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|April 25, 2011||Volume 17, Number 16|
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Table of Contents
- Round 2 Could Include More Products—Lots More
- Audit Situation: 'Worst I Have Ever Seen'
- MED’s Pederson: O&P Might Be Just What the Doctor Ordered
- Time Running Out for CEDI Transition
- And the Medtrade Spring Winners Are ...
- Lincare Reports Q1 Results
- Reliable Respiratory Launches 'Hot' Campaign
- MAMES Elects New Officers; Invacare Recruits for Compliance Chief; CU Hires Sales Manager
- VGM Offers Audit Assistance; MK Battery Gives Industry Another Boost; More News in Brief
For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com.
- Headline News
Round 2 Could Include More Products—Lots More
ATLANTA—While Round 2 of competitive bidding will expand the program to 91 additional cities, that’s not all that could expand. The national bidding program might also include a much wider selection of products, according to a joint message from the American Association for Homecare, the National Association of Independent Medical Equipment Suppliers and VGM.
Round 1 of the program hit nine product categories, with Group 2 support surfaces bid in the Miami competitive bidding area only. According to the three industry organizations, that list could grow to as many as 20 categories shared by CMS officials at an April 5 meeting of the Program Advisory and Oversight Committee.
Here is the list of products under consideration for inclusion in Round 2:
1. Oxygen Supplies/Equipment
2. Diabetic Supplies & Equipment (National mail-order program)
3. Standard Power Mobility Devices
4. CPAP/Respiratory Assist Devices
5. Enteral Nutrition
6. Infusion Pumps & Related Drugs
7. Manual Wheelchairs
8. Hospital Beds/Accessories
9. Off-The-Shelf Orthotics
10. Negative Pressure Wound Therapy (NPWT) Devices
12. Group 2 Support Surfaces
15. TENS Devices
16. Commode Chairs
17. Patient Lifts/Seat Lifts
18. Blood Glucose Monitors
19. Group 1 Support Surfaces
20. Lymphedema Pumps
That’s all the more reason providers should get in gear to get competitive bidding stopped, industry advocates said last week, urging support for H.R. 1041 to repeal the program entirely. Introduced in March, the bill has picked up more than 80 cosponsors in the House but needs a companion bill in the Senate.
While Congress is in recess and legislators are in their home districts, said VGM’s John Gallagher, vice president of government relations, “You need to go across the street and grab your competitor and go to a town hall meeting and make an impact. Numbers are what matter. It can’t be just one individual out there crying in the woods.”
Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products, echoed the action call. “The industry needs to meet with legislators to educate them on the problems with Round 1 competitive bidding in order to build enough support to stop it prior to any further expansion of this fundamentally flawed program,” he said.
Based on a new timeline for Round 2, CMS will announce the final product categories this summer, although agency officials have called that timeline “tentative.”
Under the new schedule, which delays Round 2 by about six months, bidder registration will begin this fall with bidding to open at some point between December of 2011 and February of 2012. Single payment amounts would be announced in the fall of 2012 with contract suppliers revealed in the spring of 2013, and implementation in the 91 additional CBAs would follow in the summer of 2013.
What the delay does, Gallagher said, “is give us this year to kill this.
“I think now is a key time. I have attended two town hall meetings this week and will attend two next week,” he said Friday. “It’s a good time to talk about health care. People are upset,” he said, noting that the public approval rating for members of Congress hovers around an abysmal 7 percent.
“Truly, people out there are mad, and members of Congress are scrambling to find someone who is not wanting to take their heads off,” he said. So they may welcome someone talking about the competitive bidding debacle, how it is a job-killer and puts patients at risk and how the industry needs their help, he said.
“It’s critical we are out there with [legislators] when they are home,” he said. “We need to be the sane people in the room, saying, ‘I want to talk to you about jobs, I want to talk to you about health care and what the government is trying to do.’”
Last week, Gallagher recorded a video update discussing the competitive bidding program, H.R. 1041 and the need to take action now.
Watch the first part of the video.
Watch the second part of the video.
“What we are trying to do is create momentum to get that Senate companion bill and get that language into a decent piece of legislation and get it to fly,” Gallagher said.
That means talking to both senators and representatives, Johnson emphasized.
