industry

HME

  • Editor’s Inbox

    Room with a View [Regarding the Dallas power wheelchair scheme (“Texas Déjà Vu,” March 2004)], it turns out I actually sold a case of bedpans to one of the defendants. When I visited him, I couldn’t figure out why he was doing so much mobility business out of a lousy, windowless office in a cheap, shared office suite in an awful location. At least in prison, he’ll get a window! — Janet White, Rehab Exchange/DME Depot LLC, Richardson, Texas Not a Dirty Word As an industry, we need to start standing tough when it comes to reimbursement issues. We are quick to say how much our services are worth when we are talking to payers and legislators, then we accept contracts that don’t even cover…
    Read More →: Editor’s Inbox

  • Suburban Success Story

    For a young DME company based in Stockbridge, Ga., location and careful demographic profiling have been the foundation for rapid growth. New housing developments are springing up in the small town located in Henry County, 25 miles south of Atlanta, virtually overnight. Based on a December 2003 demographic profile, the county is the third fastest-growing county in the United States and the fastest-growing county in Georgia. “A lot of people are moving to the South and working in Atlanta, but they don’t want to live in the city,” explains Darren Tarleton, president and CEO of Mobility Warehouse. The idea for Mobility Warehouse came from the owners of a local Stockbridge pharmacy. The four owners of Moye’s Pharmacy, a five-store, 28-year-old Henry County business and household…
    Read More →: Suburban Success Story

  • Latest HME News

  • Getting Rid of the FEHBP-Based Cuts

    The quintessential Washington wisdom this year is that of all election years — it will not be an active legislative season. So the HME industry must use this time to enlist political support for the objectives we have, both short-term and long-term. Although it appears all attention is focused on the presidential election, Congress is still charged with a number of must-do actions this year. As an industry, we simply have too many issues on our plate to be politically complacent. Think of the sheer number of issues imposed on our industry by the Medicare Modernization Act (MMA). We cannot afford to sit on the sidelines. In the short term, we are faced with reimbursement cuts for five categories of DME slated for January 2005…
    Read More →: Getting Rid of the FEHBP-Based Cuts

  • Get Ready, Get Set

    Remember the saying “look to your left, look to your right, one of you …?” Today, that sentence can be finished with “… will be in a competitive bidding area in 2007.” An alternative ending is “… two of you will be in competitive bidding in 2009.” That’s right, one out of three providers in 2007, and two out of three in 2009. A couple of weeks ago the following message was in my e-mail inbox: “I run a smooth HME respiratory business. Dropping around 8 percent to the bottom line. $2.2 million in annual revenue. Does your group have a strategy in the competitive bidding arena?” The address indicated that this forward-thinking provider is located in one of the country’s 10 largest metropolitan statistical…
    Read More →: Get Ready, Get Set

  • Hobson Drafts Legislation To Repeal 2005 Reimbursement Cuts

    Washington A U.S. Representative plans to introduce legislation that would repeal 2005 reimbursement cuts for some DME products and oxygen. The Medicare Modernization Act (MMA) implements the cuts next year for manual and power wheelchairs, nebulizers, diabetic supplies, air mattresses and oxygen. Cuts will be based on an Office of Inspector General (OIG) report on Federal Employees Health Benefits Plan (FEHBP) median pricing and a forthcoming OIG report on home oxygen and oxygen equipment. But Rep. David Hobson, R-Ohio, said he wants to stop the cuts from happening. In a letter to House Speaker Dennis Hastert, R-Ill., and Rep. Bill Thomas, R-Calif., former chairman of the Medicare Conference, Hobson said he planned to draft legislation to rescind the reimbursement-cut provision in MMA. “I continue to…
    Read More →: Hobson Drafts Legislation To Repeal 2005 Reimbursement Cuts

  • 2004 Reimbursement Survey

    To remain profitable in the new Medicare era — with closer scrutiny of K0011 claims, slowed payment of non-HIPAA-compliant claims (which CMS says soon it won’t accept at all) and coming cuts across a string of bread-and-butter products in 2005 — it’s more important than ever that claims are clean and that reimbursement practices are efficient. To find out where home medical equipment providers stand in denials and appeals, days sales outstanding (DSO), staffing and more, HomeCare fielded the magazine’s annual reimbursement survey — our fifth — to a randomly selected group of domestic subscribers asking about their reimbursement procedures. Providers of all types and sizes responded, and the results of this year’s survey are based on answers from 281 of your peers throughout the…
    Read More →: 2004 Reimbursement Survey

