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| May 9, 2011 | Volume 17, Number 18 |
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ADVERTISEMENT Experience the ACHC difference with personal account managers, relevant and realistic standards, competitive pricing and a friendly, consultative approach to accreditation. For more information, visit us at www.achc.org or contact customerservice@achc.org or 919-785-1214. Table of Contents - PAOC Members Ask CMS for Specific Info on Round 1 - H.R. 1041: If You Pushed Before, Push Harder - Florida Medicaid Providers Get Friday Double-Punch - Mobility Stakeholders Cautious about PMD Face-to-Face Checklist - PFQC Sends DVDs Featuring Patients to Washington - CMS, DME MACs Busy with Messages, Reminders - There Is No Breathing Easy with Competitive Bidding - HHS Offers Support for Storm-Ravaged States; More News in Brief For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. - Late-Breaking News PAOC Members Ask CMS for Specific Info on Round 1 Exactly how many contracted suppliers are there? And are they providing service? WASHINGTON—In a May 6 letter emailed to CMS Deputy Administrator Jonathan Blum, a dozen members of the Program Advisory and Oversight Committee asked for the release of additional data on competitive bidding. The PAOC was formed to advise CMS on implementation of the bidding program, but committee members have long said the agency seldom takes its advice. At a PAOC meeting April 5, CMS officials gave what attendees described as a “rosy” picture of Round 1 since its January 1 rollout. But after the meeting, PAOC member Walt Gorski, vice president, government relations, for the American Association for Homecare, said, “There seems to be a very large disconnect that CMS has no problems.” Copied to CMS Administrator Donald Berwick and Marilyn Tavenner, principal deputy administrator and COO, the letter follows in its entirety: Dear Jon, The undersigned members of your Program Advisory and Oversight Committee (PAOC) for the DMEPOS Competitive Bidding Program are writing you today to request that the Centers for Medicare & Medicaid Services (CMS) disclose additional data points which we feel are essential to our role of timely and accurately advising CMS in determining if the bidding program is operating effectively. In order to fulfill our duty as PAOC members, we request that CMS provide the following: • For better clarity to demonstrate there are no adverse health effects, please provide the current tracking of the percentage of beneficiaries accessing DME (e.g. the charts presented at our April 5th meeting), but expressed as a percentage of beneficiaries purchasing or renting the category item during the previous 12 months (trailing 12 months). We request quarterly updates of this data. • To better understand the impact of the Round One Re-Bid implementation on CMS’ call center, please provide tracking of the inbound 1-800-MEDICARE calls within the nine CBAs, using area codes to approximate the CBA boundaries, for January through March, 2010 and 2011, to include data on number of calls presented, the number of lost/dropped calls, average time to answer by live operator, average talk time, and any available data on tracking resolution of the call (a standard in call centers). • To plan for optimal beneficiary service needed within Medicare’s call center upon Round Two implementation, we request CMS address the following: —At our April 5th meeting it was reported there were nearly 54,000 inbound calls for competitive bidding issues from January through some point in late March, 2011, and that 75 percent of these calls were related to diabetes testing supply products. —Extrapolating this to 91 additional CBAs, including our country’s most populous communities, CMS can anticipate a dramatic increase in queries, totaling more than one million additional calls in less than a three-month period following implementation of Round Two. —We would like to know the CMS call center statistic on average calls answered per agent per day for the period January through March, 2011. With this in mind, how many agents might be required to fulfill this need? What is the staffing level today? • Diabetes test supplies were bifurcated between the mail order (included in CB) and retail (excluded from CB) markets. Please provide, by month and cumulative, the quantity and percentage of diabetes test strips (A4253) within each of the CBAs, and in total, provided via mail order (KL modifier) and non-mail order, for 2010 and 2011. A shift to retail costs Medicare and beneficiaries as much as 279% more, almost four times, than the competitively bid Single Payment Amount. • A goal of CMS in the Round One Re-Bid was to ensure multiple suppliers and beneficiary choice. Please provide PAOC members with quarterly updates, by CBA and by product category within each CBA, for the following: —The number of