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|June 6, 2011||Volume 17, Number 21|
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Table of Contents
- Cramton Floats 'Repeal and Replace' Option for Competitive Bidding
- H.R. 1041 Gains Ground, but There’s More Work to Do
- Looking for Those 'Aha' Moments at Heartland 2011
- Jeff Baird on Requesting an OIG Advisory Opinion: Eliminating Uncertainty
- Debt Ceiling Debate Puts HME in Perilous Spot
- News You Can Use: OIG Cautions against Online Referrals; Going the Retail HME Route
- Pride Adds Kids Up; Invacare’s Richey on 200,000th HomeFill; Shaq Attacks Sleep Apnea and 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
Cramton Floats 'Repeal and Replace' Option for Competitive Bidding
COLLEGE PARK, Md.—Peter Cramton, the University of Maryland economics professor at the vanguard in condemning CMS' competitive bidding design, is pursuing a new avenue to get the current program shelved, he told HomeCare last week.
As HME advocates push for legislators to sign on to H.R. 1041, the bill that would repeal the bidding system, Cramton is working on legislative language that would spell out how an efficient and effective DMEPOS bidding program would work.
It's the auction specialist's latest effort to get the CMS program shut down and redesigned. Last fall, he sent a letter to Congress signed by 166 fellow economists detailing the program's flaws; in April, he held a mock auction that drew both officials from CMS and stakeholders in the HME community.
On May 24, he appeared at two Capitol Hill briefings to educate House and Senate staffers on the problems with Round 1, which was implemented in January, and the "train wreck" that is coming.
"The bottom line, from my perspective, is that we have to have draft legislation for an efficient auction. The repeal by itself is an incomplete strategy," Cramton said. "That is what I am endorsing, and that is going to be what makes the legislative strategy coherent."
Introduced in March by Reps. Jason Altmire, D-Pa., and Glenn "GT" Thompson, R-Pa., H.R. 1041 had garnered 113 cosponsors as of Friday, about a dozen more since the congressional briefings. While the number of cosponsors on the House bill continues to rise, there has been concern in some industry quarters that a Senate companion bill might not happen.
Wayne Stanfield, president of the National Association of Independent Medical Equipment Suppliers, is not hopeful, he told members in the group's newsletter. "Suppliers should not hold out any hope that any repeal or delay will happen," he wrote in a commentary.
"Since 2003, this program has been coming and nothing the industry has done so far has done anything to stop it or change it, though we did pay dearly to delay it 18 months," he continued, referring to the 9.5 percent DME cut the industry took in 2009 to "pay for" the delay.
"Anyone who thinks that we can alter the course of this program had better step forward now and take the lead of the industry. Lord knows we need the help."
The biggest stumbling block to a Senate bill, some insiders say, is concern over its financial ramifications. The Congressional Budget Office has estimated competitive bidding could save Medicare $20 billion over 10 years; H.R. 1041's offset for its repeal calls for use of $20 billion in undesignated discretionary funds, meaning that the HME community has "no skin in the game," as one stakeholder said.
Even if the House passes H.R. 1041 because members recognize the program as devastating to both business and beneficiaries, "the Senate won't touch it because of budget concerns," Cramton predicted.
By pairing the repeal with a plan for a well-run auction—Cramton said it must be one piece of legislation—the resulting CBO score should ensure Senate buy in, he said.
"Repeal and replace: Instead of coming back with a bad score, it comes back with a good score," Cramton said. "That's the beauty of it. That's something they can adopt."
Cramton understands he might be rowing against the tide with his plan. Industry providers have been largely opposed to competitive bidding in any form.
"There certainly are some issues with their degree of comfort with auctions altogether," Cramton acknowledged, but he said a well-run auction pays off for everyone—providers, beneficiaries and CMS. "You eliminate the badly flawed auction, you save the home medical equipment industry, you save the Medicare beneficiaries and more important from the standpoint of the taxpayer, you save the budget," he said. "I think providers should get on board with it."
The auction legislation would also create some oversight of CMS. In the current design, the agency has worked with little if any transparency, Cramton said, allowing it to manipulate prices and refuse information to everyone from the PAOC to Congress. Under a correctly designed program, an independent market monitor would be privy to all information and would report directly to the Health and Human Services secretary rather than to CMS.