“There have been some good meetings with Senate offices in recent weeks, and efforts are underway to get a Senate companion bill introduced this spring,” he said. “There is no specific timeline set for H.R. 1041 to be passed, but I think most would agree that in order to stop the advancement of the process for Round 2, H.R. 1041 needs to pass this year. That should be our goal.”
“We must pull out all the stops to press for repeal of the flawed bidding program,” NAIMES’ President and CEO Wayne Stanfield told members in the group’s newsletter last week. “We cannot stop the bidding nightmare without every supplier getting involved.
“Call the local district office of your representative and senators and schedule a meeting during this recess when they are home. Attend every town hall meeting or other public event possible … The current bidding program is fatally flawed and will fail. It’s time to stop it and preserve the industry while looking for alternative solutions to reducing Medicare costs.”
Have you had to add staff to comply with the growing number of audits? To vote in HomeCare's monthly Web poll, visit www.HomeCareMag.com.
Audit Situation: 'Worst I Have Ever Seen'
ARLINGTON, Va.—AAHomecare’s Regulatory Council has its hands full this year. With ZPIC, RAC, CERT and medical review audits in play, oversight has never been so intense.
“It is the worst I have ever seen,” said Kim Brummett, Regulatory Council chair. “We have auditing bodies tripping over each other.”
The council met March 31 to focus specifically on audit activity and has identified inconsistencies in documentation requested by various Medicare audit contractors, Brummett said. Council members are currently developing recommendations on exactly what documentation should be requested by auditors for several product categories, including oxygen, CPAP, diabetic supplies, enteral nutrition, nebulizers and power mobility devices.
The goal is to ensure that all audit contractors request consistent documentation that is appropriate and specified under each Medicare coverage policy, said Brummett, vice president, contracting and reimbursement, for Advanced Home Care, High Point, N.C.
With no relief yet, Brummett said, the association is continuing education efforts with members of Congress, staff at CMS and the Office of Inspector General about the problems stemming from “unclear, inappropriate and overly complex” regulatory requirements.
“Instead of just fixing what we have, they just keep piling it on,” said Brummett, a 24-year veteran of the HME billing world. She noted proliferating medical reviews from the DME MACs and audits from CMS’ Program Safeguard Contractors/Zone Program Integrity Contractors, CERT (Comprehensive Error Rate Testing), RACs (Recovery Audit Contractors) and others. Where the ZPICs are concerned, she said, these contractors have the authority to look across a wide spectrum of services, and in many cases they are looking for indictments.
In some cases, providers may be subjected to pre-pay audits that can equal a near-death sentence, Brummett said.
“If an error rate is over a certain percentage, the carriers are going to do 100 percent pre-pay audit,” she said. “When providers get into 100 percent pre-pay audits, they can’t survive. Even the ZPICs are doing some 100 percent pre-pay audits, and in the next six months we will start to see people who are just closing their doors.” Brummett added that was already happening in some areas, including her own backyard in Charlotte, N.C.
Meanwhile, Brummett said the association council is also monitoring implementation of new anti-fraud provisions enacted under health care reform. These include additional provider screening measures such as application fees, licensure checks, site visits, fingerprinting and criminal background checks, as well as mandatory face-to-face exam requirements for DME.
There’s no shortage of additional topics on the watch list either, she said, including modifications to the DMEPOS supplier standards, changes to coverage policies based on elimination of the use of least costly alternative, oxygen and CPAP policy and, of course, competitive bidding.
MED’s Pederson: O&P Might Be Just What the Doctor Ordered
LUBBOCK, Texas—If you think the home medical equipment sector is going nowhere these days, The MED Group has a word for you, or three: orthotics and prosthetics.
The member services group has created a new program designed to help HME providers establish a viable O&P operation.
Tim Pederson, who is leading development of the program, introduced the National Orthotics and Prosthetics Network during the company’s business meeting at Medtrade Spring earlier this month. Pederson, formerly CEO and president of WestMed Rehab in Rapid City, S.D., and past chair of the American Association for Homecare’s Complex Rehab Mobility Council, believes that by adding O&P to their product mix, providers can reinvigorate their futures. With only about 1,800 existing O&P providers, according to the group, there’s plenty of room to maneuver.
“Just because things are down in parts of our industry does not mean there are not opportunities,” Pederson said. “There are opportunities to get back in the game and be a force in our industry and be successful. This is one thing you can do to make sure you’re successful.”
