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| May 2, 2011 | Volume 17, Number 17 |
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ADVERTISEMENT Help is Just a Phone Call Away AnCor Healthcare Consulting provides reimbursement and operational consulting, project management, interim management and computer conversion services designed to assist home medical equipment and home infusion companies improve operating efficiency and reduce bad debt. If you would like to improve your company’s operating performance call AnCor today at 954-757-3121 for a free telephone consultation or visit our website for more information on our services at www.ancorconsulting.com.Table of Contents - Deadly Tornadoes Push Southern HME Providers to the Limit - They’re Serious about the KX, Folks - Q&A with Jeff Baird: Utilizing a Call Center - The van Halem Group Adds HC Comply as Stribling Departs - Max-Wellness Launches Mini-Max Concept - Invacare Reports Strong First Quarter - ResMed Racks Up Record Results - CarePoint Expands in Texas and Georgia - 'Black Hawk Down' Hero to Headline Heartland; NRRTS Remodels Website; 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 Deadly Tornadoes Push Southern HME Providers to the Limit ‘When every oxygen patient you have does not have power, that makes it difficult’ ATLANTA—Home care providers with the best of emergency plans were stretched to the breaking point during last week’s devastating storms and tornadoes that hit seven southern states. At press time, The Associated Press estimated 341 people dead; the Alabama Emergency Management Agency had confirmed 254 fatalities in that state alone. “This is almost too large to plan for,” said Mike Hamilton, executive director of the Alabama Durable Medical Equipment Dealers Association (ADMEA). “This is like Katrina, and most providers’ emergency preparedness plans have been overwhelmed because the storms covered such a huge area.” With thousands injured and without power, HME companies throughout the South were left scrambling to take care of patients. Leigh Ann Matthews, owner of Complete Care, with locations in Fort Payne and Scottsboro, Ala., swung into action to help patients in devastated areas. “We are now trying to go in and replace backup systems for our oxygen patients,” said Matthews, who also serves as president of ADMEA. “Some of those areas are almost impassable. We are just trying to get to them by whatever route possible. We have also had patients who have completely lost their homes and had to relocate.” The last set of storms came through about five miles from Matthews’ Fort Payne location, a town that saw widespread destruction and more than 30 fatalities. Officials told Fort Payne residents they might not have power until some time during the week of May 2, and Matthews was preparing for that situation. As soon as the storms broke April 27, Matthews directed delivery personnel to hit the road, and they went non-stop all day. These efforts are mostly not reimbursable under Medicare guidelines, and providers across the region will likely feel the hit. “It will be a financial burden,” acknowledged Matthews. “And we have no idea how much equipment we have actually lost, because there are some areas we have not been able to get into,” she said Friday. “If it was one small area that was hit, you could handle it, but when every oxygen patient you have does not have power, it makes it very difficult.” The full measure of the storms’ impact will continue to be revealed in the days ahead. For some, it could end up as a double whammy of damage to both business and home. “I talked to one supplier this morning, and he had locations in Tuscaloosa, Birmingham and Huntsville,” said Matthews. “His home had been damaged, and he said, ‘I don’t even know if I have any businesses standing.’” Joe Bryant, owner of Happy Home Health, escaped damage to his business in Pelham, Ala., and his home in Alabaster, Ala. However, many of the patients he serves in Bibb, Blount, Chilton, Jefferson, Shelby, St. Clair, Talladega, Tuscaloosa and Walker counties were not so fortunate. “The biggest problem is electrical power disruption,” said Bryant. “Patients on oxygen who are without power have been handled in one of two ways. First, LOX systems do not require electricity, so we made these systems available to as many of our patients as possible. Second, some years ago we purchased portable gasoline-powered generators, and we have made these available as needed.” Bryant faced a similar situation years ago with Hurricane Opal (1995). At the time, he had to supply rural patients with oxygen cylinders, since he was not heavily involved in LOX. “Following that hurricane, we swore we would not go through that many oxygen cylinders again and the headaches associated with the logistics of refills and delivery,” said Bryant. “So far, we have met all of our patients’ needs and are operating under our emergency preparedness