The agency would administer the program, "but their discretion would be eliminated," Cramton continued. "[The new program] would be transparent. They wouldn't have the ability to do whatever they want."
On the plus side for CMS, Cramton said, "Now they are forced to implement an efficient auction, which means that things work; they aren't addressing thousands of complaints, racing around putting out fires.
"When you really screw something up, it requires a lot of work and it is also not very pleasant," he added.
The economist said his recommendation is for the current program to be immediately halted, then "what I recommend is that we spend the rest of this year and all of next year working out the details with the industry and the beneficiaries, and perhaps CMS would be involved, too. Then the first auction begins Jan. 1, 2013, and that would be only part of the country—say, one-third.”
The program would be implemented in phases so that "by 2015, we would have the whole country involved," he said.
Cramton said he hopes to have the legislative language completed soon; the next action would be to find a sponsor. Whether the redesign specifications would simply be added to H.R. 1041 or a completely new bill crafted would have to be decided, he said.
The point is, said Cramton, CMS needs to "start all over again, but this time, do it right with clear direction from Congress."
See a PDF titled "Repeal and Reform Legislation for Medicare DME Auctions," including draft elements of Cramton's proposed legislative language, on his website at www.cramton.umd.edu/papers/health-care.
How would you fix Medicare? To vote in HomeCare's monthly Web poll, visit www.HomeCareMag.com.
H.R. 1041 Gains Ground, but There’s More Work to Do
WASHINGTON—Key industry stakeholders applauded the growing numbers of legislators signing on as cosponsors to H.R. 1041, but said last week there is much more work to be done if competitive bidding is to be repealed.
The bill to halt the bidding program has so far gained 113 cosponsors, with one of the latest signers Rep. Carolyn McCarthy, D-N.Y. That gives the state 10 of 29 representatives signed on, according to Michael Reinemer, vice president, communications and policy, for the American Association for Homecare.
Representatives in other large states are signing on in significant numbers, too: Pennsylvania, 12 out of 19; Ohio, 10 out of 18; and Florida, 11 of 25. In some states—Iowa, Maine, Vermont and West Virginia—all of the representatives have signed on.
“There are still some big holes,” Reinemer acknowledged. “About 17 states have zero cosponsors including California, which has 53 House seats. So there is plenty more work to do in the House—and in terms of getting a sponsor for a Senate companion bill.”
Two Pennsylvania legislators, Rep. Jason Altmire, a Democrat, and Rep. Glenn “GT” Thompson, a Republican, are responsible for H.R. 1041, and the Pennsylvania Association of Medical Suppliers is working diligently to get the rest of the state’s representatives on board, said John Shirvinsky, executive director of PAMS.
“Of the seven remaining, one includes the chairman of the Energy & Commerce Health Subcommittee,” Shirvinsky said. “While Chairman [Joe Pitts, R-Pa.], is unlikely to sign on to a measure that is within the purview of his subcommittee’s jurisdiction, he has been very sympathetic on this issue, and the eastern half of his district includes the Philadelphia MSA. We continue to work with the two sole holdouts in the Pittsburgh MSA and we are establishing ties with the remaining four non-sponsors, all of whom represent the Philadelphia area.”
Rob Brant, president of the Accredited Medical Equipment Providers of America, said he is urging more Florida legislators to sign on to the bill. “In the state of Florida, we have 10 new legislators, so we had to do a lot of work to educate them,” he said. “We hope to get some more from Florida. I think that the message is getting out.”
Five months into the program, he said, patients are now calling for services and equipment that they are accustomed to receiving the same day. That is not happening, he said, largely because providers working under the competitive bidding reimbursement rates cannot afford it.
“If they don’t like it, they need to contact their legislator,” said Brant.
Reinemer seconded that.
“Bottom line, we need to have multiple, credible advocates—providers and patients—in each of the 435 congressional districts making frequent calls and holding regular meetings with their representatives and senators,” he said. “In this environment especially, there’s no way we can achieve our goals without much deeper and broader action in every corner of the U.S. And that’s exactly what we’re working on with our grassroots program. Providers and other advocates can visit capwiz.com/aahomecare/home or www.aahomecare.org to get started.”
