happened in Ohio is, the providers who were unlicensed got licensed in June of this year, so they weren’t licensed until 15 months after the fact,” Bachenheimer said. “CMS has been using a highly irregular process.”

    The OIG also plans to determine the impact of how CMS applied state licensure requirements on the single payment amounts.

    “If these were non-bona fide bids and they were included—it really starts to peel back the layers of the onion on CMS,” said John Gallagher, vice president of government affairs for The VGM Group.

    Stakeholders expect the OIG to complete its investigation by the end of this year. Also forthcoming: 1.) Another report from the OIG, this one required by law, reviewing whether CMS selected contract suppliers and determined single payment amounts in accordance with federal requirements; and 2.) a report from the Government Accountability Office (GAO) reviewing the impact of Round 1 on, among other things, quality of and access to equipment and services. 

    “This all helps to keep the noise level high,” said Seth Johnson, vice president of government affairs for Pride Mobility Products.

    Stakeholders believe the OIG and GAO will come to the same conclusions that they have.

    “We’ve outlined a number of problems and we’re receiving a number of reports of complaints, so we’re confident that the OIG and GAO will find significant issues,” said Jay Witter, vice president of government affairs for AAHomecare. “This will send a strong signal to CMS.”

     


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    08/30/2013
    Theresa Flaherty

    BALTIMORE – It appears CMS has finally realized that you can’t get blood from a stone—or oxygen equipment and services from an HME provider that has gone out of business.

    CMS announced on Aug. 22 that, effective immediately, a new provider can replace oxygen equipment and restart a 36-month rental period when another provider exits the business. The agency will consider the original equipment lost.

    “CMS is hearing that oxygen patients are being abandoned,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “You’ve just got people closing their doors.”

    Under a cap that went into effect in 2009, providers cannot bill for patients after 36 months but they must still service them. Once the patient hits 60 months, providers can supply new equipment and start billing again. 

    The problem with that: A perfect storm of audits and competitive bidding has drastically reduced the number of providers willing and able to service oxygen patients, creating significant access issues, stakeholders say.

    “Nobody wants them anymore,” said Brummett.

    CMS has not yet released information on how to prove abandonment, but stakeholders expect that will come soon. The agency also stated that providers exiting the business must facilitate the transfer of their patients or they are in violation of statutory and regulatory requirements.

    The new rental period likely does not apply, however, in cases where a provider sells its business to another provider, says healthcare attorney Lisa Smith.

    “CMS is going to expect the seller and the buyer to negotiate and value that oxygen business, including all of the patients regardless of where they are in the cap period, and come to a fair assessment of the value,” said Smith, an attorney with Brown & Fortunato.

    Smith cautions providers to perform due diligence before picking up abandoned patients. Providers need to make sure the patient isn’t part of a company that has been sold or isn’t just looking for another supplier, she said.

    One provider that will be picking up patients: Tyler Riddle. Earlier this summer, Riddle had to turn away about 50 oxygen patients when a local competitor was driven into bankruptcy by audits.

    “We are now looking at converting those patients,” said Riddle, vice president of Albany, Ga.-based MRS Homecare. “We are really excited—that’s a big boost.”


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    08/30/2013
    HME News Staff

    ORLANDO, Fla. – A bankruptcy court in Delaware has approved Rotech Healthcare’s reorganization plan, paving the way for the company to emerge from Chapter 11 in September, it announced Aug. 29. “We said at the outset this would be a swift passage through the reorganization plan, and it has been,” said Steven Alsene, president and CEO of Rotech, which filed for bankruptcy in April. “We have successfully completed an important milestone in the financial restructuring that positions Rotech to operate successfully in today’s very competitive environment.” The bankruptcy court has approved $358 million in exit-financing commitments from Wells Fargo and from certain existing holders of 10.5% senior second lien secured notes, according to a press release. Under the reorganization plan, Rotech’s existing common stock will be cancelled and most of the new common stock of the reorganized company will be distributed to holders of the senior second lien secured notes. The company’s Statutory Committee of Unsecured Creditors supports the plan, which also received the approval of voting creditors during a hearing. Rotech says the plan reduces its debt by more than $300 million.

    Shoprider launches complex rehab division

    CARSON, Calif. – Shoprider Mobility Products expects to hit the market in 2014 with a line of complex rehab products and accessories, the company announced Aug. 27. Shoprider will provide the products through a new division called ROVI Mobility Products, which will be led by industry veteran Cody Verrett. “ROVI is all about a fresh move forward,” he stated in a press release. “We understand what is available in the market today and we are striving to offer clients, clinicians and ATPs an alternative.” Since 1988, Shoprider Mobility has done the bulk of its business in standard power wheelchairs and scooters. “We are excited to enter the complex rehab business segment and we are committed to utilizing our 25 years of experience in manufacturing high-quality power mobility products to aid this division in every way possible,” stated David Lin, president of Shoprider, in the release.

    Beneficiary on bid program: ‘This is a terrible situation’

    PHILADELPHIA – Competitive bidding is driving local suppliers out of the market, leaving beneficiaries who use DME with few close-to-home options for services such as wheelchair fitting and training, industry stakeholders and Medicare beneficiaries said during a press conference Aug. 23. “Eighty-two percent of Philadelphia-area providers (within 50 miles of the Philadelphia-Camden-Wilmington bidding area) have been eliminated in favor of providers from as far away as Texas and California,” said John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers (PAMS). Before the bidding program began, there were 185 wheelchair providers in a 50-mile radius of Philadelphia; now there are seven, stakeholders said. The decline in options could force people into more expensive care options, they said. “This is a terrible situation for seniors and the disabled,” disability-rights activist and wheelchair user Alan Holdsworth said. “Buying and repairing durable medical equipment like wheelchairs is a local activity. People, especially people with disabilities and the elderly, look to local providers to take care of their equipment needs.”

    Sleep Nation makes 38th buy this year

    NASHVILLE, Tenn. – Sleep Nation, Inc., is taking advantage of a changing market by continuing to make acquisitions. The CPAP provider announced Aug. 29 that it has made its 38th purchase this year and the 43rd since its inception in May of 2012. “We have invested significant resources into our platform’s systems and now are starting to reap benefits as we spread our fixed costs over more and more orders,” stated CEO Richardson Roberts in a press release. The Franklin, Tenn.-based company specializes in products for sleep apnea, shipping supplies to CPAP patients throughout the U.S.

    Sanomedics receives financing for deals

    MIAMI – The medical-technology holding company Sanomedics International Holdings Inc. announced Aug. 26 that it has received $5 million in funding to put toward working capital and the completion of a pair of targeted acquisitions. The financing breaks down to a $3 million revolving line of credit and a $2 million term loan. “This financing is a major step in our success and a further endorsement of the plans we have for the future,” said Keith Houlihan, Sanomedics co-founder and president, in press release. “The proceeds will permit us to move forward in our plans to close our two targeted acquisitions of Prime Time Medical, Inc. and Duke Medical.” Subject to the lender’s due diligence and another commitment agreement, the financing is expected to close by the end of September. HME News earlier reported on these purchases: Prime Time Medical* provides home medical equipment from Largo, Fla., and Duke Medical** provides products and supplies to people with sleep apnea in the Houston and Galveston, Texas, areas.