plan.” All these secondary devices—LOX systems and generators—are not subject to reimbursement because they are considered backup systems. “The costs have to be absorbed by the DME provider,” said Bryant, echoing the sentiments of Matthews. “I know of no other industry that does this. This is non-reimbursement as mandated by Medicare, Medicaid and other insurance carriers, including Blue Cross Blue Shield. “Wouldn’t it be nice if banks and mortgage companies had to supply you with a house at no cost until you replaced your lost or damaged home?” The disaster sparked industry advocates to question again the wisdom of nationwide competitive bidding and how it might affect patients in times of dire need. “The fewer suppliers you have,” said Hamilton, “the less likely it is that you will be able to respond properly to a disaster like this.” Bill Hewlett, a VGM member and vice president of the Kentucky Medical Equipment Suppliers Association (KMESA), wrote that a lack of providers—especially in rural areas—would surely be felt once competitive bidding spreads. “When competitive bidding comes to this rural area, will we all still be around to make sure patients are cared for in a proper way? Probably not,” said Hewlett. How much of your business comes from retail? To vote in HomeCare's monthly Web poll, visit www.HomeCareMag.com. They’re Serious about the KX, Folks INDIANAPOLIS—HME billers’ nemesis, the KX modifier is back in the spotlight after a notice last month from Jurisdiction B reminded providers that its improper use could lead to a false claims violation and a hefty fine. In fact, said National Government Services, the Jurisdiction B DME MAC, using the KX modifier without making sure that all the requirements specified in the appropriate policy have been met “could be viewed as filing a false claim and potential abuse of the Medicare program.” Added the message in italic type: “Penalties for violating the Federal False Claims Act can be up to three times the value of the False Claim, plus from $5,500 to $11,000 in fines, per claim.” Industry consultant Andrea Stark of Columbia, S.C.-based MiraVista said the KX “has been a constant source of confusion for suppliers, and they don’t realize the ramifications of what they are signing up for when they add that modifier.” Medicare keeps “tweaking” a lot of claims requirements, making it difficult for providers to keep up with all the changes, Stark said. When providers have doubts, they sometimes indiscriminately add the KX modifier to make sure they get paid. According to its definition, the KX signifies that requirements specified in the medical policy have been met. Those requirements vary from policy to policy, and use of the KX on a claim serves as an attestation by the provider that the requirements set out in the local coverage determination are true for that specific beneficiary. The Jurisdiction B message encourages review of the documentation requirements section of each LCD to understand fully the criteria for proper use of the KX: “Obtaining physician records, test reports, and other documents is the best means of assuring that all of the information needed to support use of the KX modifier is present in the event of an audit.” Stark pointed out that providers add the KX because they believe they have the required documentation, but often that is a “moving target” as far as what regulators—and audit contractors—want. “Many times providers are stepping out on good faith thinking that the physician is going to back up what they ordered, but that is not always the case,” said Stark. “The only way to know that the doctor actually wrote down something viable is to ask for those records every time. But then the referral sources dry up, because it is a hassle and they don’t want to give it to you every single time. You must get to where you are comfortable, while not overburdening physicians. This can only be accomplished with compromise, where the provider obtains a sample of progress notes to gain confidence in a referral source.” General practitioners are more apt to say they don’t have the time, but specialists can often supply what providers need, Stark noted. “The more reliable documentation is coming from specialists,” she said. “Specialists are more reliable because they are delving into the disease and sitting down with patients. Ultimately, auditing contractors won’t read between the lines, so providers are constantly in an impossible position. The Medicare program must not pay for undocumented services to protect the funds, and they must only pay for the cases that are most obvious. The borderline patients suffer in this scenario.” G modifiers have added to the headaches, Stark said. Many medical policies require a KX, GA, GZ or GY modifier to show that the coverage criteria have been met and whether an Advance Beneficiary Notice (ABN) has or has not been used. With recent changes, said Stark, “If a claim does not come