It isn’t the same as the drive last year to get support for a similar repeal bill, H.R. 3790, Shirvinsky said.
“The dynamics of H.R. 1041 are very different than what we saw last session. We have strong, bipartisan cosponsors who really understand this issue and our industry,” he said. “We have nine MSAs that are already impacted and 91 others that will find out the exact borders of their bidding areas within the next two months.”
There's also the ongoing national debate on health care and the budget, which leaves the industry with either an opportunity—that in framing Medicare reform there could be a legislative vehicle to stop competitive bidding—or that, as usual in Washington budget negotiations involving Medicare, could put HME cuts on the table once again. (For more, see the “Industry Commentary” from AAHomecare in this issue.)
And then there is Peter Cramton, a University of Maryland professor who has alerted both Congress and CMS to the fatal flaws of the competitive bidding design. Cramton thinks a bidding program for DME could work—just not the current one—and he is now advocating a “repeal and replace” strategy that includes his plan for an “efficient” auction design. (See Cramton Floats ‘Repeal and Replace’ Option for Competitive Bidding.)
While most in the industry oppose any sort of bidding program no matter how well it is designed, they're grateful Cramton is beating the drum.
“We have a very motivated economist and auction expert who is virtually carrying on a one-man campaign against the Medicare bidding scheme because it is so atrociously flawed,” Shirvinsky said, “not to mention that those who are in a position to do something about it have been outright dismissive of his considerable professional opinion.
“And we have a new House leadership that seems to understand the inherent problems with the program and the bipartisan support that exists for its repeal,” he continued. “All in all,” he said of H.R. 1041, “we are off to a very strong start, and we have the potential for committee discussion in the near future.”
Will that result in a Senate champion to carry the repeal bill? The jury is still out on that one. In any case, the onus is on providers to move their legislators to fight the current CMS program, stakeholders said.
Wayne Stanfield, president of the National Association of Independent Medical Equipment Suppliers, said “there is a vast corps of providers out there that think this thing is going to go away, and they have to get over it.” He told NAIMES members in a commentary last week that providers watching from the sidelines essentially could be allowing the demise of the industry.
“I have told every supplier for years now that ‘all politics are local,’” he wrote. “Every supplier reading this has had the power to change the course of this bidding disaster for years. For every one of you that have not made that call, or e-mail, or visit, or sent the letter to Congress, when Round Two starts, go look in the mirror. You will see one of the thousands of faces who didn’t see the need to get involved.”
NAIMES is running a survey asking how providers think the industry should proceed in fighting competitive bidding. Take the survey here.
Looking for Those 'Aha' Moments at Heartland 2011
WATERLOO, Iowa—For Lisa Ziehl, going to VGM’s annual Heartland Conference is kind of like going home. She meets old friends, has a great time and promises to come back next year.
She always takes something home, too.
“You always come back with some tangible things you can put into play,” said the operations manager for Rice Home Medical in Wilmer, Minn. “There is always that ‘aha’ moment that you have when you’re down there when you think, ‘This could work’ or ‘We could do this.’”
So for the fourth year, Ziehl is going back to Heartland, one of seven Rice Home Medical employees who will be attending the conference, which starts today and continues through Thursday in Waterloo, Iowa, VGM Group headquarters.
There could be more than one “aha” moment for Ziehl and the other 1,000 expected participants, since the 10th annual event will feature 104 educational sessions, 91 speakers, up to 23 hours of credit from seven continuing education entities and 74 exhibitors, all designed to help home medical equipment providers build better businesses.
The conference includes nine course tracks this year: billing/reimbursement, rehab/accessibility, regulatory/advocacy, competitive bidding/legislative, products/technology, respiratory/sleep, wound care, executive/business operations and sales and marketing. In addition, there will be small group discussion sessions on such topics as audits, accountable care organizations and best intake practices, as well as retail business.
Ziehl has set her sights on a few topics, she said.
“They’ve just added wound care and bariatrics. I am kind of excited about that,” she said. While Rice already does wound care, “we just want to see if there are things that we are missing or could be doing better,” Ziehl said.
She’s also keen on checking out the business operations track and hearing the speakers. It’s a hallmark of Heartland conferences that participants can get one-on-one time with the presenters, Ziehl said, and she is eager to take advantage of that and the numerous networking opportunities.