That’s especially true for providers who are already offering complex rehab, which has plenty of commonalities with O&P, Pederson said. Even as the sector works toward a separate Medicare benefit—which already exists for O&P—there has been much consolidation in the rehab segment, Pederson said.
However, “you won’t find companies with O&P and complex rehab trying to consolidate,” he said. Why? Because the more stable O&P is saving the day for those providers.
Pederson believes he can help HME companies, even those without a complex rehab foundation, navigate the ins-and-outs of getting into O&P.
“I made a lot mistakes along the way myself in my own business,” he said, adding that network providers “can all have the benefit of my mistakes. I have graduated from the school of hard knocks with honors. My goal is to make sure nobody else has to go through that program.”
Here are more of Pederson’s insights into the new program:
HomeCare: As providers consider diversification, why should they look into O&P? What about this line makes it particularly viable?
Pederson: If you are interested in maintaining your independence, [this is the way to go]. The margins are higher, payment and funding cycles are shorter and the regulation is really not that different [from complex rehab]. It provides the stability and profitability that you’re looking for. Revenue diversification is a key component to future prosperity in our business, so why not diversify in the right way and maintain your profit and your revenue stream?
HomeCare: What are the pros and cons of the sector?
Pederson: The pros are that it’s already defined as a separate benefit in the DMEPOS category, it has very well defined coding and reimbursement and it is similar to the complex rehab model, so it can be familiar.
There are indicators that some of the off-the-shelf orthotics may be included in competitive bidding, but it’s really a small part of O&P. They won’t bid that for the same reason they don’t bid Group 3 power wheelchairs.
[Also], they actually give medical weight to the notes from the medical practitioner. In O&P, they are considered part of the medical notes. In many cases the O&P practitioner will have hospital privileges.
I think the cons would be expecting too much too soon. You want to build it logically and not expect the moon when you first start. You need to pay very close attention to charting and medical documentation; it is also subject to the crazy audits we are having in the rest of the industry.
HomeCare: What does it take to get into this sector in terms of financial outlay, inventory, staffing, credentials, etc.?
Pederson: Just like complex rehab, you need adequate facilities, but they are very similar to what you already have. In the facility, you are going to need evaluation and fitting rooms. One is going to have to be outfitted with parallel bars for gait training. You need space to fit somebody with a prosthetic and show them how to use it.
You are going to need a fabrication lab and some special fabrication equipment. If you don’t have sufficient space, you may need to look at adding more space or reallocating space. You’re going to have to have an oven to heat plastic, an area for cutting and grinding. Other than that, it is identical to custom rehab with your patient lounge, your showroom, etc.
The ability to cross-train your personnel is also important. A good complex rehab technician is probably going to become a good O&P technician. There is credentialing available. It is not required, but it is a certainly a nice career path. There are certified fitters.
There are two credentialing bodies for professional staff: the American Orthotics and Prosthetics Association and the American Board for Certification in Orthotics and Prosthetics. You have your certified prosthetist, certified orthotist or joint certified orthotist/prosthetist. This is not something you can just pick up and take an exam; it is very much like a physician model for their schooling. They are compensated very similarly to your better ATPs.
There is some outlay for inventory, but not as much as you think. It’s very much like complex rehab—it is a referral business. You meet with the team, outline a solution, figure out funding, then figure out the components of what you need to do for that patient. The outlay for inventory is as the orders come in. You will need to carry some bracing and some components for service and repair, but it’s not a huge outlay.
You have to be diligent in wanting to be in this business. It is probably going to be a rough couple of first years if you’re starting from scratch, but once you are past that and you are effective in your marketing, you’ll be successful.
HomeCare: How long would it take for a provider to get an O&P section up and running?
Pederson: You can have it up and running in a short time. It depends on how hard you work on it. You have to be prepared to have a good marketing plan and get into those referral sources, which are all the same if you have complex rehab. If you work at it as you should, you should see a return in less than the two years I mentioned.
HomeCare: Any caveats?
Pederson: You can’t run it as a sideline. It’s got to be a focused part of your business. You don’t want your O&P division to feel like the stepchild, because then it won’t thrive. Much like complex rehab, it’s not product-driven, it is referral-driven.
Time Running Out for CEDI Transition
ATLANTA—In only a few more days, direct dial-up options to the Common Electronic Data Interchange will no longer be available. As of May 1, all providers will be required to use an approved network service vendor for access to the CEDI gateway.