in with a KX modifier, it must come in with another G modifier that indicates it was intentional to leave the KX off, and we either have an ABN or we don’t.” That’s not all. According to the Jurisdiction B message: “Suppliers are reminded that the GA, GZ, and/or GY may not be reported on the same claim line. Additionally, it is inappropriate to report both the GY and KX on the same claim line. Suppliers must select the appropriate modifier according to the guidelines outlined within the medical policy. Effective with claims received on or after May 1, 2011, claim lines containing more than one of these modifiers, GA, GZ, GY, will be rejected.” You can access LCDs and related policy articles on the NGS website at apps.ngsmedicare.com. Select “Medical Policy Center” under “Coverage Determinations.” For additional information on use of the KX, see the March issue of the Jurisdiction B “Connections.” A section on the KX begins on page 15. Q&A with Jeff Baird: Utilizing a Call Center Call centers are a viable option, according to health care attorney Jeff Baird of Brown & Fortunato, but providers should be aware of the legal landmines. Question: I keep hearing about call centers. What exactly is a call center? Answer: A call center can be internal or external. Let’s say that ABC Medical is a mail-order supplier of diabetic testing supplies. ABC may have a group of employees who take up 1,000 square feet. This group of employees can, by phone and the Internet, market to referral sources, communicate with patients, communicate with physicians, and “chase the paperwork.” Because the internal call center is made up of ABC’s employees, the standard HIPAA, kickback, and subcontracting rules do not apply. (This Q&A will not discuss internal call centers.) Now let’s say that ABC contracts with an external, or outside, or outside, call center. I will refer to this outside call center as “XYZ.” XYZ is a 1099 independent contractor of ABC. XYZ may be located down the street, across the state, in another part of the U.S. or in a foreign country (e.g., the Philippines). From a business standpoint, ABC would like for XYZ to do the same sorts of things that an internal call center can do. However, the law will not allow this. Question: Let’s say that ABC properly accumulates leads, or prospective customers. For example, ABC may own and manage its own website. A lead will visit the website, submit contact information and ask ABC to call the lead. Or ABC will advertise in a magazine, newspaper, television or radio; a lead will call ABC in response to the ad, leave a voicemail or message and ask for a return call. Or ABC will mail out (U.S. Postal Service) marketing materials. In response, the lead will mail back to ABC a signed card asking to be called. Or ABC will purchase leads from a reputable Internet lead provider; the leads will have consented to be called by a diabetic supplier. You get the picture; ABC now has a bucket of leads that it needs to call. Can ABC forward the leads to the external call center, have the call center call the leads, and have the call center (i) collect the lead’s medical information; (ii) collect the lead’s Medicare (and other insurance) information; (iii) obtain the AOB (assignment of benefits) from the lead; and (iv) contact the lead’s physician in order to obtain the physician’s order and other documentation? Answer: I would advise against this. The external call center (XYZ) will be construed to be a subcontractor of ABC. CMS has published guidance that states that a subcontractor may not engage in intake, assessment and coordination of care with the physician. The information described in (i) through (iii) of the question will be construed to be “intake, assessment and coordination of care.” An employee of ABC needs to initially talk to the lead and obtain the lead’s (i) medical information, (ii) Medicare (and other insurance) information, and (iii) AOB. An employee of ABC needs to talk to the lead’s physician and obtain the order and other documentation. The call center can subsequently call the lead (who, by that time, will be a customer) and confirm reorders. Question: After ABC has obtained the medical, insurance and other information, can the call center assume the responsibility of calling the customer each time that the customer comes up for a refill of his order? Answer: Yes. Question: What kind of agreement needs to be in place between ABC and XYZ? Answer: ABC and XYZ need to enter into a call center agreement that has a HIPAA-compliant “business associate addendum” attached to it. The agreement needs to be detailed and needs to spell out clearly what the call center can and cannot do. For example, the agreement will need to include the following provisions: • XYZ will not release or use lead information for any purpose other than to handle reorders and other specific duties spelled out in the agreement. • XYZ customer service reps will adhere to a telephone