That’s one of the selling points for Louisville, Ky.-based Premier Home Care, said Wayne Knewasser, vice president of public relations and government affairs.
“Premier is sending [eight] people to Heartland this year,” he said, adding that the company values both the education and the friendships formed from previous years. Knewasser said he will concentrate on the competitive bidding and sales tracks, but “I may dabble a bit in the wound care and retail sales areas, as well.”
For Chuck Vetsch, CEO of Keller’s Medical Supply in Yakima, Wash., one of the key drawing cards is the rehab/accessibility track.
“We’re hoping to move more into the home modifications,” he said, noting that it is largely a cash business and at this point in the embattled HME industry, that’s a big plus.
Vetsch said last year’s conference with its emphasis on accessible homes helped cement his interest in the growing sector. He took the training and got his accreditation through VGM’s Accessible Home Improvement of America division. Within the last year, his company has installed several ramp systems and some bathrooms, and he has bids out for jobs on new construction projects, he said.
“We’ve seen that it has given us [an advantage] not only to be able to offer the home modification but the rest of the equipment on top of it,” he said.
VGM is continuing the emphasis this year with an Accessible Living Pavilion, AHIA vendor training and an all-accessible Care Cottage. AHIA partnered with Nationwide Custom Homes to bring the cottage, which was customized for Angie Plager, a former Ms. Wheelchair Iowa and president of the Iowa Spinal Cord Injury Association, to the Five Sullivan Brothers Convention Center grounds. Once the conference concludes, the home will be moved to Plager’s family property in Cambridge, Iowa.
The cottage concept, developed by Nationwide Homes, allows the structure to be attached to an existing home or placed as a separate dwelling on a caregiver’s property.
Vetsch, an ATP, said that in addition to the home modification track, he is also interested in hearing the speakers—the keynote speech will be given by Matthew Eversmann, a hero of the Battle of Mogadishu featured in the movie “Black Hawk Down”—and in getting the latest updates on competitive bidding.
“I’m always trying to see what’s the next step. Luckily, we are outside of a competitive bidding area, but it’s going to affect us,” Vetsch said. When CMS adopts the competitive bid prices for all providers, he said, “We’re going to take a hit.”
In addition to the educational seminars, Heartland will also feature its traditional hog roast, fireworks and 400 dozen cookies homemade by VGM staff members and distributed to attendees in their registration packets. A golf tournament opens the event, vendors will in the spotlight at a reception tomorrow night, and on Wednesday evening, the group will attend the annual Heartland Gala.
It’s enough to make Knewasser pledge to come back next year.
“Will we go back next year? You bet we will,” he said. “It’s already in our 2012 budget.”
Jeff Baird on Requesting an OIG Advisory Opinion: Eliminating Uncertainty
“Dealing with fraud and abuse issues is akin to visiting Alice in Wonderland,” says attorney Jeff Baird, chairman of the health care group at Brown & Fortunato. “What is down is up, what is up is down, and every day we descend through the proverbial rabbit hole. This is particularly true when a DME company desires to enter into a business arrangement with a referral source such as a physician, hospital or long-term care facility.
“The challenge,” continues Baird, “is that when a DME company ‘does business with’ a referral source, kickback issues invariably arise. The Medicare anti-kickback statute states that a kickback may occur when a provider gives anything of value to a person/entity in exchange for referring a Medicare patient or in exchange for ‘arranging for the referral of’ a Medicare patient.
“The anti-kickback statute is broadly worded and, arguably, it can apply to almost any type of arrangement between a provider and a referral source,” Baird says. “When designing a business arrangement with a referral source, the prudent DME company will be careful to avoid violating the anti-kickback statute. It can do so by fitting the arrangement (or substantially fitting the arrangement) within one of the safe harbors to the anti-kickback statute.”
An even more conservative approach, according to Baird, “is for the DME company to submit a request to the OIG for an advisory opinion.”
Check his explanation in the following Q&A.
Question: In laymen’s terms, what is a request for an OIG advisory opinion?
Answer: The Office of Inspector General is an agency within the Department of Health and Human Services. CMS, which administers the Medicare program, also falls within HHS. The purpose of the OIG is two-fold: to educate health care providers on how to avoid fraud and investigate alleged fraudulent activities.