Security concerns are driving the switch, according to CEDI contractor National Government Services, which announced its decision in September. Fortunately, there is still time for procrastinating providers to make the transition.
“The only thing changing is the way providers connect to the gateway,” explained Tara Mondock, group vice president of healthcare for Ivans, Stamford, Conn., one of the CEDI’s approved NSVs. “Providers do not have to change submitter IDs or anything like that. It is swapping out how they connect to the gateway.”
NSVs provide a variety of connectivity options, according to NGS, and also offer faster and more reliable connections than direct dial-up. The migration will also align CEDI trading partners with CMS direction for connectivity to the DME MACs for online claim status inquiry.
While nobody relishes a government mandate, Mondock contends that eliminating slower legacy technology will likely add up to a net benefit for most providers. A more robust and reliable connection for submitting claims can only increase efficiency.
Since many providers tend to work with multiple vendors, one connection to administer work flow, control the revenue cycle and check claims status adds up to better business. “This gives them the ability to layer on additional automation and integrate that electronic work flow all across one connection,” Mondock said.
Since January, officials at Ivans have seen hundreds of suppliers turn to web-based and broadband technology to migrate off the CEDI’s dial-up service. Providers are using the opportunity to verify patient eligibility online; access the CSI system to view the status of a claim, more quickly retrieve front-end edit reports and submit claims and retrieve electronic remittance advices electronically.
NGS said that enrollment forms do not need to be completed to make the NSV transition. Once setup is completed, file transmission can begin right away. For providers who haven’t switched, however, this week’s priority is to decide on an NSV, set up a relationship and quickly establish connectivity to avoid a disruption in service. NGS noted in a recent message that some providers who have not switched might already be getting a busy signal with their dial-up service.
NGS’ approved NSVs are listed below, and additional contact information can be found on the CEDI website at www.NGSCEDI.com under “Telecommunications.”
• Ability (VisionShare): www.abilitynetwork.com
• ClaimShuttle: www.claimshuttle.com
• Cortex EDI: www.cortexedi.com
• ECC Technologies: www.ecctec.com
• Ivans: www.ivans.com
• McKesson CareBridge: www.carebridge.net
• MedXpress: www.icssoftware.net/medxpress
• Nebo Systems: www.nebo.com
The National Government Services CEDI Help Desk can be reached via email at email@example.com or phone at 866/311-9184.
And the Medtrade Spring Winners Are ...
LAS VEGAS—This year’s new product winners at Medtrade Spring, held April 12-14 at the Sands Expo and Convention Center, utilize technology and design to promote quality of life and business opportunities.
Top honors in the New Product Pavilion awards, based on attendee votes, went to:
• The VPOD Freedom wireless oximetry device from VirtuOx, Coral Springs, Fla., which captured the Innovation Award as the new product that best exemplifies top design/high tech/state of the art;
• Sneaker Walker Glides that look like shoes from Drive Medical, Port Washington, N.Y., which took the Merit Award for the new product that best exemplifies improvements in quality of life; and
• Sami the Seal, a kid-friendly nebulizer from Philips Respironics, Murrysville, Pa., which went home with the Providers Choice Award as the new product that best exemplifies optimal use of technology.
Medtrade Group Show Director Kevin Gaffney offered congratulations to the award recipients “for their continual push for new products and enhanced technology. It is an honor to recognize their contribution to patient care and provider options,” he said in a release.
The show’s Best Booth Award was presented to ResMed, San Diego, for its streamlined style and attractive use of color and design.
Mark your calendar: Medtrade 2011 will take place at the Georgia World Congress Center in Atlanta Oct. 24-27, and Medtrade Spring 2012 is set April 10-12 at the Sands Expo and Convention Center in Las Vegas. For more information, go to www.medtrade.com. We’ll see you there!
HME Company Newswire
Lincare Reports Q1 Results
CLEARWATER, Fla.—Lincare reported first-quarter results April 18 showing net revenues of $431.6 million, a 5.2 percent increase over $410 million in the first quarter of 2010. The increase included approximately 9.3 percent internal and acquisition growth offset by a 4.1 percent negative impact from $16.7 million of Medicare payment changes, the company said in a release.
Net income for the quarter ended March 31 was $46.4 million, a 6.3 percent increase over $43.6 million for the same period in 2010.
