Author

Kay Cox

  • HME Products

    Respiratory Drug Access at Risk

    The Medicare Modernization Act (MMA) mandated that respiratory providers no longer be reimbursed at a percentage of the average wholesale price (AWP) for respiratory medication. Instead, starting January 2005 Medicare will reimburse the drugs at the average sale price (ASP) plus 6 percent. While the MMA required the General Accounting Office (GAO) to determine whether current payment for inhalation therapies is adequate, the report will not be completed until late this year. As a result, we believe that there will not be adequate time for Congress to consider the GAO findings and take necessary actions to modify this provision before ASP reimbursement begins. The American Association for Homecare strongly believes that this level of reimbursement will fall short of covering operating and administrative costs associated...

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  • Operations

    A Reason to Raise Your Voice

    Civic engagement is the cornerstone of our society. A 20th century politician once said, “there can be no daily democracy without daily citizenship.” However, for those of us in the home care industry, our daily lives are consumed with serving our patients’ needs and meeting the payroll for our employees, and the world in Washington seems far removed from these very important tasks. When you add to that the overwhelming perception of power, influence and money in Washington, D.C., it is easy to become ambivalent about your role in democracy and to question your ability to make a difference. I would like to offer another perspective on the HME provider’s role in democracy. Despite the old adage of “politics as usual,” the political landscape in...

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  • Legislation & Regulation

    The Value of Home Care

    It should come as no surprise that one of the most pressing problems facing lawmakers and policymakers today is finding solutions to the many challenges facing America’s health care system. With the explosion of Medicaid costs, the expansion of Medicare and the high costs of prescription drugs, there are no easy answers and no quick fixes. No group is faced with these challenges more than the nation’s governors and state legislatures. AAHomecare is working with the National Governors Association (NGA), state legislative groups and individual states as coalition partners to help them address these challenges, and help them understand that home care is part of the solution for the future of health care in America. Obviously, now is the time to turn the debate around...

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  • Legislation & Regulation

    Ready for the Challenge

    The home care industry is facing many challenges in 2004 due to enactment of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The American Association for Homecare is well prepared. We have developed an action plan to ensure that policy-makers hear our message to preserve access to high-quality home care equipment and services. And we are putting our strategy in place, a multi-pronged approach that entails concerted efforts on Capitol Hill, in the administration and federal agencies, at the state level and in the public arena. Relationship Building Since passage of the new law, Capitol Hill and the administration have been in an “Okay, how do we move forward now?” mode. There have been lots of personnel changes in Washington, as is always the...

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  • CMS/Medicare

    CMS Eases Supplier Number Moratorium

    The home care industry recently received some positive news. Thomas A. Scully, administrator of the Centers for Medicare and Medicaid Services, authorized the National Supplier Clearinghouse to begin approving applications for those providers who have submitted their enrollment application and have passed their site visit, signaling an ease in the provider-number moratorium. This development is the culmination of months of hard work by the entire home care industry, and marks a significant victory for law-abiding durable medical equipment providers and the patients we serve every day! Earlier this fall, CMS announced “Operation Wheeler Dealer” to help prevent Medicare fraud and abuse. The initiative came on the heels of an isolated Houston-based wheelchair scam, in which corrupt doctors submitted Medicare claims for power wheelchairs that were...

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  • CMS/Medicare

    Preventing Medicare Fraud and Abuse

    Recently, the Centers for Medicare and Medicaid Services announced a 10-point plan targeting Medicare fraud and abuse in the power mobility sector. The impetus for this aggressive crackdown was a Houston-based wheelchair scam involving unscrupulous doctors and providers who billed Medicare for power wheelchairs that were either never delivered or substituted with a less expensive model. The scam cost taxpayers millions of dollars, and AAHomecare and durable medical equipment providers applauded CMS for taking action to prevent this type of fraudulent activity from occurring in the future. But, because the new CMS initiative is untested, we need to be diligent in alerting CMS to our concerns and monitoring the effect that it has on the vast majority of law-abiding DME providers and the patients they...

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