    AAHomecare joins in coding reform effort

    WASHINGTON – Due to lack of oversight and industry input, AAHomecare believes the current CMS coding system does not accurately describe items and services covered and reimbursed. That’s why the association has signed on to a letter from the Alliance for HCPCS II Coding Reform asking for increased transparency and due process. At CMS’s request, the alliance has developed a list of recommendations for improving the process, including separating coding decisions and coverage policies; establishing an appeals process to independently review coding decisions; and improving the Pricing, Data Analysis and Coding (PDAC) verification and revision processes. The alliance includes associations, manufacturers and medical groups that have come together to work with CMS to make improvements to coding.

    CMS outlines expedited process for NCDs

    WASHINGTON – CMS has announced an updated process for new or reconsidered national coverage decisions (NCDs). According to a notice published in Federal Register, CMS will periodically publish on its website the NCDs it proposes to remove and the reasons why. After taking public comment for 30 calendar days, the agency will remove, retain or formally reconsider the NCDs in question. CMS says the revised policy does not alter or amend regulations that establish rules related to the administrative review of NCDs. The notice was effective Aug. 7.

    Inappropriate, questionable billing for test strips, OIG says

    WASHINGTON – Medicare inappropriately allowed $6 million in claims for diabetes test strips in 2011, according to a report from the Office of Inspector General (OIG). The claims were for beneficiaries without a documented diagnosis code for diabetes, or for beneficiaries who were in hospitals or skilled nursing facilities. The OIG also found that $425 million in Medicare-allowed claims had characteristics of questionable billing, and that suppliers in 10 geographic areas nationwide were responsible for 77% of that questionable billing. CMS partially concurred with the OIG’s recommendations to enforce existing edits to prevent inappropriate claims, and to increase the monitoring of suppliers. It concurred with recommendations to provide mode education to suppliers and beneficiaries about appropriate billing practices, and to take appropriate action regarding inappropriate claims and suppliers with questionable billing. In all, Medicare allowed about $1.1 billion in claims to 51,695 suppliers for test strips to 4.6 million beneficiaries in 2011.

    Fisher & Paykel improves forecast

    IRVINE, Calif. – With new products boosting sales and widening margins, Fisher & Paykel Healthcare has raised its earnings, according to news reports. The company will likely have a profit of $90 million to $95 million for the year ending March 31. Earlier this year, it forecasted a profit of $85 million to $90 million. Fisher & Paykel reported a profit of $77.1 million for 2013. The company is also benefitting from lower costs from its plant in Mexico. “Our margins are increasing as a result of new products and applications driving a favorable product mix, and efficiencies through lean manufacturing, logistics and supply chain improvement,” stated Mike Daniell, chief executive. Fisher & Paykel expects operating revenue of $625 million to $645 million for the year ending March 31. Previously, the company forecasted $610 million to $630 million. It reported operating revenue of $556.3 million for 2013.

    Study: Up-front spending on O&P saves money long term

    WASHINGTON - Providing patients with orthotic and prosthetic devices saves taxpayers money in the long term, according to the findings of a new study released Aug. 27. The study, conducted by health economist Dr. Allen Dobson and commissioned by the Amputee Coalition, found that Medicare spent the same or a comparable amount on patients who received devices as it did on those who needed the devices but did not receive them. The reason: The study suggests that the devices help patients not only rehabilitate, but also reduce hospitalizations and the use of costly live-in care facilities. Patients who received the devices had more physical therapy and rehabilitation, which kept them at home and out of facility-based care. Additionally, those who are more independent may have fewer emergency-room visits and hospitalizations. According to the study, which examined 42,000 paired sets of claims between 2007 and 2010, Medicare could experience 10% savings ($2,920 less) for those receiving lower extremity orthoses, and comparable amounts for patients receiving spinal orthoses and lower extremity prostheses.

    Short takes

    The early bird rate for Medtrade—$100 savings—ends Sept. 6. Register at www.medtrade.com…Shield HealthCare has announced its 13th annual caregiver story contest. The contest, which the company holds to honor the work of family caregivers and healthcare professionals, runs from Sept. 3 through Nov. 30…Drive Medical is partnering with the American Cancer Society (ACS) to raise money to fight breast cancer. Drive will donate part of the proceeds from the purchase of its new Adjustable Height Rollator to the ACS Making Strides Against Breast Cancer campaign…Denver-based CareTouch Communications, which is celebrating the one-year anniversary of CareTouch Collect, a program that contacts patients and connects them with their providers to secure payment or devise a payment plan, has launched a new account transfer service. CareTouch FAST allows users to switch from their previous vendor to the CareTouch…Elmsford, N.Y.-based BioScrip has completed its acquisition of CarePoint Partners, a national provider of home and alternative-site infusion therapy. CarePoint services 20,500 patients annually and has 28 sites of service in nine states in the East Coast and Gulf Coast regions.

    People news

    Golden Technologies has hired Michael Scarsella as its Northeast regional sales manager. Scarsella has an MBA in marketing and strategic planning and has more than 14 years of experience in the retail furniture industry…Jens Mielke is the new CFO of Hasco Medical Inc. Mielke, who holds a Master of Business Administration degree, was previously an audit partner with a Dallas firm, where he served Fortune 500 and smaller, private companies; and a senior financial reporting analyst for PepsiCo, Inc.


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    09/04/2013
    HME News Staff

    WASHINGTON – A new report from the Office of Inspector General (OIG) says that while CMS took corrective actions to address the majority of the vulnerabilities it identified, the agency did not evaluate the effectiveness of these actions.

    “As a result, high amounts of improper payments may continue,” the report states.

    The OIG found that, of 2.6 million claims reviewed in 2010 and 2011, the RACs identified 1.3 million as having improper payments—at a cost of $1.3 billion.

    During those two years, the OIG found that CMS identified 46 vulnerabilities resulting in improper payments, with the majority of them (26 out 46) occurring in Medicare Part B. Vulnerabilities included providers billing add-on codes without primary codes or indicating the incorrect place of service.

    The OIG found that, by June 2012, CMS took corrective actions to address 28 of the vulnerabilities, which addressed $1.86 billion of the improper payments. Corrective actions included contractor technical direction letters, computerized edits and quarterly education letters.

    But the OIG also found that, by that same date, CMS had not evaluated the effectiveness of its corrective actions.

    CMS blamed a lack of resources and the difficulty of determining relationships between corrective actions and reductions in improper payments. The agency also stated that some corrective actions need to be in place for several years before it evaluates them.

    The OIG also criticized CMS for not implementing metrics to evaluate the performance of the RACs on all contract requirements.

    CMS concurred with the OIG’s recommendations that it take appropriate action on vulnerabilities that are pending corrective action and evaluate the effectiveness of corrective actions; ensure that RACs refer all cases of potential fraud; and develop additional performance evaluation metrics of the RACs.

    The agency did not say whether it concurred with a recommendation to take appropriate action on RAC referrals of potential fraud.


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    09/06/2013
    Theresa Flaherty

    WASHINGTON – New regulations governing patient privacy go into effect Sept. 23, and industry stakeholders say many HME providers aren’t ready.

    In January, the Department of Health and Human Services issued a final rule modifying the Health Insurance Portability & Accountability Act (HIPAA) to increase enforcement efforts and penalties when protected health information is breached.

    “It’s no longer a matter of you getting a complaint and mitigating the damage,” said Denise Fletcher Leard, an attorney with Brown & Fortunato. “They are doing audits and looking for issues.”

    The biggest change: The rule expands the type of “business associates” who must also comply with the rule.

    “It’s almost everybody who has access to personal health information, with the exception of couriers and Internet service providers,” said Mark Higley, vice president of regulatory affairs for The VGM Group. “They have much more scrutiny over subcontractors that were not previously considered business associates.”