If you go to Google and type in “Office of Inspector General,” you will land on the OIG’s official website. One of the links on the website leads you to published advisory opinions. Any health care provider, including a DME company, can submit a detailed letter to the OIG that describes an existing or proposed arrangement with a referral source.
The requestor will ask the OIG to give its opinion as to whether or not the arrangement violates the anti-kickback statute. The OIG will review the arrangement and then say one of three things: “Absolutely not!” or “Looks OK” or “We don’t particularly like it but would not be inclined to bring an enforcement action.”
Question: Is a published advisory opinion “the law?”
Answer: No, it is not the law, but the provider would be foolish to act contrary to a published opinion. It is likely that the Department of Justice, the NSC and the courts will take the same position as set out in the advisory opinion.
Question: Does an OIG advisory opinion address other potentially fraudulent issues such as the Stark physician self-referral statute, the telephone solicitation statute, the beneficiary inducement statute and the False Claims Act?
Answer: No. An advisory opinion only addresses whether remuneration, in an arrangement proposed by the requestor, constitutes illegal remuneration in violation of the anti-kickback statute.
Question: Is the published advisory opinion binding on providers other than the requestor?
Answer: No. The opinion is binding only on the requestor. However, other providers that are involved in the same or a similar arrangement should take notice of the advisory opinion and adhere to its guidance.
Question: Will the requestor have the ability to talk informally to the OIG before it issues the opinion? Will the requestor have the right to withdraw the advisory opinion request?
Answer: Yes to both questions. The requestor may have informal discussions with the OIG regarding the advisory opinion request. If the OIG expresses concerns about the arrangement, then the requestor will have the opportunity to modify the arrangement so as to address the OIG’s concerns. If it appears that the OIG simply does not like the arrangement, then the requestor will have the right to withdraw the advisory opinion request.
Question: Who is the advisory opinion request addressed to?
Answer: Chief, Industry Guidance Branch; Department of Health and Human Services; Office of Inspector General; Office of Counsel to the Inspector General; Room 5527, Cohen Building; 330 Independence Ave, S.W.; Washington, D.C. 20201.
Question: How many originals and how many copies must be submitted?
Answer: Original and two copies.
Question: What information must be included in the advisory opinion request?
Answer: (1) To the extent known to the requestor, the identities, including the names and addresses, of the requestor and of all other actual and potential parties to the arrangement, that are the subject of the request for the advisory opinion.
(2) The name, title, address, and daytime telephone number of a contact person who will be available to discuss the request for an advisory opinion with the OIG on behalf of the requestor.
(3) A declaration of the subject category or categories for which the advisory opinion is requested.
(4) A complete and specific description of all relevant information bearing on the arrangement. This description includes: (a) for existing arrangements, complete copies of all operative documents; (b) for proposed arrangements, complete copies of all operative documents, if possible, and otherwise descriptions of proposed terms, drafts, or models of documents sufficient to permit the OIG to render an informed opinion; (c) detailed statements of all collateral or oral understandings; (d) if applicable, a designation of trade secrets or confidential commercial or financial information; (e) a signed certification by the requestor; (f) a declaration regarding whether an advisory opinion request (regarding Stark) will be submitted to CMS; and (g) each requestor’s Taxpayer Identification Number.
Jeffrey S. Baird, Esq., is chairman of the Health Care Group at Brown & Fortunato, P.C., a law firm based in Amarillo, Texas. He represents pharmacies, infusion companies, home medical equipment companies and other health care providers throughout the United States. Baird is Board Certified in Health Law by the Texas Board of Legal Specialization. He can be reached at 806/345-6320 or email@example.com.
Debt Ceiling Debate Puts HME in Perilous Spot
This analysis was written by the American Association for Homecare’s lobbying firm, Mehlman Vogel Castagnetti Inc.
Without congressional action by August 2, 2011, the United States will exceed its statutory borrowing authority. While most expect that Congress will raise the current $14.3 trillion debt ceiling, Republicans in Congress plan to use the debt limit debate to pursue strategies to reduce the nation’s federal deficit and debt.