  • Power Play

    You can’t keep a good market down. Take the power wheelchair market, for example. It has endured a DMERC policy clarification that stalled thousands of payments for power wheelchairs to home medical equipment providers; it has long grappled with an inadequate Medicare coding system; and it has had to compete with an influx of offshore manufacturers, many of whom undercut both prices and quality. But it’s still one of the best HME markets out there, manufacturers say, and there is nowhere to go but up. “The market has steadily grown because the population continues to [get] older,” says Cy Corrigan, national sales manager for Pride Mobility Products, Exeter, Pa. “Individuals have had their freedom, they’ve seen a lot more than our fathers’ fathers saw in…
    Read More →: Power Play

  • CMS Considers Changes To Wheelchair Coverage Policy

    Washington This year, HME industry advocates and the Centers for Medicare and Medicaid Services (CMS) have volleyed back and forth in a K0011 coverage debate that may end with vigilant payment oversight, pricing changes or even changes to national coverage policy for wheelchairs. Since a DMERC clarification of power wheelchair policy was issued in December, industry stakeholders have spoken out against CMS’ strict interpretation of policy language, voicing concerns regarding beneficiary access to medically necessary power equipment and provider payments. Although CMS retracted the clarification in mid-March, some advocates say access questions remain. At a March 31 Open Door session on the issue, CMS officials said the agency cannot give a more specific definition of its policy language. “Being more specific than the national policy,…
    Read More →: CMS Considers Changes To Wheelchair Coverage Policy

  • CMS Prepares to Form DME Advisory Committee

    Baltimore The wheels may be starting to turn toward competitive bidding. At a Home Health, Hospice and DME Open Door Forum in late March, CMS announced it is preparing for the formation of a DME advisory committee to advise the agency on quality standards, financial standards, data collection strategies and, ultimately, the logistics behind implementation of competitive bidding as required under the Medicare Modernization Act (MMA). “We’re just getting started now,” a CMS official told HomeCare. “The committee … has to be there at the start of the process. I would hope we would have internal decision-making done … by late summer. [But that is] pure speculation.” MMA creates an Advisory and Oversight Committee to advise the Secretary of Health and Human Services on development…
    Read More →: CMS Prepares to Form DME Advisory Committee

  • Houston Psychiatrist Convicted In PWC Fraud Scheme

    Houston On April 1, Houston psychiatrist Lewis Gottlieb was convicted for his involvement in a multi-million-dollar power wheelchair billing scheme uncovered last year. The psychiatrist defrauded Medicare and Medicaid of $16 million by approving hundreds of motorized wheelchairs for beneficiaries in return for kickbacks from wheelchair suppliers. Indicted last September, Gottlieb pleaded guilty to executing a health care fraud scheme and receiving kickback payments between October 2001 and May 2003. He now faces a maximum penalty of 10 years in federal prison for the health care fraud conviction, five years for the illegal kickback conviction and another five years for the conspiracy conviction. Sentencing is set for June 24. During last month’s hearing, Gottlieb admitted to signing hundreds of CMNs in exchange for $200 per…
    Read More →: Houston Psychiatrist Convicted In PWC Fraud Scheme

  • DME Competitive Bidding Back on the Table in Florida

    Tallahasee, Fla. For the third time in three years, competitive bidding for Florida Medicaid DME business is back in play. The current proposal, stated as proviso language in state appropriation bills, asks for a contract on Medicaid DME — excluding customized wheelchairs, colostomy and ostomy supplies, orthotics and prosthetics — with payments no more than 80 percent of current Medicaid rates. “The bid [would] begin at a 20 percent reduction and go from there,” said Javier Talamo, director of political services at PediStat, a Miami provider of pediatric DME and services. The proposal says DME providers should “bid on services like ventilator care and high-tech pediatric care, which by their complexity should be [acquired] on a capitative basis,” he said. “[The proposal] deprives the [beneficiary]…
    Read More →: DME Competitive Bidding Back on the Table in Florida

  • Rotech Signs On with Gentiva Health Services

    Orlando, Fla. Last month, Rotech Healthcare signed an agreement with Melville, N.Y.-based Gentiva Health Services, the nation’s largest home health nursing company, to supply respiratory therapy and DME services to patients. Rotech now has primary preferred provider arrangements in 23 states and shared preferred arrangements in 10 states through Gentiva’s CareCentrix network, which provides managed care organizations with home care services including traditional home nursing, chronic and acute infusion therapies and DME and respiratory equipment. Rotech has also signed a three-year primary preferred provider agreement with Gentiva to provide CPAP devices and related OSA products for CareCentrix patients. Phillip L. Carter, Rotech’s president and CEO, said the company’s annual revenue from these contracts “could well be greater than $25 million as we enter 2005,” and…
    Read More →: Rotech Signs On with Gentiva Health Services

OUR DIGITAL PARTNERS

trending

From Our Partners