script provided by ABC. This is important because, at the end of the day, ABC is the entity that is responsible to the Medicare program. ABC cannot ship supplies to the customer unless the customer truly qualifies for the reorder; if the XYZ customer service rep goes off script and arranges for the reorder when the customer does not need the reorder, then the responsibility falls on ABC’s shoulders. • The gold standard will be for the calls to be recorded; the silver standard will be for the calls to be monitored on a regular basis and for some of the calls (at random times) to be recorded. • There will be a formal customer complaint procedure. In other words, when a customer complains about something to XYZ’s customer service rep, then XYZ must take down the information and immediately notify ABC. • ABC will have the right to audit XYZ’s operations. Question: How can ABC pay XYZ? Answer: The most conservative approach is for ABC to pay a fixed annual fee (e.g., $120,000 over the next 12 months) to XYZ. A less conservative approach (but one that has low risk of an enforcement action) is for ABC to pay XYZ on a per call or hourly basis. The compensation cannot be directly or indirectly tied to whether or not a customer reorders. The compensation cannot be a percentage of what ABC collects. Let me explain. XYZ is not marketing for ABC; XYZ is not calling on physicians nor is it bringing in new customers for ABC. XYZ’s role is to communicate with customers about their reorders. Therefore, at first blush it appears that there is no way that the agreement can violate the Medicare anti-kickback statute. The statute states that a provider may not pay anything to a person or entity for referring a Medicare patient, “arranging for” the referral of a Medicare patient, or for essentially doing anything that will result in a Medicare payment. The “one purpose” test, set out in court decisions, states that if one purpose behind a payment is to induce referrals of Medicare patients, then the anti-kickback statute is violated, even though the primary purpose behind a payment is to compensate for actual services rendered and even if the compensation is fair market value. However, an argument can be made that each time a customer reorders his supplies from the call center, he becomes a “new customer;” and each time XYZ talks to a customer about a reorder, and the customer states that he is ready for a new shipment of supplies, then XYZ is “arranging for the referral” of a Medicare patient or is otherwise responsible for a Medicare payment. In order to address this risk, the compensation from ABC to XYZ cannot be tied to the number of reorders. A fixed annual fee is an important element of the “Personal Services and Management Contracts” safe harbor to the anti-kickback statute. If an arrangement falls within a safe harbor, then as a matter of law, the anti-kickback statute is not violated. If the compensation is on an hourly or per call basis, and is not tied into whether the customers reorder, then it is unlikely that the government would bring an enforcement action. Question: Is there a way that XYZ can call a lead (a prospective customer), on behalf of ABC, before the lead decides to become a paying customer of ABC? Answer: Yes. Look at the second question above. Assume that leads (or prospective customers) are coming ABC’s way from a number of directions: in response to television, magazine, newspaper, radio ads; in response to direct mailings; in response to ABC’s website; and/or the purchase of leads by ABC from a reputable internet lead provider. Assuming the leads have given a proper consent to be called, then XYZ (on behalf of ABC) may call the leads and verify the information previously given by the leads and verify that the leads are interested in purchasing products from ABC. However, at that point, the lead needs to be handed over to ABC so that an ABC employee can handle the intake, assessment and coordination of care. Thereafter, XYZ can assume responsibility for calling the customers to confirm their needs for reorders. 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 jbaird@bf-law.com. HME Company Newswire The van Halem Group Adds HC Comply as Stribling Departs ATLANTA—The van Halem Group announced April 25 that Amarillo, Texas-based HC Comply will become a new division of the company focused specifically on compliance. Effective May 16, the move follows the departure of HC Comply founder Clay Stribling, who leaves to become president and CEO of the Amarillo Area Foundation, a regional charitable organization. “Clay has been a tireless advocate and compliance pioneer within the HME industry. I’ve been proud to work alongside him as we’ve both sought to help companies navigate through new and often complicated federal requirements and rigorous enforcement,” said van Halem Group founder and President Wayne van Halem. Begun in 2006, the company has helped clients navigate