On May 31, the House of Representatives held a vote that underscored this point. Republicans in the House put forth legislation that would have implemented President Obama’s request to increase the statutory debt limit without any reductions in government spending. The bill (H.R. 1954) failed by a vote of 318-97. Nearly half of the House Democrats voted with all Republicans in a preemptive strike to demonstrate the lack of support for a “clean” debt limit increase. Thus, it is clear that any vote in Congress to increase the debt limit will have to be accompanied by significant corresponding reductions in government spending.
The venue for reaching a potential agreement to simultaneously raise the debt ceiling and curtail government spending are discussions being hosted by Vice President Joe Biden. The House and Senate leadership all have appointed representatives to participate in these bipartisan, bicameral negotiations.
It has become increasingly clear that the bipartisan discussions led by Biden are the center of gravity on budget negotiations. On May 17, Republican Senator Tom Coburn (R-Okla.) abandoned the “Gang of Six” effort saying he could not support the direction that the group was heading. Reportedly, Senator Coburn believed that the group would not embrace deeper reductions in health care entitlement programs that he viewed as critical to his support. The remaining members are Senators Saxby Chambliss (R-Ga.), Mike Crapo (R-Idaho), Mark Warner (D-Va.), Kent Conrad (D-N.D.) and Dick Durbin (D-Ill.). They continue their meetings to draft legislation based on the recommendations of President Obama’s fiscal commission. But with Senator Coburn’s departure, the group is much less likely to have any impact.
There are three potential outcomes of the ongoing budget debate. Under any of these scenarios, there is likely to be an impact on Medicare and/or Medicaid programs because these health entitlement programs are such a big part of the federal budget.
The first scenario is the “Grand Bargain.” Under this scenario, Republicans would agree to a framework that included revenue increases and Democrats would agree to accept major spending reductions, including to sacrosanct programs such as Medicare, Medicaid and Social Security.
The second scenario would be for no agreement to be reached and for the United States to breach the debt limit and default, at least temporarily, on the country’s debt service obligations. Both of these scenarios are possible, but highly unlikely.
A third, more likely, scenario, would include some immediate savings from entitlement and other programs, additional reductions to discretionary spending programs and some sort of statutory limits on future spending that would lead to automatic spending reductions in future years.
For the home medical equipment (HME) sector, there are both risks and opportunities in these discussions. On the one hand, the negotiations could provide a framework for Medicare reforms that would be a legislative vehicle to halt the harmful competitive bidding program.
On the other hand, an agreement to make deep reductions to government health care programs could make repeal more difficult. The need to find billions if not trillions of dollars in government savings could put HME reimbursement cuts on the table in the negotiations. Those cuts might include reductions to home oxygen payments or the proposal from President Obama earlier this year to pay for HME under state Medicaid programs at the lower Medicare rates that result from the bidding program.
Note from AAHomecare: What You Can Do
What this means is the HME sector will need to remind lawmakers about the cost-effectiveness and value of home medical equipment and home-based care. Visit the Take Action Center at www.aahomecare.org.
Headlines from HomeCareMag.com
News You Can Use: OIG Cautions against Online Referrals; Going the Retail HME Route
Having trouble keeping up? Check these headlines from www.HomeCareMag.com.
NAS Posts PWC Payment Q&A
OIG Says Beware of Paying for Online Hospital Referrals
Retail HME Can Be Route to Success
Agencies Release Regulatory Review Plans
Cramton Bashes Competitive Bidding Again
ResMed Reorganizes, Restructures Management
Pride Adds Kids Up; Invacare’s Richey on 200,000th HomeFill; Shaq Attacks Sleep Apnea and More News in Brief
EXETER, Pa—Pride Mobility Products announced last week it has acquired Kids UP, a pediatric seating and mobility company based in Belgrade, Mont., and will integrate the company’s seating and positioning products into Quantum Rehab’s manual wheelchair offerings.
“The acquisition of Kids UP as a division of Quantum Rehab is a very exciting venture for our organization,” said Scott Meuser, Pride chairman and CEO, in a release. “Kids UP has very unique products for the pediatric population that have gained the reputation for changing the quality of life for children and their families. These products have positively touched so many lives and we look forward to building that momentum by adding their innovative technology to our family of rehab solutions.”