    While some breaches of security—like the theft of a laptop containing patient data—are obvious, the new rule extends to other areas of a provider’s business, like marketing practices, says Fletcher Leard.

    For example, it’s no longer acceptable to include information about another HME provider in patient mailings.

    “If you have a pharmacy that does neb meds and a DME that does nebulizers, the DME could send out information on the pharmacy and vice versa—you can no longer do that,” she said. “It’s one of the things that will get you in more trouble than anything.”

    Industry associations have ramped up educational outreach on the rule. VGM, for one, has posted a “HIPAA Compliance Toolkit” to its website.

    Information is out there if you use a little due diligence, says Higley.

    “Most of the information is available from Google and the Internet,” he said. “Most of it is available for free. Enter Sept. 23, HIPAA.”


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    09/06/2013
    HME News Staff

    WASHINGTON – The Texas Medicaid program could have saved $2 million in the Dallas/Forth Worth area alone if it had used competitive bidding pricing for certain DME items in fiscal year 2011, according to a new study from the Office of Inspector General (OIG).

    The OIG found that Texas Medicaid’s payment amounts for 30 of 32 DME items exceeded competitive bidding amounts.

    “Our findings provide a tangible example of potential state and federal savings for Medicaid programs if the programs were to use the Medicare competitive bidding program payment amounts for DME items,” the OIG states in the study.

    In all, the OIG found that Texas Medicaid spent about $12 million on those 32 items in Dallas/Forth Worth in 2011.

    To conduct the study, the OIG examined pricing for 32 items covered under both the Texas Medicaid program and competitive bidding, and made comparisons across the two programs in the Dallas/Fort Worth area. For each item for which the Texas Medicaid payment amount exceeded the Medicare amount, it used the Medicaid claims volume to estimate the potential savings that could have been achieved using the Medicare amount instead. It then calculated the overall potential savings by summing the potential savings per item.

    The OIG found that Texas Medicaid could have saved the most on oxygen concentrators ($883,483). It found that the state paid $161.05 for the equipment compared to Medicare’s $123.

    Spurring the OIG to conduct the study: the president’s fiscal year 2014 budget, which emphasizes cost containment by Medicaid programs. The budget, the agency points out, proposed “limiting federal reimbursement for a state’s Medicaid spending on certain DME service to what Medicare would have paid in the same state for the same services.”

    The study did not contain recommendations.

    OIG: ‘High amounts of improper payments may continue’

    WASHINGTON – A new study from the Office of Inspector General (OIG) says that while CMS took corrective actions to address the majority of the vulnerabilities it identified, the agency did not evaluate the effectiveness of these actions.

    “As a result, high amounts of improper payments may continue,” the study states.

    The OIG found that, of 2.6 million claims reviewed in 2010 and 2011, the RACs identified 1.3 million as having improper payments—at a cost of $1.3 billion.

    During those two years, the OIG found that CMS identified 46 vulnerabilities resulting in improper payments, with the majority of them (26 out 46) occurring in Medicare Part B. Vulnerabilities included providers billing add-on codes without primary codes or indicating the incorrect place of service.

    The OIG found that, by June 2012, CMS took corrective actions to address 28 of the vulnerabilities, which addressed $1.86 billion of the improper payments. Corrective actions included contractor technical direction letters, computerized edits and quarterly education letters.

    But the OIG also found that, by that same date, CMS had not evaluated the effectiveness of its corrective actions.

    CMS blamed a lack of resources and the difficulty of determining relationships between corrective actions and reductions in improper payments. The agency also stated that some corrective actions need to be in place for several years before it evaluates them.

    The OIG also criticized CMS for not implementing metrics to evaluate the performance of the RACs on all contract requirements.

    CMS concurred with the OIG’s recommendations that it take appropriate action on vulnerabilities that are pending corrective action and evaluate the effectiveness of corrective actions; ensure that RACs refer all cases of potential fraud; and develop additional performance evaluation metrics of the RACs.

    The agency did not say whether it concurred with a recommendation to take appropriate action on RAC referrals of potential fraud.

    http://oig.hhs.gov/oei/reports/oei-04-11-00680.pdf


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    09/06/2013
    HME News Staff

    CHARLOTTE, N.C. – Prodigy Diabetes Care has conducted a regulatory assessment by an independent auditor to examine, review and revise certain procedures and training to ensure compliance with FDA requirements, it told patients, caregivers and partners in a Sept. 4 letter.

    “Prodigy assures you that this attention to improvement is an ongoing effort to ensure full compliance,” stated CEO Richard Admani in the letter.

    In a Feb. 22 letter, the FDA warned Prodigy about numerous violations, including the company’s failure to notify the agency within 30 days of receiving complaints that its devices may have caused or contributed to a death or injury.

    Admani states in the letter that, since February, Prodigy has reviewed all complaints received during 2011-13 and filed medical device reports or MDRs. Additionally, he pointed out that the complaints stem from the occasional “out-of-normal” readings that some patients experience from blood glucose monitors and that are not uncommon.

    “Whether the cause be contaminated strips due to temperature, batteries, improper storage or handling of strips, or otherwise, all manufacturers receive reports that their devices ‘may have been a factor’ in an injury,” he states in the letter.

    The FDA also warned Prodigy about its inspection of goods prior to release to customers. Admani stated in the letter that all test strips sent to patients meet FDA standards, and that in the wake of the warning, Prodigy has conducted additional testing of the lots in question and found all products were in line with federal standards.

    “Prodigy’s goal is to provide accurate and reliable products at a good value,” he stated. “Just as important to us as the FDA’s input is feedback from persons who use our products day after day. We welcome your input and will work hard to address your concerns.”

    Sunrise Medical launches compatibility program

    FRESNO, Calif. – Sunrise Medical now guarantees product compatibility through a new program, the company announced Sept. 5. When customers order mobility products and seating systems through Compatibility Assurance, Sunrise will issue a single invoice and inspect the orders to ensure the components will work together properly. If not, the company will contact customers immediately to find a solution before the items ship. “By assembling the seating products and mobility base before shipping, we’re preventing what could cause a significant delay in getting the products to the consumer,” said Tim Morrison, product manager for Compatibility Assurance.

    TSS auction approaches

    NEW BRAUNFELS, Texas – The Scooter Store will auction off many of its assets at a Sept. 13 bankruptcy auction, according to news reports. The sale will take place at the company’s former New Braunfels, Texas, headquarters, where The Scooter Store employed more than 1,200 people before an FBI raid in February and a mass-layoff in March. About 200 employees relocated to a 30,000-square-foot location, also in New Braunfels. Among the items to be auctioned: computers, kitchen items and patio furniture.

    Bard to acquire Rochester Medical

    MURRAY HILL, N.J. – C.R. Bard and Rochester Medical, two players in the urology market, announced Sept. 4 that they have entered into an agreement to merge. The deal is expected to close later this year, with Bard paying $20 per share, about $262 million, for Rochester. “Rochester’s double-digit growth product portfolio, including their customer access programs, is a key building block in our strategy to access faster growing markets over the long-term,” stated Timothy Ring, Bard chairman and CEO, in a press release. “We believe that strengthening our position in the home care market, and specifically the large and fast-growing intermittent self-catheter segment, is strategically important at this time.” The merger has been approved by the directors of each company, and will be subject to regulatory approval and shareholder approval.