contracted suppliers at 1/1/11, —The number of the 1/1/11 contracted suppliers, above, which have closed and/or surrendered their provider number, —The number of the 1/1/11 contracted suppliers, above, which have provided no service in the CBA since 1/1/11, —The number of currently remaining and active contracted suppliers, and —The number of any contracted suppliers added since 1/1/11. Such data should be easily accessible given the extensive tracking system CMS has in place for this program. With time of the essence in preparing for Round Two, we would appreciate receiving this information no later than May 31, 2011. Again, thank you for empowering PAOC members to provide the best possible input and advice to CMS for effective and efficient implementation of this Program, and we look forward to our next PAOC meeting with you. Very truly yours, Peter Amico, Prime Care Medical Supplies Inc. Doran Edwards, M.D., Advanced Healthcare Consulting LLC Sue Elhessen, M.D., Careers Unlimited Inc. Walter Gorski, American Association for Homecare Jeffrey Mansell, Texas Department of State Health Services Sharad Mansukani, M.D., NationsHealth Inc. Thomas Milam, Tatum LLC Wayne Murphy, The Joint Commission Rita Hostak, Sunrise Medical Inc. Thomas J. Jeffers, Hill-Rom Inc. Barbara Rogers, COPD Association Esta E. Willman, Medi-Source Equipment & Supply How much of your business comes from retail? To vote in HomeCare's monthly Web poll, visit www.HomeCareMag.com. Headline News H.R. 1041: If You Pushed Before, Push Harder WASHINGTON—Members of the House of Representatives are steadily signing on as cosponsors of H.R. 1041, but getting a companion Senate bill going—well, that’s a longer story, stakeholders say. As of Friday, 90 House legislators had signed on to the competitive bidding repeal bill, introduced in mid-March by Reps. Glenn “GT” Thompson, R-Pa., and Jason Altmire, D-Pa. “We’re making good progress,” said Cara Bachenheimer, senior vice president, government relations, for Invacare, Elyria, Ohio. “It’s member by member … We started out with a bang and now it’s sort of a steady accumulation. We need to keep that up.” “I think 90 within the time frame is not bad,” agreed Wayne Stanfield, president and CEO of the National Association of Independent Medical Equipment Suppliers. “The signatures have been going very well. Obviously, we’ve got to keep pushing for more and more. But I think progress has been steady.” He said there was “a little pushback on the floor from some people because the government is so conscious of the deficit and trying to save every penny it can.” Still, Bachenheimer said she was “hopeful that we’re going to hit 100 by the two-month mark” this week. It is critical that the number continues to climb, she noted. “A lot of bills have only a few cosponsors,” Bachenheimer said, “so the number is of high importance … It sends a strong message to the leadership that this is something they need to do something about.” While members of the House have been responsive, that has not been the case in the Senate. “We have a short list of pretty supportive senators but we are having real difficulty getting one of them to say, ‘I’ll take the lead,’” Bachenheimer said. “We’re having a tougher time than I would have liked.” Republicans, she said, do not want to spend money, and on the Democratic side, “we have the Max Baucus” issue. Chairman of the powerful Senate Finance Committee, which has jurisdiction over Medicare, the Montana Democrat has long been a foe of the HME industry and is a champion of competitive bidding. In addition, there are other objections to the repeal bill, including its pay-for from undesignated discretionary funds, the notion from CMS that Round 1 of competitive bidding is going fine and fear that supporters of a repeal would come off as being against competition. While last’s year’s H.R. 3790, a similar repeal bill, garnered more than 250 House supporters, it failed to attract a champion in the Senate and died with the old Congress. This time around, Round 1 is at full throttle in the nine competitive bidding areas and business casualties are mounting. Many companies have closed their doors, and beneficiaries have reported problems finding providers to serve them or do repairs. Industry advocates point out the situation is getting worse. Last week, several HME organizations reported that some independent insurers are copying the competitive bidding reimbursement rates, which in some cases are below cost. “One private health insurance company that operates in 11 states already announced it will begin to pay HME items at 70 percent of the new, 32 percent-reduced competitively bid rates,” the American Association for Homecare told members in its May 4 newsletter. “That means their payment rates for HME will drop to 48 percent of the 2010 Medicare allowable.” Said the association, “This is an alarming trend as HME providers in