Kids UP products include the Reaction Dynamic Seating System, the Kids FAST Chair, the ROCK 2 Chair, the ROCK 3 Chair and LifeForm, a full line of positioning components. The Kids UP manufacturing facility in Belgrade, now known as Quantum Montana, will handle all product quoting, ordering and shipping.
Invacare’s Richey: HomeFill Is a ‘Win-Win’
ELYRIA, Ohio—Invacare announced June 1 that it has shipped its 200,000th HomeFill transfilling oxygen system. J. B. Richey, the manufacturer’s senior vice president of electronic and design engineering and president of Invacare Technologies Division, designed the system. “When we first launched the HomeFill System, the idea of having patients fill their own cylinders at home was considered radical, but Invacare was always behind this product,” Richey said in a release. “Non-delivery oxygen is good business for providers and provides patients with an endless supply of oxygen. It’s a win-win.”
Video: Shaq Attacks Sleep Apnea
A YouTube video from Harvard Medical School shows Shaquille O'Neal having a sleep study and being diagnosed with OSA. Check it out!
Carex Moves to Mass.
NORWELL, Mass.—Carex Health Brands has relocated its corporate headquarters to Boston to support the expansion of its marketing team, an initiative planned to increase brand-building and double new product development, the company announced last week. Carex product lines include medication compliance, bathroom safety products, aids to daily living, mobility support and pain management through reusable hot/cold products with its Carex, Apex, Bed Buddy, TheraMed, Enablers and Vita System brands. In addition to its new East Coast headquarters, the company has an office in Sioux Falls, S.D.
Cigna Is Now CGS
NASHVILLE, Tenn.—Following its acquisition by BlueCross BlueShield of South Carolina, Cigna Government Services has changed its name to CGS LLC effective June 1. The web address for the Jurisdiction C DME MAC has also changed to www.cgsmedicare.com/. All other services, features, education, addresses, telephone numbers and claim submission processes remain exactly the same, CGS said in an announcement last week.
CMS to Hold 5010 Test Day June 15
BALTIMORE—In a number of recent notices, CMS reminded that the Version 5010 compliance date—Jan. 1, 2012—is coming up fast. According to the agency: “All HIPAA-covered entities should be taking steps now to get ready, including conducting external testing to ensure timely compliance. Are you prepared for the transition? Medicare Fee-for-Service (FFS) trading partners are encouraged to contact their Medicare Administrative Contractors (MACs) now and facilitate testing to gain a better understanding of MAC testing protocols and the transition to Version 5010. To assist in this effort, CMS, in conjunction with the Medicare FFS Program, announces a National 5010 Testing Day to be held Wednesday, June 15, 2011 … You are encouraged to begin working with your MAC now to ensure timely compliance.” For more information on HIPAA Version 5010, go to www.CMS.gov/Versions5010andD0.
NHIC Continues K0823 Prepay Review
HINGHAM, Mass.—NHIC announced Friday that it will continue its widespread prepayment review of K0823 power wheelchair claims in Jurisdiction A. Its most recent quarterly review, which resulted in an overall charge denial rate of 52 percent, involved 768 claims with dates of service from January through March submitted by 225 suppliers. Results showed responses to the Additional Documentation Request were not received for 135 (17 percent) of the claims. Of the 633 claims for which responses were received, 297 claims were allowed and 336 were denied, due mainly to insufficient documentation to support medical necessity. In its first K0823 review covering claims in the second quarter of 2010, the overall CDR was 75.3 percent. “NHIC appreciates the hard work by suppliers that has resulted in the improvements in the error rate over the past year,” the DME MAC said about the recent review. “We encourage all suppliers to continue to examine their K0823 claims for compliance with all of the LCD requirements.”
Medtrade Names Two Task Force Members
ALPHARETTA, Ga.—Jeff Woodham, senior vice president and general manager of The MED Group, Lubbock, Texas, and Christa Miehe, vice president of events for The VGM Group, Waterloo, Iowa, are the newest additions to Medtrade’s Blue Ribbon Task Force, formed to offer ideas for improvement of the Medtrade and Medtrade Spring conferences and expositions. Task force members include executives from organizations involved in each major aspect of the HME industry. Medtrade 2011 will take place at the Georgia World Congress Center in Atlanta Oct. 24–27. For information, see http:www.medtrade.com.