    Numotion acquires Wheelchairs Plus

    GRAND RAPIDS, Minn. – Numotion has acquired Minnesota-based complex rehab provider Wheelchairs Plus, the company announced Sept. 3. “Wheelchairs Plus is an established provider with locations in Grand Rapids and St. Cloud, Minn., providing quality equipment and services for all ages and needs for 37 years,” stated Christine Schedin, owner of Wheelchairs Plus, in a press release. “The equipment specialists will remain the same and we will continue to provide the excellent service our clients depend on.” The acquisition expands Numotion’s coverage and improves access to complex rehab technology for Minnesota residents, stated Timothy Havel, regional vice president.

    Bruno sponsors ‘My Finish Line’ tour

    OCONOMOWOC, Wis. – Vehicle lift manufacturer Bruno Independent Living Aids is now a major sponsor of the movie tour for “My Finish Line,” according to a press release. The film about paralyzed IndyCar driver Sam Schmidt is the subject of a 50-state movie and music tour raising money to give every disabled veteran in the country a DVD of the movie. Bruno provides more than 20 automotive lifts to suit a variety of vehicles. 

    More veterans want help with sleep apnea, insomnia

    FORT HOOD, Texas – An increasing number of veterans are seeking treatment at the Carl R. Darnall Army Medical Center for sleep apnea and insomnia. The hospital opened a sleep lab in 2012 and has already tested 600 patients, Lt. Col. Karin Nicholson, sleep services chief, told the Fort Hood Herald. Obstructive sleep apnea and insomnia are the most common disorders, she said. The increased number of cases is likely due to awareness, according to the article. Last year, 24,800 veterans began receiving compensation for service-connected sleep apnea, bringing the total to 114,000, at a cost of more than $1.2 billion a year, according to Stars and Stripes, a military news source.

    China surpasses US in prevalence of diabetes, study says

    CHICAGO – A new study suggests the prevalence of diabetes among Chinese adults has risen to 11.6%. Published Sept. 4 in the Journal of the American Medical Association, the study results show the percentage of Chinese adults with diabetes is now greater than the percentage of Americans adults with the disease. The American Diabetes Association says 11.3% of Americans 20 years old or older have diabetes. The study found those with diabetes in China tended to be older residents in more developed regions.

    Integra Partners snags O&P contract

    NEW YORK – Integra Partners now provides orthotics and prosthetics (O&P) to members of New York City’s Independence Care Systems (ICS), according to a Sept. 3 press release. ICS operates a nonprofit Medicaid managed long-term care plan in the city. It assists eligible adults with physical disabilities and chronic illnesses by coordinating care, housekeeping and other services, according to the release. Integra Partners is a healthcare network manager, connecting O&P and durable medical equipment providers with healthcare plans and patients.

    Fewer than half sleep well, study finds

    WASHINGTON – No matter where you live, a good night’s sleep is hard to find, according to the results of the Sleep Foundation’s 2013 International Bedroom Poll. Among adults ages 25 to 55 in six countries, half or fewer sleep well. The study, released Sept. 3, found Japanese and Americans get the least amount of sleep. “This groundbreaking poll suggests that chronic sleep deprivation is a significant global health problem,” said Russell Rosenberg, research director and investigator at NeuroTrials Research. The Sleep Foundation suggests that exercising regularly, maintaining a sleeping routine and banishing electronics from the bedroom can improve the quality of sleep. Every country—the United States, Canada, Mexico, the United Kingdom, Germany and Japan—sleeps in on the weekends.

    Sanomedics finishes Prime Time buy

    MIAMI – Medical technology holding company Sanomedics has completed its acquisition of Largo, Fla.-based Prime Time Medical Inc. for $3.1 million. “The completion of this acquisition marks a significant milestone in Sanomedics’ high-growth strategy of acquiring and integrating positioned medical equipment providers in today’s ever-demanding sleep apnea vertical,” stated Keith Houlihan, co-founder and president of Sanomedics, in a Sept. 3 press release. The acquisition was effective Aug. 30. Prime Time Medical provides mobility devices, respiratory equipment and diabetes supplies. Sanomedics says its goal is to purchase sleep therapy businesses to develop a portfolio of products and providers for the sleep apnea market, according to the release.

    Patients in place for ResMed sleep apnea study

    AMSTERDAM – More than 1,300 patients are signed up for a large study examining the outcomes of heart-failure patients using ResMed’s PaceWave to treat central sleep apnea. ResMed announced Sept. 3 that enrollment is complete for the randomized, international study called SERVE-HF. The study will determine whether Resmed’s Minute Ventilation ASV technology increases survival and reduces hospitalization of those with central sleep apnea. The technology monitors and stabilizes breathing patterns of those with sleep apnea, according to the release.

    Aeroflow launches CPAP replenishment program

    ASHVILLE, N.C. – With a new CPAP replenishment program, Aeroflow can help DME companies struggling under competitive bidding to serve patients more productively and cost-effectively, the company stated in a Sept. 3 press release. Aeroflow received contracts in 80 of the 91 areas included in Round 2 of competitive bidding. Through its fulfillment program, Aeroflow will contact patients to see what supplies they need, handle their paperwork, file their insurance and deliver products to their homes.

    Short takes

    U.S. Rehab, The VGM Group’s alliance for complex rehab providers, has announced a new vendor partnership with Conduit Technology, which offers a web-based software tool that reduces the time required to collect documentation. Conduit Technology also links to Brightree, another strategic partner of U.S. Rehab and VGM…The COPD Foundation announced Sept. 5 the launch of the COPD Pocket Consultant Guide, an iPhone app to make diagnosis and therapy for COPD easier and more effective in daily, clinical care. The app also allows healthcare professionals to interact with each other, and question and comment on the app…A Frost & Sullivan report estimates revenues in the Asian-Pacific wound-care market will grow at an estimated 6.9% through 2017, while the wound-closure market will grow at 7.5% through 2017. Released Sept. 5, the report says the increase of diseases such as diabetes and the influx of medical tourists are fueling the growth…Full-service mobility provider 101 Mobility is growing in West Virginia, opening retail markets in Clarksburg, Morgantown and Martinsburg, according to a Sept. 5 press release. The move expands 101 Mobility’s offerings beyond its existing Veterans Affairs contract in the state.

     


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    09/10/2013
    HME News Staff

    BALTIMORE – Just weeks before it began enforcing a new face-to-face rule, CMS has announced that it has pushed that enforcement until some time in 2014.

    CMS, which made the announcement Sept. 9, says the delay is needed to give providers and healthcare practitioners time to establish necessary protocols to fully comply with the rule. It’s the second delay for the rule. In a June 27 letter to Congress that delayed enforcement of the rule until Oct. 1, the Office of Legislation at CMS cited similar concerns.

    The face-to-face requirement was originally slated to take effect July 1, 201—the same day that Round 2 of competitive bidding kicked off in 91 MSAs across the country. The rule requires patients to meet with their physician or other healthcare provider within six months of getting a prescription for home medical equipment.

    Stakeholders and HME providers have criticized the lack of education on CMS’s part and also fear that the rule places burdens on certain patients, such as the homebound. The July HME NewsPoll found that 95% of respondents at that time said they worried that the requirement will reduce patient access.

    CMS said it will address industry questions and provide updated information at www.cms.gov/medical-review.


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    09/13/2013
    Theresa Flaherty

    WASHINGTON – Congress returned to work last week to a heavy docket: the debt limit, Syria and, for the HME industry at least, competitive bidding.

    “There are all sorts of important issues, but when someone can’t get oxygen or is not testing for diabetes properly, that’s devastating to them, to the healthcare system and to the cost of health care,” said Jay Witter, vice president of government affairs for AAHomecare. “Bidding is still a problem and they’ve heard about it over the recess.”