Medicare and Medicaid issues related to audits, investigations, medical review, appeals, enrollment, coding, education and training. The new HC Comply division adds compliance program design and training, compliance audit services, monitoring, risk assessment and privacy services. Having a suite of compliance offerings “will help ensure our clients have the best counsel before, during and following any potential oversight action by the federal government,” said van Halem, a former Medicare fraud investigator. According to van Halem, simply having a compliance handbook sitting on a file cabinet will no longer cut it in the industry’s current environment. “First,” he said, “ health reform is going to make it mandatory that companies have a valid compliance program.” While no deadline has yet been set, van Halem said, “I’m guessing that by the end of 2013 it will be mandatory for DME. Not only that, but much like accreditation, there will be certain requirements that have to met in order for a compliance program to be considered a ‘valid’ program. “The second piece is,” he continued, “the government and audit contractors have never been more aggressive with their auditing techniques than they are now. Funding has been increased for audits, and they are not going to go away.” An effective compliance program, van Halem contends, can point up an HME company’s vulnerabilities so any issues can be identified and corrected in advance of an audit, which, at some point, is certain to come. “Having an effective compliance program in place is just a good business decision,” van Halem said. “It protects the Medicare trust fund and protects providers as well by keeping little issues from turning into big issues in case of an audit.” Stribling, a health care attorney with Brown & Fortunato before founding HC Comply, agreed. “At this point, compliance programs are vital for HME providers because they are the best defense a company has against the new onslaught of government audits, from the ZPICs and the RACs to other audit sources. An effective internal compliance program can significantly decrease the error rate you have when facing these external audits,” he said. With compliance requirements under the Affordable Care Act in play, Stribling said, if HME providers wait too long to begin adopting and implementing compliance programs, “a lot of companies are going to suffer the same growing pains they did when they waited too long to get accredited.” Advised Stribling, “The companies that are going to be the most successful will be the ones that get out ahead of this and get a compliance program in place that makes them a better company today.” Max-Wellness Launches Mini-Max Concept CLEVELAND—Max-Wellness announced April 26 it will partner with Lake Health, a private community health care provider in Northeast Ohio, on the launch this summer of a Mini-Max store concept designed to be located in hospitals and rehab centers. The new Mini-Max will have a smaller footprint—600 sq. ft.—than the health-and-wellness retailer’s first four stores, which opened in 2010 in two Cleveland locations and in Sarasota and Naples, Fla. Between 5,000 and 6,000 sq. ft., those stores carry some 7,000 products ranging from nutritionals to footwear and DME including bath safety, incontinence supplies and mobility aids such as walkers and wheelchairs. Lake Health operates two acute care hospitals and 13 other health care sites, including urgent care and physical therapy locations, in Lake County, Ohio, near Cleveland. The first Mini-Max will debut in Lake Health’s West Medical Center, an acute care hospital in Willoughby, Ohio. Even though they will be smaller, Max-Wellness CEO Michael Feuer said “a complete selection of DME will be available” at the new Mini-Max stores. Feuer co-founded OfficeMax, which he began with one store in 1988 and sold in 2003 for $1.5 billion. Max-Wellness and Lake Health officials will collaborate on a product offering for the Mini-Max that includes “head-to-toe care tailored to the needs of patients at West Medical Center,” according to the companies. Max-Wellness associates will staff the Mini-Max to help patients and caregivers with products for continuing care after discharge. The stores will also feature products that should draw hospital visitors and employees, according to a spokesperson. “Based on experience gained in this first location at Lake Health, it will be the model for future Mini-Max stores expected to open in hospitals throughout the country,” Feuer said. Wherever a Mini-Max store is located, Max-Wellness may also add another concept called “Wellness-in-a-Box,” a computerized dispensing device similar to a vending machine that features health-and-wellness products. “This allows wellness products to be available at other locations within a hospital, near adjacent or nearby medical office areas of the hospital and outside the Mini-Max during non-store business hours,” said Feuer. The