“As the year progresses, we look forward to building on our market share gains and driving earnings growth through organic expansion, selective acquisitions and other strategic opportunities," said Lincare CEO John P. Byrnes.
Lincare generated $81.3 million of cash from operating activities during the first quarter of 2011 and invested $24 million in net capital expenditures and $20.6 million in business acquisitions, the company said. As of March 31, total long-term obligations, including current installments, were $509.2 million, and cash and investments were $173.6 million. In February, the company acquired a specialty pharmacy business with $82 million in annual revenue.
While an analyst from Jeffries called the earnings results “lackluster,” another from Oppenheimer said Lincare would be a “long-term winner in the oxygen space,” according to an April 19 Associated Press report. Oppenheimer’s Michael Wiederhorn added that with rates likely to remain pressured, the move to diversify “could set the company up for its next leg of growth.”
Reliable Respiratory Launches 'Hot' Campaign
NORWOOD, Mass.—In an effort to emphasize the company’s focus on patient compliance and health care cost containment, Reliable Respiratory has launched a marketing campaign that incorporates bottles of Tabasco sauce.
Cards being distributed to referral sources by the eight-year-old company’s account reps read, “We’re HOT on Compliance & Cost Containment.”
Bob Chase, RRT, Reliable’s clinical manager, said it’s important for individuals with sleep disordered breathing who have been prescribed CPAP devices to use them regularly each night. “When patients are compliant, they feel better, have a more positive attitude, are less prone to accidents and various medical conditions.”
He also pointed out that “the better the compliance, the better the chance of reducing health care costs because deeper sleep reduces risks for high blood pressure, heart disease, heart attack, stroke, anxiety, memory issues and more.”
With over 40 years in the airway management field, Chase has worked with thousands of patients, including the late actor and disability activist Christopher Reeve and U.S. House Speaker Thomas P. 'Tip' O’Neill. Chase wants to spread the compliance message however he can.
In January, the company began a year-long CPAP Road Tour to take its respiratory therapy experts into the New England communities it serves. The series includes free bi-weekly programs across Massachusetts and Rhode Island for people who have been diagnosed with or may have sleep-disordered breathing. Attendees can try out new CPAP masks, check their CPAP pressure, see the latest equipment and learn sleep tips.
One of the first tour events was highlighted in The Boston Globe. “My goal is to improve the quality of life for my patients," Chase told the newspaper. "The more challenging the cases, the more interesting."
Ten tour events have already been held and more are planned, said Stan Hurwitz, a company spokesperson. Tour sponsors include ResMed, Philips Respironics and Fisher & Paykel.
MAMES Elects New Officers; Invacare Recruits for Compliance Chief; CU Hires Sales Manager
STILLWATER, Minn.—At its annual Spring Convention last month, the seven-state Midwest Association for Medical Equipment Services elected its new executive committee, including: President Julie Weidemann, Palmer Home Medical Supply Services, Iowa, who takes over from Past President Tim Pederson, formerly of WestMed Rehab, South Dakota; Vice President Gerald Sloan, Progressive Medical Equipment, Kansas; Treasurer Jackie Semrad, Reliable Medical Supply, Minnesota; and Secretary Jerry Culver, Central Nebraska Home Care, Nebraska.
New and returning members to the 2011 MAMES Board of Directors include: Iowa, Terry Flatt, Hammer Medical Supply, and Connie Lind- Fraher, A-1 Home Healthcare; Kansas, Mike Conlin, Jayhawk Pharmacy and Patient Supply; Minnesota, Lisa Ziehl, Rice Home Medical, and Al Neumann, Corner Medical; Missouri, Patrick Naeger, Healthcare Equipment & Supply Co., Karen Atkins, Mobility First, and Melissa Fisher, Progressive Medical Equipment; Nebraska, Frannie Greene, Total Respiratory & Rehab, and Cheryl Sander, Tooley Drug and Homecare; North Dakota, Greg Lord, Great Plains Rehabilitation Services, and Barb Stockert, Healthcare Accessories.