the next 91 bidding areas prepare for a second round of bidding.” The only way to sidestep the issue is to get competitive bidding repealed, stakeholders maintain. “It’s going to be a tough fight,” Stanfield admitted. “Without a Senate companion bill, it will be very difficult to move [the repeal] forward.” “We’ve got to keep going!” urged Bachenheimer. In an action alert last week, AAHomecare called on “everyone who values good home care” to call or email U.S. senators and ask them to stop competitive bidding. You can reach your senators through the Capitol Hill switchboard at 202/224-3121, or to email, go to www.capwiz.com/aahomecare. Florida Medicaid Providers Get Friday Double-Punch TALLAHASSEE—On the last day of its session Friday, Florida’s legislature passed a comprehensive reform plan for Medicaid that moves most of the state’s beneficiaries into managed care. Lawmakers have long said the plan would be a money-saver for the state's Medicaid program, which serves about 2.7 million and has seen costs balloon to a staggering $20 billion a year. But the cost elsewhere in the system could be huge, according to Sean Schwinghammer, executive director of the Florida Alliance of Home Care Services. Under the plan, the state will be divided into 11 regions with HMOs and provider-service networks competing for contracts in each area. Many HME companies currently providing equipment and services to Medicaid beneficiaries could lose that business, he said. A final appropriations bill approved Friday also moves the Sunshine State to a single-source supplier for all Medicaid incontinence supplies. Schwinghammer called that move an “inappropriate, sweetheart deal” that amounts to lost incontinence supply business for HME providers in the state. According to Schwinghammer, the decision is the result of a major out-of-state company’s long-term efforts to corner the market by advocating a competitive bid system that only it can likely win. As one feature of a massive $60 billion appropriations bill, the new system would shave 20 percent off current incontinence supply costs. However, FAHCS officials point out that the state implemented a fee schedule that already assured a 20 percent cut. “This bill requires groups to use whatever company wins the bid and not to use any other,” said Schwinghammer. “It controls and creates a monopoly for the market and the new managed care systems that have yet to be fully crafted. It is detrimental and long-term.” The setback is part of a fight that goes back several years. Joan Cross, executive director of the Florida Association of Medical Equipment Services, believes the difference this time came down to clout and economics. “About five years ago we hired a high-priced lobbyist to get it stopped, but this year nobody could afford it,” said Cross. “The government wants to reduce costs, and the state is in trouble like everybody else. Now a provider from Michigan is likely going to get Florida’s money. They talk about saving jobs, then they do this kind of thing.” The owner of Miami-based Health Medical Equipment views the legislature’s vote as yet another salvo in the assault against small providers. “We are a small mom-and-pop store, but the government is looking at working with just one provider,” lamented Ivonne Gonzalez, owner, Health Medical Equipment. “Our revenues will go down and employees will lose their jobs. Every time they decide to go with one provider, just like the HMOs do, that could close us down.” With a dozen employees and 18 years as a home care provider, Gonzalez relies on all elements of her business to meet payroll. At this point, even a small hit causes pain. “It all adds to the pot to make our business work,” said Gonzalez. “If everyone keeps taking away from us, it hurts us but it also hurts patients. With the way things are changing in Florida—more cuts and more managed care—where are we going to go?” Mobility Stakeholders Cautious about PMD Face-to-Face Checklist ATLANTA—CMS came out with a face-to-face examination checklist for power mobility devices last week, but it might be a case of too little, too late, some HME providers believe. The one-page checklist for the exam, required before physicians prescribe a PMD, is included in a Special Edition MLN Matters article (SE1112). Power mobility providers must have proof of such an exam in their records in order to be reimbursed. CMS also issued a disclaimer with the checklist saying that it was a guide only and “does not replace the underlying medical records” or ensure Medicare payment for a PMD. “Considering that we have been dealing with the nightmare that is the face-to-face examination for several years, I’d say it was a little late,” commented Michele Gunn, CRTS, of Browning’s Health Care in Orlando, Fla. The face-to-face requirement has been a bone of contention for mobility providers, largely because guidance from CMS regarding the