self-service dispensers are also slated for urgent care centers, senior living facilities and airports, with merchandise customized to meet the specific needs of customers in each particular venue. Max-Wellness recently launched an e-commerce site and also plans to add more of its larger brick-and-mortar stores this year, the chain’s spokesperson said. For more on Max-Wellness, see “Taking HME to the Max,” November 2010. Invacare Reports Strong First Quarter ELYRIA, Ohio—“Invacare is off to a solid start in 2011,” President and CEO Gerald Blouch said of the company's first-quarter results, announced during an April 28 conference call with analysts. For the three months ended March 31, net earnings were $7.5 million versus $3.1 million for the first quarter of 2010. Net sales grew 6.5 percent to $428.5 million from $402.2 million last year. Organic net sales increased 6.1 percent with increases in all business segments. North America/HME net sales for the quarter increased 6.1 percent to $185.6 million from $175 million last year. The increase was primarily driven by oxygen concentrators, custom power and custom manual wheelchairs and beds, according to the company. Net sales for Invacare Supply Group increased 6.2 percent to $74 million against $69.7 million for the same period in 2010, with the increase across all major product lines. Focusing on the outlook for 2011, Blouch said the company is managing rising commodity and freight costs, along with the potential for fluctuations in foreign exchange rates, through ongoing cost reduction and selective price increases. While rising costs didn't have much effect on results in the first quarter, Blouch said, things could change. “Fortunately the company did not experience much pressure related to commodities in the first quarter due to our supplier contracts,” Blouch said. “However, we'll begin to feel more of this pressure in the second quarter.” The North America/HME division recently announced a price increase for certain products effective May 1, and Invacare's other segments are reviewing whether freight and price increases might be warranted, Blouch said. The company is keeping a particularly close watch on the tragedy in Japan, he added, as Invacare sources a few key electronic components from suppliers in that country. If there is a disruption in the supply chain, the company is “developing component and supplier alternatives to be implemented if and when necessary.” Neither did Invacare see a significant impact to its business in the first quarter related to Round 1 of competitive bidding, Blouch said. Even though CMS' has announced a six-month delay of the program, that does not mean there will be any changes. The company will continue to work with the industry to implement “meaningful changes” to the program, Blouch said. Invacare is also providing updates to the Food & Drug Administration about improvements in response to regulatory compliance concerns raised in 2010. Blouch said the company “is in the process of adding resources to the regulatory affairs and corporate compliance departments and has engaged outside experts to accelerate implementation of its corrective actions.” The company reconfirmed its 2011 guidance to include: • Organic net sales growth between 3 and 4 percent (narrowed from original guidance between 2 and 4 percent); • Adjusted earnings per share between $2.05 and $2.15; • Free cash flow between $85 million and $95 million; • Effective tax rate of approximately 30 percent on adjusted pre-tax annual earnings; and • Adjusted EBITDA between $145 million and $155 million. All in all, Blouch said, “It was a great first quarter … We’re basically saying that Invacare is back to a growth environment, and we’re going to keep delivering that for investors.” ResMed Racks Up Record Results SAN DIEGO—ResMed announced record revenue and income for its third quarter and nine months, ended March 31. Revenue for the quarter was $313.3 million, a 12 percent increase over the 2010 quarter. For the nine months, revenue was $901.3 million, an increase of 13 percent over the same period last year. "In the third quarter of fiscal 2011 we continued to show strong year-over-year growth especially in Europe and the Asia-Pacific region. Revenue outside the Americas increased by 16 percent to $152.7 million over the prior year's quarter, or a 15 percent increase on a constant currency basis,” said Peter C. Farrell, chairman and CEO, in a release. “Revenue in the Americas increased by over 9 percent to $160.5 million over the prior year's quarter. “Americas' revenues,” Farrell said, “continued to be adversely impacted by reduced bilevel sales, but we expect that the recent launch of the S9 bilevel series will help to reverse this trend. Worldwide, our growth in flow generators was mainly driven by sales of the S9 AutoSet. Patient interface sales did extremely well in all regions. With the recent launches of the Quattro FX