Invacare Recruits for Compliance Chief
ELYRIA, Ohio—Invacare announced Friday that Doug Newlin, senior vice president of global engineering, will assume leadership of the company’s regulatory team in place of Colleen Craven, chief compliance officer, who has resigned for personal reasons. Newlin has experience working with the Food & Drug Administration from his time at Fenwal, a medical device company and former division of Baxter International. “We are fortunate that Doug’s experience allows him to step into this role, while we are actively recruiting for Colleen’s replacement. Invacare has many important initiatives underway to enhance its corporate compliance procedures, and we will continue to add resources and expertise to our regulatory affairs and compliance functions,” said Gerald B. Blouch, president and CEO, in a release.
CU Hires New Sales Manager
BILLINGS, Mont.—Computers Unlimited has hired Joe Silverthorne to manage and oversee all sales activities for the company. Silverthorne brings seven-plus years’ experience in selling enterprise-wide application software and computer systems.
Knight Joins MRC as State Program and Policy Coordinator
NEW YORK—Krystal Knight, MPH, will join the Medicare Rights Center’s Washington, D.C., office to serve in the newly created position of State Program and Policy Coordinator. Knight will oversee a new project funded by Atlantic Philanthropies to expand the Center’s community-based education and policy programs in five states—Alabama, Florida, Kansas, Maine and Wisconsin.
Hoey Appointed CEO of NCPA
ALEXANDRIA, Va.—The National Community Pharmacists Association has appointed Douglas Hoey, RPh, MBA, as executive vice president and CEO following the resignation of Kathleen Jaeger. A registered pharmacist, Hoey is the son of an independent pharmacist in Bartlesville, Okla., and previously was the association’s senior vice president and COO, a position he assumed in 2005. Prior to joining NCPA’s staff, Hoey spent 14 years working in community pharmacies that provided home infusion, long-term care consulting, compounding and full-line DME. “Local pharmacists still face many pressing challenges in both the government and business sectors. These issues wait for no one—not any of us. So I look forward to getting started right away,” Hoey said in a release. “My litmus test for NCPA’s initiatives and programs will be simple: How do they advance the ability of community pharmacists to care for their patients?”
NACDS Beefs Up Government Affairs Team
ALEXANDRIA, Va.—The National Association of Chain Drug Stores has added Julie Philp as director of federal government affairs, and Joel Kurzman as director of state government affairs. Both will play a role in maintaining the viability of pharmacy access and services to improve patient health and reduce health care costs, according to the association.
VGM Offers Audit Assistance; MK Battery Gives Industry Another Boost; More News in Brief
WATERLOO, Iowa—VGM Group has compiled a team of professional audit consultants and developed a new website that offers help with audits at www.vgmaudithelp.com. Features include a blog detailing the latest audit news and “road maps” to guide providers through various audit processes. VGM audit specialists Mark Higley and Peggy Walker, in conjunction with audit experts James Herren, who was provider relations senior analyst at Cigna Government Services; Wayne H. van Halem, a former Medicare fraud investigator; and attorney Edward Vishnevetsky of Munsch Hardt Health Care group, will provide support to help providers keep their businesses up and running, the company said. “While it’s most obvious HMEs would prefer to avoid audits, it remains quite likely that many companies will be audited,” said VGM’s Walker.
MK Battery Gives Industry Another Boost
ANAHEIM, Calif.—After donating more than $73,000 to industry advocacy efforts last year—$24,356 each, to be specific, to NCART, NRRTS and AAHomecare—MK Battery is working on a “Power for Funding” event that will take place at Medtrade 2011 in Atlanta. Celebrating its 26th consecutive year as a Medtrade exhibitor, the company said it would use the milestone to unite the industry “for an evening of solidarity as providers and exhibitors gather together to reminisce about the past 25 years while raising funds to help weather the next quarter century.” MK Battery will underwrite the event with a contribution of $50,000. The fundraiser will be held Oct. 25 at the Omni Hotel, and tickets will be available to all providers. Medtrade and MK are looking to raise additional monies through sponsorships, with the net proceeds once again to be presented to NCART, NRRTS and AAHomecare at the evening gala.
NGS Continues K0823 Prepay Review
INDIANAPOLIS—In a Thursday update, National Government Services, the Jurisdiction B DME MAC, said it is continuing a widespread prepayment medical review for K0823 power chairs. During the first quarter of 2011, NGS’ medical review department examined 63 claims that had been developed for additional documentation. Of these, 44 were denied—a 70 percent claim error rate. According to the update, the top issues causing the denials were not responding to the ADR letter within the required 30-day timeframe, and “no medical records submitted, or the medical records submitted did not establish medical necessity.”