    One lawmaker who wasted no time getting back on the wagon: Rep. Glenn Thompson, R-Pa., who took to the floor Sept. 10 to reiterate his concerns with the program and ask his colleagues to support H.R. 1717, a bill to replace competitive bidding with a market-pricing program (MPP).

    “While CMS makes claims that the competitive bidding program will increase market competition and lower costs, in practice, it’s shown to be anything but competitive,” Thompson told lawmakers. “Over the past several years, we’ve seen the program negatively affect seniors and force small medical companies—many that are local and the only entity capable of providing quality goods and a high level of service—out of the market.”

    Introduced in April by Rep. Tom Price, R-Ga., H.R. 1717 currently has 152 co-sponsors—a number that stakeholders expect to climb rapidly now that Congress is back in session.

    “I think we’ll see double-digit co-sponsors added in the next week or so,” said Seth Johnson, vice president of government affairs for Pride Mobility Products. “We are hearing of lawmakers throughout the country that are looking at the bill again in light of concerns that they are hearing not only from the industry but also from beneficiaries and consumer groups that really see the harm that this program is causing.”

    In the 91 cities included in Round of competitive bidding, the implications of the program continue to be far-reaching. With so many contract suppliers outside bid areas, for example, there are now reports that local contract suppliers can’t keep up with the demand. In response, the Competitive Bidding Implementation Contractor (CBIC) has confirmed to AAHomecare that contract suppliers may set capacity limits, but they must notify the agency so they won’t be in violation of their contracts.

    “It’s a reprieve for those people that are getting barraged from people who need stuff,” said Kim Brummett, senior director of regulatory affairs for AAHomecare.

    With Round 2 of the program, which kicked of July 1, well into its third month, stakeholders also expect to see an uptick in complaints as beneficiaries become eligible to renew their diabetes and CPAP supplies.


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    09/13/2013
    Liz Beaulieu

    ST. LOUIS – A brain trust of HME providers met for the HME News Business Summit last week to discuss—not the obstacles of the moment—but the opportunities of the future.

    One speaker said the way to grab those opportunities by the horns is thinking progressively.

    “What’s going on in Washington, D.C., isn’t going to stop,” said Mike Bailey, CEO of Handi Medical Supply, who sat on a panel of HME Excellence Award winners. “The providers who are going to make it—I don’t know if size is going to be as important as creativity.”

    The following are snapshots from the event, held Sept. 8-10 at The Four Seasons Hotel, that speak to how providers can bend the business rules for HME.

    Take a 360-degree view

    Healthcare providers are sitting on an arsenal of data, and HME providers are no different. But what are HME providers doing with that data? Printing out fragmented and historic reports?

    “Reporting is what; analytics is why,” said speaker Gregg Timmons, president and CEO of MedAct Software.

    Simply put, analytics is a data-mining tool that allows users to make sense of patterns, said speaker Geoff Kearney, founder and CEO of Praedx.

    “It helps give you a 360-view of your business,” he said.

    If HME providers marry different types of data—both operational and financial—they’ll get that more complete picture, speakers said.

    “Taking your analytics and marrying your DSO to HCPCs to denials—then you start to get some powerful information,” said speaker Steve Andrews, general manager of customer service for Brightree.

    Speaker Chris Kinard, director of corporate systems development for Long’s Home Medical, said he puts data in the driver’s seat.

    “The info is there to make the right decision,” he said. “You just need to extract it and understand it. Our confidence comes from what the data is telling us.”

    Think beyond reimbursement

    While reimbursement for telehealth services is still spotty, that’s changing, said speaker Dr. Cynthia LeRouge, an associate professor at Saint Louis University, and a telehealth expert.

    “Every year there’s more and more,” she said. “Sixteen states now have to reimburse for these services. The door has opened a little—it’s just a matter of keeping it ajar.”

    One possibility that may be new to the radar screens of HME providers: grants through organizations like the Office for the Advancement of Telehealth or OAT, LeRouge said.

    One thing’s clear: A multitude of factors are driving growth in telehealth, including the desire to reduce healthcare costs by keeping high maintenance patients in their homes whenever possible, LeRouge said.

    “No one has found the silver bullet to treat people with chronic conditions,” she said.

    Also noted

    Speaker Paul Bergantino, CEO of Numotion, on his post-deal acquisition strategy: “There are two things you’re investing in: people and a revenue stream. You’re not just taking the costs out. Pulling costs out is important, but growth is more important.”

    Speaker Mike Sperduti, CEO of Emerge Sales and Renewal Technologies, on why you need a “big idea”: “Eighty-two percent of referral sources refer patients to five or more HME companies.” Why? “Because they’re all the same. No one’s stepping up. Everyone’s playing the same game.”

    Speaker John Sphon, CEO of MedCare Equipment Company, on how to approach strategic relationships with other healthcare providers: “Think like a hospital—what’s attractive to them?” He says all providers should be asking themselves this question about their business model: “Are we going to be in a position for the future reality?”


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    09/13/2013
    HME News Staff

    BALTIMORE – CMS had no choice but to delay—for the second time—enforcement of its face-to-face rule until sometime in 2014, say industry stakeholders. “We just haven’t seen any further education,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. In its Sept. 9 announcement, CMS said the delay is needed to give providers and healthcare practitioners time to establish necessary protocols to fully comply with the rule. The face-to-face requirement took effect July 1, 2013, and although enforcement of it has been delayed, stakeholders are concerned that providers are at risk. “It is unclear, at this point, whether several years down the line, the auditor may have the ability to go back and enforce it as of July 1, 2013,” said Cara Bachenheimer, senior vice president of government relations for Invacare. CMS said it will address industry questions and provide updated information at www.cms.gov/medical-review.

    Golden Technologies back in bed biz

    OLD FORGE, Pa. – Golden Technologies will introduce Reverie’s luxury adjustable beds and sleep systems to the HME industry at Medtrade in October. Golden exited the bed business last spring to focus on its core competencies of lift chairs and mobility products. “The adjustable bed category is an important and exciting cash opportunity for retail, and I believe Reverie has a great story to tell and dealers need to know about it,” said C.J. Copley, executive vice president of sales and marketing for Golden, in a press release.

    Permobil to sell TiLite wheelchairs in Canada

    LEBANON, Tenn. – Permobil will now represent the full line of TiLite titanium and aluminum wheelchairs in Canada, the companies announced Sept. 6. “There is one company in the world that matches TiLite’s vision that what matters most in mobility is quality and performance, and that company is Permobil,” said David Lippes, TiLite CEO, in a press release. “The combination of TiLite’s manual mobility with Permobil’s power mobility will provide our Canadian sales team with an advanced mobility product line.” Permobil will represent TiLite, but TiLite will still provide all customer service and support.

    Bill seeks formal process for sleep reg

    WASHINGTON – A bill was introduced in the House of Representatives today that would require the Federal Motor Carrier Safety Administration (FMCSA) to draft a formal regulation governing the diagnosis and treatment of sleep apnea in commercial drivers. Reps. Larry Bucshon, R-Ind., and Daniel Lipinski, D-Ill., seek to require the FMCSA to go through a formal rule-making process that includes an evaluation of costs and benefits—rather than simply issuing guidance, which has been its plan. Stakeholders like the American Trucking Association and the National School Transportation support the bill. Without a formal process, stakeholders fear they wouldn’t have a clear understanding of their legal responsibilities, according to an article on truckinginfo.com. That could leave them vulnerable to lawsuits. Stakeholders estimate it could cost more than $1 billion annually to treat sleep apnea among commercial drivers, according to the article. But benefits could include lower medical expenses, reduced turnover and fewer crashes, they say.