requirement has been murky at best. “The industry has been asking CMS to clarify the criteria since the original NCD and LCDs were published,” said Wayne Grau, vice president, contracting and business services, for The MED Group, Lubbock, Texas, referring to the coverage determinations that were issued in 2005. “The industry recognized even back then that the present guidelines are too ambiguous … “The coverage criteria is open for interpretation, and because CMS has not clarified it, there is a lot of confusion among providers as to what meets qualifications and what does not.” That has been borne out by sky-high high denial rates for PMDs. A Jurisdiction B medical review of K0823 claims in the first quarter this year turned up a 70 percent claim error rate. A recent Jurisdiction D prepay review of K0823 claims resulted in a 90 percent error rate, mostly because of lack of documentation, according to the DME MAC. Noridian said that of 648 claims it reviewed, 576 were denied. Some claims did not include face-to-face exams or were missing elements of the exam, the Jurisdiction D DME MAC said. That doesn’t surprise Grau. “When any product has a very high denial rate and there are no clear-cut guidelines, then CMS must take a look and clarify those guidelines to make sure beneficiaries are going to get the equipment they qualify for,” he said. In an effort to get the documentation they need regarding the face-to-face exam, "many suppliers have created forms which have not been approved by CMS which they send to physicians and ask them to complete," Noridian said. "Even if the physician completes this type of form and puts it in his/her chart, this supplier-generated form is not a substitute for the comprehensive medical record." Gunn said Browning’s, which has been just as confused by the guidance as other providers, has nevertheless shied away from such forms. “Browning’s is one of the companies that hears, ‘No one else makes me do that. I usually just fill out a form,’” she said. “We have a system to collect documentation that we do not stray from. “We also use the ADMC process for any of our chairs that qualify,” she added, referring to the Advance Determination of Medicare Coverage, a program that allows suppliers and beneficiaries to request prior approval of eligible items before delivery. “It is not a guarantee, but it does seem to help if you end up at an [administrative law judge] hearing. Our claims get paid because we take the time on the front end to get the correct documentation,” Gunn said. Mobility provider Doug Westerdahl agreed. "The PMD documentation requirements have always been hard to understand, and any communication from the DME MACs that will provide additional guidance and clarification will be helpful," said Westerdahl, president of Monroe Wheelchairs in Rochester, N.Y. "However,” he added, “the best checklist in the world can never replace a strong documentation review process by the supplier.” Westerdahl said the basic elements of the PMD coverage guidelines are understandable, but providers need to have knowledgeable staff reviewing the documentation at every step, ensuring that it shows the beneficiary meets the coverage guidelines, that physician chart notes are in hand and that they include the information critical for a paid claim. "I have believed for some time that physicians are the people who understand the PMD documentation requirements the least, and the DME MACs should always be looking for ways to further educate doctors," he said. While it appears the checklist is an attempt to do that and address the steep denial rates, Gunn is not sure whether it will be helpful or not. “It looks like the usual stuff we see from Medicare,” she said. “No one besides those of us who do this for a living will ever actually take the time to read it. The legitimate suppliers will have to break it down into the Reader’s Digest condensed version for our referrals, and unscrupulous suppliers will continue to complete the paperwork as they always have.” Download a PDF of the checklist in Special Edition MLN Matters article SE1112. PFQC Sends DVDs Featuring Patients to Washington ‘We need you to stop competitive bidding’ WATERLOO, Iowa—Teri Lynn Jorgensen of Cedar Falls, Iowa, has a special message about competitive bidding for Sen. Tom Harkin, D-Iowa: “The choice [of provider] needs to remain mine.” So does Angie Plager of Cambridge, Iowa. “We really need you now more than ever to stop this competitive bidding.” The two women are among people with disabilities featured in a new, personalized DVD from People for Quality Care, a grassroots advocacy group that educates people with disabilities, their families and Medicare beneficiaries about competitive bidding. Called “9 Powerful Minutes,” the DVD turns the camera on several Iowa wheelchair users and lets them tell their own stories of what their HME providers mean to them, the