NCB, IR and HIPAA Could Have Major Impact on Respiratory Providers

The respiratory care community well knows that all politics eventually affect businesses in their own backyard, according to Marcia Nusgart, executive director of the Coalition of Respiratory Care Manufacturers (CRCM), and Ron Billingsley, director of government relations for Murrysville, Pa.-based Respironics.

In their conference session, “Update on Respiratory Issues Facing Manufacturers and Providers,” Nusgart and Billingsley explained how CRCM was addressing several regulatory topics — competitive bidding, inherent reasonableness, the Health Insurance Portability and Accountability Act (HIPAA) Uniform Code Set issues and HCPCS coding process issues — then urged the audience to be advocates for the industry as well.

Inherent reasonableness is an important issue to watch and speak to congressmen about, Nusgart said. IR has always been a regulatory mechanism that can be used to adjust Medicare reimbursement rates, but the process was redefined, allowing DMERCs to make changes of 50 percent without the formal rule-writing process, she said, adding that the first products to undergo IR may be power wheelchairs due to the recent federal crackdown on fraud in that sector of the industry.

HIPAA Uniform Code Set issues are also a concern because there might be a gap if there were no national HCPCS code that described the local code, Nusgart said. Consequently, over the past two years, CRMC has worked with state Medicaids to review “crosswalking” of Medicaid to national HCPCS codes and apply for new codes if gaps existed.

Manufacturers and providers also need to speak out about issues such as non-invasive positive pressure ventilation (NPPV), oxygen local medical review (OLMR) policy, new respiratory HCPCS codes for 2004 and pending local medical review policies, Nusgart said.

While the Coalition represents the industry, “it’s still important for respiratory manufacturers and providers to speak intelligently about issues that affect them and not to be intimidated by the Washington process,” Billingsley noted. “Your congressman wants to hear what [these issues] really mean to you and to the economy. Plus, you vote for them and pick their salaries.”

Winners of Medtrade’s New Product Pavilion awards, based on attendee votes, were:

Distinction Award

The Ergonomic Shower Chair with Built-in Bidet by Mobility Inc., LaJolla, Calif.

Innovation Award

The DeVilbiss FlexAire Mask from Sunrise Medical, Longmont, Colo.

Merit Award

The Weighted Exercise Vest by Walkvest, Beverly Hills, Calif.