NCART Sets Second Medicaid Summit
BUFFALO, N.Y.—NCART has scheduled its second National Medicaid Summit in St. Louis Nov. 30 – Dec. 1. Additional details will be announced as the program is finalized, according to Executive Director Don Clayback.
Community Pharmacies Still Want Out of Competitive Bidding
WASHINGTON—H.R. 1936, the Medicare Access to Diabetes Supplies Act, would permanently exempt small community pharmacies from the competitive bidding program for diabetes testing supplies. The exemption in the bill, introduced May 23 by Reps. Aaron Schock, R-Ill., and Peter Welch, D-Vt., covers diabetes test strips, monitors, lancets, glucose control solutions and applies to community pharmacies with 10 or fewer locations.
“Without enactment of this legislation, or a comparable exemption, seniors would suffer diminished access as small pharmacies could no longer offer these supplies and provide face-to-face guidance,” the National Community Pharmacists Association noted in an endorsement of the legislation. “Most independent pharmacies will not be able to meet the competitive bidding requirement to service an entire Metropolitan Statistical Area and to match the cut-rate bid prices of giant mail order facilities.”
CMS’ current bid program includes mail-order diabetes supplies, but the agency has indicated that it may include diabetic supplies obtained at retail locations in future rounds of competitive bidding.
Erogolet Shows Safe Lifting in Any Language
MINNEAPOLIS—Patient lifting manufacturer Ergolet has redesigned its website, www.ergolet.com so customers can check product information in their language of choice. The new multi-lingual website, which features the company’s overhead lifts, sit-to-stand aids and mobile lifts, includes detailed descriptions of safe lifting options and videos to illustrate proper lifting techniques and practices.
TAG Launches New Website
NORTH RIDGEVILLE, Ohio—HME replacement parts and supplies vendor The Aftermarket Group has launched an updated and improved website at www.aftermarketgroup.com. The TAG site now features the ability to search by part number, manufacturer and product category. Additional features will include Medicare codes, a keyword search function, extended product descriptions, quality images of parts and accessories, tire installation videos, PDF instruction sheets and MSRP and provider pricing.
Bargmann Joins Audit Team
CANTON, Ohio—Lisa Bargmann has joined Harrington Management Group’s Audit Team as senior vice president of consulting services, the company announced. Bargmann brings 22 years of reimbursement, claim review and compliance expertise to the firm, and will also advise on new business development. Previously, Bargmann served as vice president of reimbursement for Health Care Solutions before its sale to Lincare in 2003, then founded Bargmann Management (also known as Homecare Collection Service), which she sold to Invacare in 2008.
OIG Audits, Legal Actions Tally $3.4 Billion
WASHINGTON—For the six months from October 2010 through March 2011, HHS’ Office of Inspector General took actions that are expected to total $3.4 billion in recoveries related to investigations, audits and other reviews, mainly of Medicare and Medicaid. The monies include about $222 million from audits and $3.2 billion from 349 criminal and 197 civil actions during the period, the OIG announced last week. Among the highlights in its tally, the OIG pointed to a Medicare Fraud Strike Force action in February involving more than 300 special agents in nine cities that resulted in the arrests of more than 100 defendants. The arrests included doctors, nurses, health care company owners and others for their alleged participation in fraud schemes involving more than $225 million in false billing. The OIG made the announcement in conjunction with the June 1 release of its Semiannual Report to Congress.
VMI, MobilityWorks Donate Van
CINCINNATI—Vantage Mobility International and MobilityWorks, a Cincinnati-based retailer of wheelchair accessible vans, teamed with Cincinnati Mayor Mark Mallory to help donate a wheelchair accessible minivan for an area family. “Our team was moved by the compassion that Mayor Mallory showed for city employees when he was recently featured on the reality TV series ‘Undercover Boss,’” said VMI President Doug Eaton, in a release. “We were especially touched by his efforts to help Arnneater Crawford, a City of Cincinnati employee who’s struggled to provide adequate transportation for her oldest son, Donté, who lives with cerebral palsy. We were very excited when we were given the opportunity to be a part of this donation.” The 2010 Town & Country van with VMI Northstar side entry was presented to Crawford and her son May 31.
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