importance of free choice in selecting a provider and the need for quality products. PFQC hopes this is just one in a series of short videos on competitive bidding that will go directly to legislators on Capitol Hill—and also be viewed by Medicare beneficiaries and others on its YouTube channel or the PFQC website. PFQC’s Beth Cox, communications/marketing director, sees the videos as a new tool to help repeal competitive bidding. “We want to replicate this in other states, in areas where there is competitive bidding,” Cox said, noting that Iowa might not be in the current Round 1 but it will be in Round 2. “It is a big educational issue. People need to know that this is happening—and they don’t.” They also need to know something else, she said: “These providers are going out of their way to take care of people, and legislators and other folks need to understand that.” Cox said the simply made DVDs can be tailored to each legislator. “This one was specifically aimed at Sen. Harkin, and we talked about disabilities issues because he was one of the authors of the Americans with Disabilities Act,” she said. The DVD was hand-delivered to Harkin during the American Association for Homecare Legislative Conference in Washington earlier this year. One of its featured advocates was on hand for that. Jorgensen, a radio station program director who was born with spina bifida, was among those in the delegation who visited Iowa congressional offices during the March lobbying event. “We would hope that he would listen to his constituents—in this case, wheelchair users,” Cox said. “People have a relationship with their current providers, they trust those providers. They don’t want to lose that relationship.” Jason Cantonwine of Ames, Iowa, said without his provider he would likely be unable to work. “Without a local provider, I would be in a real bad way,” he said on the DVD, recalling a time when his tilt-recline power wheelchair got stuck in a recline position. It was after hours, but he called his local provider anyway. A company representative came out and soon got him rolling again. “I can call them on the spur of the moment, after hours, and they’re always there for me,” he said of the company that has provided for him for 14 years. HME users in every state have moving, sometimes dramatic, stories to tell, Cox said, and she hopes other stakeholders will get people in their own hometowns on camera to tell their stories, then send those DVDs to their federal legislators. “This video was done by amateurs, using a simple camera,” Cox said. “We’d like to encourage other providers, advocates and caregivers around the country to use it as a model and contact PFQC for assistance in organizing similar efforts in their areas.” Cox said PFQC can do everything from the filming to simply providing questions and/or getting the DVDs to Washington. “We are actually willing to come … and sit down and ask the people the questions and film them,” she said, adding that the videos need only be between three and five minutes. PFQC teams have completed a second video featuring patients and patient advocates in the Dallas area, and another is planned for Kansas City, Cox said. Could hearing personal stories from beneficiaries across the country be the key to getting competitive bidding repealed? Cox hopes that seeing the real-life stories will compel legislators to sign on to H.R. 1041. “I believe that bringing the patient together with [legislators] and having them tell their story can really make a difference,” she said. For more information about the program, go to www.peopleforqualitycare.org or contact Cox at 319/274-7913. CMS, DME MACs Busy with Messages, Reminders BALTIMORE—CMS’ DME MACs issued several notable messages over the past two weeks, including: • A policy revision allowing the use of ABNs on Group 2 POVs and Group 4 PWCs. According to an April 28 message from Cigna Government Services, the Jurisdiction C DME MAC (and followed by others), the power mobility devices local coverage determination and policy article are being revised to allow the use of Advanced Beneficiary Notices for Group 2 power operated vehicles (K0806-K0808) and Group 4 power wheelchairs (K0868-K0886) so that consumers can elect upgrades that best suit their needs. Recent revisions to the previous policy eliminating the least costly alternative had the unintended consequence of classifying these items as “non-covered” by Medicare, the MACs said, making them ineligible for the ABN upgrade process. The change will be effective for dates of service on or after June 1, 2011. The revised LCD and policy article will be published in the near future, the message said. Read the notice in full on the Jurisdiction C website. • A reminder on what CMS calls “home.” An April 22 message from National Government Services said the Jurisdiction B DME MAC had received a number of questions about place of service