Earlier this month, the DME MAC said it would begin a widespread prepayment medical review of random claims for CPAP devices (E0601KJ). Suppliers of the selected claims will be sent a documentation request letter must return the requested documentation within 30 days from the date of the letter or the claim will be denied as not medically necessary.
Bill Would Reveal More about Medicare Payments
WASHINGTON—Sen. Dick Durbin, D-Ill., introduced legislation April 14 that would make summary-level Medicare data publicly available to allow better oversight of the program. Even though the government has stepped up fraud detection and enforcement, Durbin said, catching false or inflated claims is a challenge since Medicare pays 4.5 million claims per work day. His Medicare Spending Transparency Act would require CMS to publish information annually about how and what Medicare is paying to individual providers, including amount paid, number of unique patients seen, total number of patient visits and a summary of the services provided. The bill would also lift the restriction on releasing a fraudulent provider’s name. All patient identifying information would be protected.
Series of Facts Sheets from MLN
BALTIMORE—The Medicare Learning Network has issued a series of new fact sheets for DMEPOS providers, all available for download:
• “DMEPOS Quality Standards” Fact Sheet
• “The Basics of DMEPOS Accreditation” Fact Sheet
• “DMEPOS New Information for Pharmacies” Booklet
• “Signature Requirements” Fact Sheet
Jurisdiction A Has Openings on POE Advisory Group
HINGHAM, Mass.—The Jurisdiction A Outreach & Education Team currently has membership openings for the 2011 POE Advisory Group, which provides input on provider/supplier education topics, materials and workshops. The group meets quarterly, with the next meeting scheduled May 11 in Philadelphia. For more information on the POE Advisory Group, go to www.medicarenhic.com/dme/dme_POEAG.shtml. If you wish to become a member, contact the O&E Team at 781/741-3950 or firstname.lastname@example.org.
UroMed Named One of Atlanta’s Top Workplaces
SUWANNEE, Ga.—UroMed has been ranked among the Top 100 companies in Metro Atlanta’s Top Workplaces, published by the Atlanta Journal-Constitution. The urological supply company, among the country’s largest providers of disposable catheters, placed fourth out of 50 entries in the small business category. The company was founded by 1992 Paralympics Gold Medal winner Bert Burns, who became a quadriplegic at the age of 20 after being hit by a drunk driver. Twenty percent of Uromed's associates either has a disability or has a family member with a disabling condition. See UroMed’s profile on the Top Workplaces list at ajc.topworkplaces.com/company_survey/uromed-inc_atlanta/atlanta_11.
NEMED Taps Comfort Company as Vendor of the Year
BOZEMAN, Mont.—Seating and positioning products manufacturer The Comfort Company has been named vendor of the year by the New England Medical Equipment Dealers association. The association presents the annual award to an associate member (individual or company) “who has promoted the industry throughout the year through grassroots lobbying, other public relations, and/or sponsored a NEMED educational/membership meeting or participated on a committee,” according to a release from the company. “We are very honored to be chosen for this award and we are very thankful to NEMED for the continued support they provide to both our company and our industry,” said East Coast Sales Manager Jamie Walsh.
SmartDiabetes Line Launches in Walgreens
TITUSVILLE, Fla.—Infopia America announced earlier this month that its new SmartDiabetes product line has launched in 284 Walgreens drug stores in central and northeast Florida, including locations in Jacksonville, Orlando, Lakeland, Daytona Beach and Melbourne. The stores will be the first in the national drug store chain to promote integrated and coordinated management of diabetes with the products among the patient, physician and pharmacist. The SmartDiabetes line features both a blood glucose monitor and blood pressure monitor that can transmit results to a HIPPA-compliant server for both provider and caregiver review.
UpLift Supports Arthritis Research
DARTMOUTH, Nova Scotia—Uplift Technologies announced last week that a portion of its May 2011 lift seat sales will be donated to support arthritis research. Recently, several Uplift products were awarded the “Ease-of-Use Commendation” after passing stringent tests developed by the Arthritis Foundation and conducted at the Georgia Tech Research Institute in Atlanta. “Our products lessen the impact arthritis can have on daily living,” Michele Fash, the company’s marketing manager, said in a release, “and research is critical to develop the tools that will help the millions affected by arthritis.”
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