    Invacare leads growing oxygen market in Europe

    VANCOUVER, British Columbia – Europe’s 59 million Euro oxygen therapy market is expected to grow as the continent’s population ages and former smokers develop lung disease, iData Research reported recently. “Among western European countries, France has the largest number of patients on long-term oxygen therapy, and the extensive use of oxygen concentrators is encouraged by some of the highest reimbursement rates in Europe,” said Kamran Zamanian, CEO of iData, in a press release. Conversely, the Italian reimbursement and regulatory system favors liquid oxygen, the report says. Invacare holds more than half the overall market share in Europe, according to the report, followed by Philips Respironics, Devilbiss, AirSep, Inogen One and SeQual.

    OIG: Cutting test-strip prices could save N.J. money

    WASHINGTON – Reducing reimbursements amounts for blood glucose test strips to retail rates or establishing competitive bidding could have saved New Jersey’s Medicaid program between $1.8 million and $2.7 million in 2011, the OIG said in a Sept. 11 report. During calendar year 2011, New Jersey’s four Medicaid managed-care organizations’ reimbursements were $3.1 million more than retail prices and $4.5 million more than Medicare payment rates, according to the report. Reducing the rate or relying on competitive bids could have saved the agency between 49% and 70%, the OIG said. The OIG recently issued similar reports for New York and Illinois. The oversight organization noted that New Jersey’s Medicaid agency disagreed with its recommendations.

    Pride Mobility strengthens retail team

    EXETER, Pa. – Stuart Robinson has joined Pride Mobility Products as National Sales Manager for retail mobility, the company announced Sept. 9.  Pride Mobility has also promoted Brett Shoemaker to retail mobility sales director and Cy Corgan to strategic accounts director. Robinson, Shoemaker and Corgan will work with Andrew Pyrih, senior vice president of domestic sales, to oversee new sales strategies. “At Pride, we are implementing a retail mobility leadership team that I am confident will take sales effectiveness and efficiency to the next level,” said Pyrih. “Retail mobility at Pride is back and better than ever, and we are working diligently to better support our customers and continuously deliver product innovations that will help them to identify and convert opportunities that increase cash flow in this challenging marketplace.” Pride Mobility designs and manufactures mobility products, including lift chairs, scooters, lifts and ramps.

    ASP: Budesonide gets big boost

    BALTIMORE – Things are looking up for several respiratory medications in the latest average sales price (ASP) figures. For the fourth quarter of 2013, budesonide (J7626) took the biggest leap, up 85 cents to $5.95 per dose. Also getting an increase: brand name drugs Brovana (J7605) and Perforomist (J7606), which saw increases of 12 cents and nearly 39 cents per dose, respectively. Pricing stayed relatively flat for albuterol (J7613) and ipratropium (J7644)—both hovering around 12 cents per dose.

    Integrity director Budetti leaving CMS

    BALTIMORE – Peter Budetti, the first director of the CMS Center for Program Integrity (CPI), is retiring. His last day with CMS was Wednesday, Sept. 11. Elizabeth Handley will take over as acting director, Bloomberg reports. Administrator Marilyn Tavenner wrote, in an internal email, “Peter, with the support of a strong team, realigned the structure of program integrity in the agency and CPI took on the challenge of moving beyond pay-and-chase antifraud activities to preventing fraud before it has a chance to start.” Established in 2010, CPI coordinates program integrity for Medicare and Medicaid.

    ResMed director sells $1.2M in company stock

    SAN DIEGO – Peter Farrell, a director at ResMed, sold 25,000 shares of stock on Sept. 5. At $48 apiece, the stock went for $1.2 million, according to Ticker Report, which says Farrell now directly owns 511,825 shares in ResMed. Shares of ResMed traded up 3.09% on Sept. 9, hitting $50.67. ResMed has a one-year low of $38.08 and a one-year high of $51.40.

    Mediware plans $2.8M software upgrade

    LENEXA, Kan. – Upgrades are coming to MediLinks’ Rehabilitation and Respiratory Care electronic documentation solutions. In a Sept. 9 announcement, MediServe parent company Mediware Information Systems said it plans to spend $2.8 million to upgrade current MediLinks products to ensure the platform meets market and industry needs. Upgrades include a new management solution, improvements to rehab solutions, revamped scheduling capabilities, and changes to the outpatient and regulatory compliance standards to meet new G-code and therapy cap requirements. The updates are scheduled to be finished in July 2014.

    Short takes

    Billing and collections company A/R Allegiance Group and billing company MedBill announced their new partnership in a Sept. 12 press release. “We decided to align with A/R Allegiance because of their unique process, which includes an online payment portal tailored to your organization, making and receiving live and IVR telephone calls, emails, text messaging and enhanced voice statements,” said Keith Kuhn, MedBill CEO, in the release…Recently injured veterans will have the chance to unwind and enjoy some friendly competition at the Invacare-sponsored National Veterans Summer Sports Clinic in San Diego on Sept. 15-20. Featuring daily rehabilitation alongside sailing, surfing, track and field, kayaking, and hand and tandem cycling, the clinic helps participants hone their skills in a variety of adaptive sports…Have a standout client? Tell Maddak why he or she inspires you and you could win that client a set of Morph Foldable Wheelchair Wheels as part of the company’s “Most Inspirational Client Contest.” The contest, free to enter, is open through Oct. 31.


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    11/07/2013
    HME News Staff

    BALTIMORE – CMS will start editing DME claims to determine whether or not the ordering or referring physician has enrolled in the Provider Enrollment, Chain and Ownership System (PECOS) on Jan. 6, 2014, according to a new bulletin.

    Claims that don’t pass muster will be denied, and the billing provider will not be paid for the items or services that were furnished based on the order or referral.

    CMS had planned to start editing claims on May 1, but it held off due to technical reasons. The agency has delayed the edits going as far back as 2010.

    Physicians and other professionals who order and refer items and services must establish a record in PECOS and a valid national provider identifier (NPI), CMS says.

    If a claim identifies the ordering or referring provider but does not include a matching NPI, the claim will still be rejected, the agency says.

    The edits will verify provider enrollment by comparing the first four letters of the last name. CMS cautions providers to leave out middle names or initials and suffixes.


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    11/08/2013
    Liz Beaulieu

    WASHINGTON – CMS has set a new start date for denying DME claims with the names of physicians who are not enrolled in PECOS and, this time, it may stick, industry stakeholders say.

    Starting on Jan. 6, 2014, claims with the names of physicians who are not enrolled in PECOS will be denied, and the provider who submitted the claims will not be paid for the items or services that were furnished. Most recently, CMS had planned to start denying claims on May 1, 2013.

    “It feels real this time,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “This has been a long, long time coming.”

    This phase of the implementation of PECOS goes back to 2009. That’s when CMS started sending providers this informational message when they billed with physicians not enrolled in PECOS: “Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected, this will not be paid in the future.” The messages came in as N544.

    Although there have been software glitches along the way that have prevented CMS from enforcing the edits, the biggest reason for the delays: Physicians just weren’t enrolling in PECOS, stakeholders say.

    “They finally forced the physicians who weren’t enrolled by making them not eligible for increases in payments associated with electronic medical record adoption and by suspending their billing privileges,” Andrea Stark said. “That was the final push.”