for DMEPOS. According to the NGS reminder: “Medicare payment is available for rental or purchase of durable medical equipment used in a beneficiary's home. A beneficiary's home may be his/her own dwelling, an apartment, a relative's home, a home for the aged, or other type of institution. However, an institution may not be considered a beneficiary's home if it is a hospital or a skilled nursing facility. “If an individual is a patient in an institution or a distinct part of an institution that meets the definition of a hospital or skilled nursing facility, the individual is not entitled to have separate Part B payment made for rental or purchase of durable medical equipment. This concept applies even if the patient resides in a bed or portion of the institution not certified for Medicare.” NGS said coverage for any DMEPOS item will be considered if the place of service is: 01 – Pharmacy 04 – Homeless Shelter 09 – Prison/Correctional Facility 12 – Home 13 – Assisted Living Facility 14 – Group Home 33 – Custodial Care Facility 54 – Intermediate Care Facility/Mentally Retarded 55 – Residential Substance Abuse Treatment Facility 56 – Psychiatric Residential Treatment Center 65 – End Stage Renal Disease (ESRD) Treatment Facility (valid POS for Parenteral Nutritional Therapy) For a complete list of place of service codes, see www.cms.gov/PlaceofServiceCodes. • In addition to the DME MAC messages, check these new articles from the Medicare Learning Network. MLN Matters article MM7213 discusses new “reasonable useful lifetime” policies for instances where the beneficiary has both portable and stationary oxygen equipment and the RUL for one piece of equipment expires before the RUL for the other piece of equipment has been reached. The new policies related to CR 7213, released April 8, apply to oxygen and oxygen equipment furnished to Medicare beneficiaries in general and are not restricted to that furnished to beneficiaries in competitive bidding areas, the article notes. The effective date is May 8, 2011. Read MM7213 in full at www.cms.gov/MLNMattersArticles/downloads/MM7213.pdf. A new fact sheet titled “Signature Requirements” includes information on the CERT contractor’s signature requirements: It has to be legible, the fact sheet says. Download a PDF from the Medicare Learning Network at www.CMS.gov/MLNProducts/downloads/Signature_Requirements_Fact_Sheet_ICN905364.pdf. There Is No Breathing Easy with Competitive Bidding MIAMI—Even as CMS maintains it hasn’t received many complaints about competitive bidding—43 out of 54,000 calls, agency officials said at last month’s Program Advisory and Oversight Committee meeting—problems continue to surface. Reported by the Accredited Medical Equipment Providers of America, here’s one from a North Miami, Fla., woman who just wanted to breathe. Under the program, Wanda Revercomb had such problems getting oxygen service that she took her story to Sen. Bill Nelson, D-Fla., a member of the Senate Finance Committee. Revercomb, an oxygen patient from North Miami, told a Nelson aide April 26 that two months ago, she was feeling short of breath and noticed her oxygen concentrator was low on oxygen. She called her provider. “They used to come around every few months to change the filters and check my machine and they were past due for service,” AMEPA reported Revercomb as saying. “I called the phone number on the top of the machine for days, but no one answered,” Revercomb continued. “There was not even a recording to leave a message. My home health nurse called Medicare and they explained that my oxygen supplier closed their account and that I had to find a new supplier, one that won a bid in their new competitive bidding program.” From Medicare, she got a list of contracted suppliers, but each one refused her because of her location and the fact that she had already been on oxygen for two years, she told Nelson’s staff. Under Medicare’s 36-month oxygen rental cap, a new supplier would be paid for only 12 months but would be required to service Revercomb for the two years after that. She finally found City Medical Services of North Miami Beach, a contracted supplier. But the company was prevented from providing immediate service because Revercomb was “now caught up in the system’s red tape,” AMEPA reported. She needed a new examination from a pulmonologist to prove her oxygen use was medically necessary, and she had to have new diagnostic tests to support the physician’s order for oxygen. It took her nearly a month to satisfy the Medicare requirements. She told Nelson’s staff she was “so short of breath she nearly went to the hospital, but she was concerned about calling for an ambulance” and its expense. She also did not want to worry her son. ”I thought it would be such a waste of time and money to go to the hospital for my oxygen needs,” AMEPA quoted her as saying. City Medical serviced Revercomb through Saturday. Then