full face mask and the Mirage FX nasal mask, we have completed the release of the trilogy of masks in the FX series. Operating profit for the March quarter was $64 million and cash flow from operations was a record $81.4 million, demonstrating excellent operating performance. Farrell said the company expects growth in all products to continue to benefit “from the vastly under-penetrated and growing sleep-disordered breathing market.” CarePoint Expands in Texas and Georgia CINCINNATI—Premier Infusion is the latest acquisition for CarePoint Partners, which now has 22 locations in nine states. Premier provides home infusion pharmacy services in Austin, Texas, and infusion pharmacy and related nursing services in the Atlanta area. The Austin location complements CarePoint’s Dallas and Houston operations while its expansion into the Atlanta market continues to grow its southeastern footprint, according to the company. The new acquisition, CarePoint’s 12th since its formation in 2007, “advances our mission of maintaining a regional footprint while becoming a leading provider of customer-focused pharmacy and related health care services in both the home and alternate site environments,” said Dana Soper, CEO. “What makes this a great fit is the fact that Premier excels at numerous IV therapies which are core CarePoint home infusion services.” Last month the company also added Infusion Technologies’ offices in North Miami and Tampa, Fla. In Brief 'Black Hawk Down' Hero to Headline Heartland; NRRTS Remodels Website; More News in Brief WATERLOO, Iowa—Matthew Eversmann, the real-life hero of the Battle of Mogadishu who was portrayed in the movie “Black Hawk Down,” will be the keynote speaker at VGM’s 2011 Heartland Conference next month. Played by Josh Hartnett in the movie about the 1993 18-hour battle in the most hostile part of Somalia, Eversmann will speak to attendees June 7 on “Dedication, Pride and Commitment.” Eversmann is the founder and president of Freeman Phillips LLC, a leadership development company, and the author of “The Battle of Mogadishu” (2004). The 10th Heartland Conference will be held June 6-9 at the Five Sullivan Brothers Convention Center in Waterloo, Iowa, VGM’s hometown. For information, see www.vgmheartland.com. NRRTS Remodels Website TRINIDAD, Colo.—NRRTS debuted its newly remodeled website last week at www.nrrts.org. Now full-text searchable, the revised site includes an updated consumer and advocacy section with information on how individuals and organizations can get involved in improving access to complex rehab technology, direct links to NRRTS news and a link to its Facebook page. CMS Sets Meets on New HCPCS Codes BALTIMORE—CMS has scheduled a series of public meetings at its headquarters during May and June to present information about specific requests for HCPCS codes for new products and services. A two-day meeting for “Supplies and Other” products and services (wound care, diabetes, enteral nutrition) will be held May 24 and 25, a meeting for orthotics and prosthetics will be held June 7, and a meeting specifically for DME is scheduled for June 8. CMS said the upcoming meetings provide “an opportunity to obtain industry and public reaction to the preliminary coding recommendations of the CMS HCPCS Workgroup, as well as CMS’ preliminary recommendations regarding payment methodology.” For meeting agendas and to register, go to www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp?utm_source=Members-Only+Updates&utm_campaign=08e1d08f77-WiW_042711&utm_medium=. Rough Review for Blood Glucose Monitors in Jurisdiction A HINGHAM, Mass.—The results of a prepayment review of claims for home blood glucose monitor supplies in Jurisdiction A weren’t exactly stellar, according to the DME MAC. Initiated because of a high volume of claims errors identified by the CERT contractor, NHIC reviewed documentation compliance for 995 claims with dates of service from November 2010 through January 2011. Out of that number, only 31 claims were approved. For 701—or 70 percent—of the claims, NHIC said, responses to the Additional Documentation Request were not received. For the 249 claims for which ADR responses were received, 218 (87.5 percent) were denied, mainly because: 63 percent of the claims were missing the supplier record of the refill request; 48 percent were missing documentation that the beneficiary or caregiver had completed training or was scheduled to begin training in the use of the monitor, test strips and lancing devices; 26 percent had incomplete detailed written orders and 19 percent were missing the detailed written order; and 23 percent were missing proof of delivery. NHIC reminded providers “that repeated failure to respond to ADR requests could result in a referral to the Jurisdiction A Program Safeguard Contractor/Zone Program Integrity Contractor.” 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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