    That, combined with proactive providers scrubbing their databases to make sure their information matches CMS’s information, has significantly reduced the number of informational messages sent out, stakeholders say.

    “We’ve seen a major reduction,” Stark said.

    Despite the advancements, there are still several gray areas with PECOS that stakeholders are trying to get addressed. For example: Can a provider use an advanced beneficiary notice (ABN) if a physician chooses not to enroll, retires or passes away?

    “What happens if a provider takes an order from a physician, delivers equipment and doesn’t realize the physician is not enrolled?” Brummett said. “Can the provider hold the claim until the physician is enrolled? These things are still up in the air.”

    Stakeholders say providers should take Jan. 6 very, very seriously.

    “We’ve worried about it so many times, but it keeps getting delayed, so it’s hard for anyone to take it seriously,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “That needs to change.”


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    11/08/2013
    Theresa Flaherty

    WASHINGTON – It’s still early, but industry stakeholders are already hearing reports of licensure issues in the Round 1 re-compete.

    This time, however, it’s licensed providers that say their bids were rejected because, according to the Competitive Bidding Implementation Contractor (CBIC), they were not properly licensed.

    “We’ve just begun licensure analysis, but CMS seems to be making the same kind of mistakes,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “And it’s only nine bid areas.”

    In Round 2, CMS awarded hundreds of contracts to suppliers that didn’t meet licensure requirements.

    One provider in Round 1 received only one contract offer in the re-compete. In an email to HME News, the provider wrote:

    “We were absolutely stunned to learn that our bids were rejected because, according to the CBIC, we are not licensed in the state in that product category. Please bear in mind that we are and have continually been licensed in North Carolina to provide medical equipment.”

    Adding insult to injury, out-of-state companies that do not meet local licensure requirements received contract offers, the provider wrote.

    Even as stakeholders parse new re-compete information, they continue to lobby for H.R. 1717, a bill that would replace the competitive bidding program with the market-pricing program (MPP). The bill has 157 co-sponsors in what’s becoming a dwindling congressional session.

    AAHomecare is working with People For Quality Care to get stories of the impact on beneficiaries in front of the public. The association’s president, Tom Ryan, acknowledges that providers are battle weary.

    “I know everybody is going about trying to survive under these new price constraints,” he said. “It’s going to take a Herculean effort to get the story out there but we’ve got to continue to engage.”


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  • 11/08/13--11:24: Q&A: Wayne Stanfield
  • ‘Bidding will change. It has to’
    11/08/2013
    Liz Beaulieu

    WASHINGTON – It’s ironic that Wayne Stanfield feels comfortable retiring now that NAIMES is part of AAHomecare.

    After all, NAIMES was created in 2007 to meet the needs of the smaller and independent providers that felt neglected by the industry’s largest association.

    But the AAHomecare of today isn’t the AAHomecare of six years ago—and that’s a good thing, says Stanfield, who was on staff there from April, when NAIMES merged with the association, until Nov. 15, when he retires.

    “With Tom Ryan taking the reins, with Robert Steedley as chairman, and with Kim Brummett and Rob Brant on staff, I think AAHomecare will be a completely different organization and a much better organization,” he said. “I can step away knowing that the best interests of all members are being taking care of.”

    Here’s what Stanfield had to say about why he still has faith in the industry that he has been a part of, in various roles, since 1987.

    HME News: Did you ever think that groups like NAIMES and AMEPA would be folded into AAHomecare?

    Wayne Stanfield: The fractures in the industry occurred partly because there was a need not being met. That may have been perceived, but perception is reality. I used to say that AAHomecare was in a boat and NAIMES was in a boat, and we were rolling in the same direction but in different boats. Now we’re all in the same boat going in the same direction. Unity is critical, and I think that’s going to continue and get stronger.

    HME: Where do you think you’ve left a mark on the industry?

    Stanfield: I helped a lot of people get involved in politics and understand that politicians don’t bite. You need to be someone they recognize. Having that relationship wins battles. It’s difficult for a member of Congress, when he calls you Wayne and you call him Robert, to say he can’t support something. I’ve had them tell me, “I can’t, because…” but they’ve never blown me off. They’ve always talked to me.

    HME: What’s the biggest lesson you’ve learned about the industry?

    Stanfield: This industry is made up of good, honest, hard-working people who have the best interest of their patients at heart. We’re not made up of crooks, scammers and people cutting corners. I’ve always hated how we’ve been painted with these broad brushes when it’s a miniscule number of companies that have caused us to have such a bad name.

    HME: You’re still part of the industry as a co-owner of an HME company in Virginia and as the executive director of the Home Care Alliance of Virginia. What’s the future hold for the industry?

    Stanfield: It is my hope that we can change the path of where DME is going, but it has been profoundly affected by competitive bidding, and it will take a tremendous and concerted effort by everyone in the industry to get it resolved. There’ll always be a need for DME; the only thing that is going to change is who provides it and how it’s paid for. DME, as a whole, is not going to get smaller. Providers need to learn how to adapt. Bidding will change. It has to.


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    11/08/2013
    HME News Staff

    INDIANAPOLIS – Prior authorization requests submitted as part of the PMD demo are being denied because of conflicting information in face-to-face exams and other medical records, and insufficient face-to-face exam information, National Government Services (NGS) announced in a recent bulletin. The list of reasons covers denials as of Oct. 24. NGS says face-to-face exams often do not specify: how a PMD will sufficiently improve the beneficiary’s daily life; what are the beneficiary’s mobility limitations (his or her ability to get into and out of a PMD); what is the beneficiary’s mental or physical ability to operate the device; or what is beneficiary’s ability to stay stable while using the device. Other face-to-face exams neglect to include the beneficiary’s weight, NGS says.

    TiLite announces new rep agreements

    PASCO, Wash. – TiLite, a manufacturer of titanium and aluminum wheelchairs, has announced new U.S. sales representation agreements that will take effect Dec. 1. Permobil will represent TiLite in Florida and Puerto Rico; The Roho Group will represent the company in Illinois and most of Wisconsin; and Target Medical will represent it in Tennessee and Mississippi, according to the Oct. 30 news release. “We are excited to extend our partnerships with these top players in our industry,” stated TiLite CEO David Lippes in the release. MSL Associates will continue to serve these areas until Nov. 30, according to the release.

    Conference news from Medtrade Spring, NCART

    Early bird rates for Medtrade Spring start Nov. 12 and stay in effect through 2013. Medtrade Spring takes place March 10-12 at the Mandalay Bay Convention Center in Las Vegas. FMI: www.medtradespring.com ... The second annual National CRT Leadership and Advocacy Conference will take place April 29-May 1, 2014, at the Hyatt Regency Crystal City in Arlington, Va. Contact NRRTS or NCART for more details.

    Alpine branches out into Idaho

    SALT LAKE CITY - Alpine Home Medical Equipment is expanding into Idaho with the acquisition of Eagle Rock Oxygen and Medical Equipment in Idaho Falls, the company announced Nov. 4. Alpine says Eagle Rock’s staff will continue to serve patients from the same location. In business since 1997, Alpine Home Medical has nine branches in Utah.

    AxelaCare acquires SCP Specialty Infusion

    LENEXA, Kan. – AxelaCare Health Solutions, a specialty home infusion services provider, has acquired SCP Specialty Infusion, the parent company of Sirona Infusion, which provides acute home infusion, the company announced Nov. 5. The buy doubles AxelaCare’s number of pharmacies, according to a release. “We are excited that Chris (York), an industry leader in home infusion, and his team at Sirona are joining us to build a ‘best in class’ home infusion company,” stated Ted Kramm, AxelaCare CEO, in the release. “Their strength in acute infusion, great geographic coverage in the west and growth profile complements our strengths in IVIg and chronic care, and also expands our platform to provide innovative patient outcomes technology.”