that company also closed its doors, a victim, said owner Rob Brant, of competitive bidding. Where Revercomb will go next is uncertain. Revercomb’s story illustrates the complaints that numerous industry organizations, including the American Association for Homecare, say they are hearing about competitive bidding. AAHomecare officials reported in March that the association had received hundreds of complaints since the program’s implementation in January. Those complaints include: difficulty finding a local equipment or service provider; delays in obtaining medically required equipment and services; longer than necessary hospital stays due to trouble discharging patients to home-based care; fewer choices for patients when selecting equipment or providers; reduced quality; and confusing or incorrect information provided by Medicare. In Brief HHS Offers Support for Storm-Ravaged States; More News in Brief WASHINGTON—In a May 6 letter to Alabama, Kentucky, Mississippi and Tennessee, four of the states hit by a string of deadly tornadoes and other storms in late April, HHS Secretary Kathleen Sebelius offered options to speed Medicaid eligibility for those who may desperately need health services but have no means to pay for it. The letter outlines ways states can immediately expand access to health care by providing temporary increases in Medicaid income eligibility limits and removing resource tests. States can also allow residents who may have lost documents in the storms to certify their income and residency, and can delay the process of redetermining whether an individual remains eligible for Medicaid. Sebelius urged states to consult with CMS and its regional offices to determine how best to meet their needs within available legal authority. Read the letter at www.hhs.gov/news/press/2011pres/05/letter0506.html. NAS Begins Wheelchair Prepay Probes FARGO, N.D.—Noridian Administrative Services announced May 5 it would begin widespread prepay probe reviews of claims for HCPCS codes K0001 (standard wheelchair), K0003 (lightweight wheelchair) and K0004 (high strength lightweight wheelchair) based on the results of CERT analysis. All suppliers billing Jurisdiction D for the HCPCS codes are subject to the review, the DME MAC said. Suppliers of the selected claims will receive an Additional Documentation Request (ADR) letter asking for specific information. Failure to supply the information within 30 days of the date on the letter will result in the claim being denied as not medically necessary, Noridian said. See the notice in full. RACs’ Collections Mount BALTIMORE—Medicare’s RAC auditors have collected $313 million in overpayments from October 2009 (when the program was expanded nationally) through March 2011, according to a CMS report. More than half of that total, or $162 million, was collected in the first three months of this year, the report said. In Regions C and D, the top overpayment issue was separate billing for bundled services for DMEPOS provided during an inpatient stay, CMS said. The report is available at www.cms.gov/RAC/Downloads/FFSNewsletter.pdf. Spett Promoted to CEO at Graham-Field ATLANTA—GF Health Products announced May 2 that Ken Spett has been promoted to president and CEO. Spett’s background in the health care industry includes a variety of senior executive, sales and marketing positions spanning more than 30 years. He began his career with Graham-Field in 1983 as vice president of operations for Labtron Scientific Corp., and served most recently as president and COO. Beatrice Scherer, the manufacturer’s former CEO, will continue as a member of its board of directors. Alpine Receives ‘Best of State’ Award SALT LAKE CITY—Alpine Home Medical Equipment announced last week it has received Utah’s ‘Best of State’ award for the third year in a row. The company was honored for its achievements in merchandising and consumer services in the medical equipment/supplies category, judged by the awards committee on points including its mission, financials, customer satisfaction and more. According to Alpine President Jay Broadbent, the award “is something to be proud of.” The Best of State Awards were created in 2003 to recognize outstanding individuals, organizations and businesses in Utah. Read more about Alpine in Survivability, the New Watchword, in the April 2011 issue of HomeCare. Stand Up for Homecare Oct. 25 ATLANTA—AAHomecare has set the date for its Fall 2011 Stand Up for Homecare reception from 5:30 to 7 p.m. on Oct. 25 at Medtrade. The fundraiser will support the association’s ongoing public awareness campaign for home care. For more about the campaign, see www.aahomecare.org. To revisit this news anytime during the week, check www.HomeCareMag.com. We welcome your comments. Drop a line to HomeCare Editor-in-Chief Gail Walker at gwalker@homecaremag.com. ADVERTISEMENT |
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