    Carex acquires ThermiPaq

    NORWELL, Mass. – Carex Health Brands has acquired the ThermiPaq Hot & Cold Therapy brand and other assets from the Springfield, Ill.-based Thermionics Corp., according to a Nov. 4 news release. Carex offers hot/cold pain therapy, including the Bed Buddy moist heat ThermaTherapy and TheraMed brands, and home medical equipment. “This acquisition further solidifies our leadership in the market and allows Carex to improve service to our existing customers through an expanded hot/cold portfolio,” stated Matt McElduff, president of Carex Health Brands, in the release. 

    Insulet posts third quarter results

    BEDFORD, Mass. – Insulet’s revenues reached $61.1 million in the third quarter compared to $54.8 million during the same period last year, a 12% increase, the company announced Nov. 7. The medical device company’s gross profit for the period was $27.4 million, also a 12% increase. Insulet’s revenues in the first nine months of the year were $178.6 million vs. $153.5 million for the same period last year, while gross profit was $79.4 million vs. $67 million. Increased operating expenses were due to the settlement of a patent-infringement dispute with Medtronic involving Insulet’s OmniPod.

    Hasco launches new TV ad campaign

    ADDISON, Texas – Hasco has begun airing new TV ads in central Florida, hoping to raise awareness of the wheelchair-accessible transportation options that are available to a growing baby-boom population, the company announced Nov. 8. “This will help them make better-informed decisions as their needs change,” stated Hal Compton, Hasco Medical CEO, in a release. “We also expect this to help increase our fourth quarter sales and trade-ins on modified vehicles.” Similar commercials will soon air in other areas served by Hasco’s Ride-Away stores, like Tampa, Fla., and Washington, D.C.

    ARI acquires Duo Web Solutions

    MILWAUKEE – ARI Network Services, a website, software and data solutions provider, has acquired Duo Web Solutions, a social media and online marketing services provider, the company announced Nov. 5. “This acquisition is in direct alignment with our strategy to grow the digital marketing services side of the business,” stated Roy Oliver, ARI president and CEO, in a release. “Duo Web Solutions’ proven social media services, including reputation management and SEM services, will now be available to dealers, distributors and manufacturers in all the verticals we serve.” Terms of the deal were not disclosed.

    Involve community pharmacists in COPD care, study says

    OXFORD, England - COPD patients working with community pharmacists stick with their medications and have improved inhalation techniques, a recent study published in the British Journal of Clinical Pharmacology suggests. Patients in the study’s intervention group learned about their disease, medication and how to use inhalers. They also discussed disease management, quitting smoking and adherence. “This trial should encourage community pharmacists to engage in COPD care aiming to sustain an effective and safe pharmacotherapeutic treatment in patients with COPD,” study authors wrote. While patients working with pharmacists stuck with their medication and improved inhalation techniques, investigators did not find that they decreased their moderate exacerbation rate, dyspnea or smoking habits.

    Short takes

    CMS has approved the Accreditation Commission for Health Care for continued recognition as a national accrediting organization for hospices that wish to participate in Medicare or Medicaid. ACHC’s recognized status will last through Nov. 27, 2019…November is COPD Awareness Month and Inogen is offering a $500 discount shopping card to the winner of its “Share for COPD Awareness Giveaway,” it announced Nov. 7. To enter, the oxygen therapy company asks people to share their success stories about living with COPD... Ottobock debuted the film “Limitless” at the ReelAbilities Disabilities Film Festival on Nov. 3. “Limitless” is an original film featuring Ottobock employee Leslie Pitt Schneider, who lost a limb early in her life…It’s been 45 years since Al Thieme invented the Amigo power operated vehicle or scooter in his Bridgeport, Mich., garage. “The reason for starting Amigo Mobility was to ‘find a better way’ for a family member to stay active,” said Theime, in an Amigo Friendly Wheels newsletter in November. The company has expanded to a 55,000-square-foot facility and has manufactured more than 222,000 Amigo scooters.

    People news

    John Dudash, president and CEO of MITY Enterprises, will take the helm of Broda Seating, the company announced Nov. 6. MITY is the parent company of Broda Seating, and was acquired by Prospect Capital Corporation in September…Scot Dube is now president and CEO of Sigvaris North America. Dube succeeds Charles Handschin, who retired from Sigvaris after serving more than 14 years as president and CEO.


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    11/14/2013
    HME News Staff

    WASHINGTON – HME providers in the competitive bidding program may no longer decline referrals after reaching their financial capacity, according to AAHomecare.

    In a recent bulletin, the association said it has received clarification from the Competitive Bidding Implementation Contractor (CBIC) that this is no longer acceptable.

    “AAHomecare has had several discussions with the CBIC expressing that financial capacity is a real issue with potentially devastating impact,” the bulletin reads. “With the number of contracts awarded to companies hundreds of miles outside of bidding areas, local providers are overwhelmed with requests.”

    The official guidance from the CBIC includes: Providers must furnish all items in the product categories and bid areas for which they have contracts, or risk having those contracts terminated. Additionally, providers are not permitted to “pick and choose” beneficiaries.

    CMS says it examines the financial capacities of providers as part of the bidding process to make sure it awards enough contracts to meet demand.

    AAHomecare says it will continue to discuss this issue with the CBIC.


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    11/15/2013
    Theresa Flaherty

    BALTIMORE – The financial capacities that contract suppliers submitted as part of their bids don’t hold much weight, based on new guidance from the Competitive Bidding Implementation Contractor (CBIC).

    Contract suppliers must continue to provide equipment and services, even if they’re beyond their submitted capacities, the CBIC now states.

    “If you are getting inundated and being asked to provide five times the products you said you could—there’s an argument for that, but it’s just not in the final rule,” said Kim Brummett, senior director of regulatory affairs for AAHomecare.

    The CBIC originally stated that providers could decline referrals after they reached their capacities, with proper notice to the agency.

    With so many contracts awarded to out-of-state providers, the fear is that local contract suppliers risk getting inundated with referrals, say stakeholders.

    “The practical difficulty is that it’s the small local providers that are getting the calls because people don’t want to go to these long-distance firms,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “They don’t call Texas to get a walker in Ohio.”

    Licensure

    Lincensure issues with the contract suppliers for the Round 1 re-compete are starting to trickle in state by state.

    “Twenty-three percent of the contracts in Ohio were awarded to firms that do not appear to be licensed or registered with the appropriate agency,” said Bachenheimer.

    In Pennsylvania, it appears only 48% of contracts for the general HME category and 56% of contracts for standard mobility were awarded to providers with proper licensing, according to the Pennsylvania Association of Medical Suppliers (PAMS).

    A big reason why many contract suppliers in Pennsylvania don’t meet the requirements: The state in 2012 stopped issuing disinfection licenses—required to provide beds and wheelchairs—to out-of-state providers. In both Round 2 and the Round 1 re-compete, a large number of contracts were awarded to out-of-state providers. PAMS believes those contracts will need to be voided.

    “This will have a significant impact on competitive bidding contract holders and Medicare beneficiaries in both the four Round 2 bid areas and the Round 1 re-compete area in Pittsburgh,” PAMS stated a letter to CMS Administrator Marilyn Tavenner.


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