WASHINGTON, D.C. (December 29, 2015)—CMS finalized the rule to implement Prior Authorization for general DMEPOS items. The final rule was published on December 29th. The proposed rule, published in May 2014, suggested that a prior authorization requirement be imposed for selected HCPCS that are frequently subject to unnecessary utilization. The originally proposed master list consisted of 139 HCPCS.
HomeCare News
WASHINGTON, D.C. (December 23, 2015)—Provisions from H.R. 284, legislation that passed the House in March 2015 were ultimately folded into H.R. 2, comprehensive Medicare legislation popularly known as the “Doc Fix,” which was ultimately signed into law on April 16, 2015. The legislation improves the competitive bidding in these three concrete ways:
WASHINGTON, D.C. (December 23, 2015)—The initial HME Audit Key test survey from earlier this year tracked audits received from October 2014 through June 2015. One of the preliminary findings was suppliers appealed 80 percent of MAC prepayment denials for respiratory products, and 92 percent were overturned. While based on a small test pool of participants, other findings from the survey indicate that:
WASHINGTON, D.C. (December 18, 2015)—Under a rare procedure to get a bill quickly considered by Congress, the The Patient Access and Medicare Protection Act (S. 2425) was passed by both the Senate and House today.
LENEXA, Kan. (December 16, 2015)—Mediware Information Systems, Inc., a provider of comprehensive post-acute care health care software, and Prometheus Group, an outcomes-based billing services provider, announced they have signed an agreement for enhanced collaboration in offering full-service billing solutions for the home medical equipment (HME) and durable medical equipment (DME) industries.
PHILADELPHIA, Penn. (December 17, 2015)—naviHealth, Inc., a Cardinal Health company, today announced the acquisition of RightCare Solutions, Inc., a health care decision support software service provider specializing in hospital discharge planning software and readmissions management. RightCare’s software is powered by proprietary, evidence-based decision-support technology developed in conjunction with the University of Pennsylvania School of Nursing.
GRAND PRAIRIE, Texas (December 17, 2015)—Point of Rental Software, a Texas-based company that provides rental and inventory management solutions worldwide, joins the U.S. Marine Corps Reserve in its mission to bring a message of hope to less fortunate children.
LAS VEGAS (December 17, 2015)—Only one more day remains for Medtrade Spring Early registration. The spring version of the nation’s premiere HME-focused trade show is scheduled for February 29—March 2, 2016, at the Mandalay Bay Convention Center in Las Vegas.
Early registration ends on Friday, December 18, at midnight.
WEBB CITY, Mo. (December, 16, 2015)—DETECTO’s new solo eye-level clinical scale is an economical and high-quality digital physician scale with height rod.
Congress Gives Big Funding Boost to NIH
This was one of the rare years when Obama and lawmakers from both parties all agreed on the need for more medical research funding. (David Nather and Dylan Scott/Stat News)
WASHINGTON, D.C. (December 15, 2015)—Congress has finalized the language for the Omnibus Spending Bill to allow the government to continue operations through 2016. The bill is scheduled for a vote today (December 15, 2015).
WASHINGTON, D.C. (December 16, 2015)—AAHomecare has confirmed that HME legislative priorities will not be a part of Omnibus spending legislation package that Congress will consider later this week. In addition, the Medicaid "pay for" targeted to help pay for rural relief legislation has been included in the Omnibus legislation, with a 2019 effective date.
GRAND PRAIRIE, Texas (December 15, 2015)—Point of Rental Software, Inc., a provider of award-winning rental and inventory management software, announces the release of new branding, including a new logo, colors and product names. With customer growth at an all-time high and the company's Australia office opening in January, Point of Rental opted for the brand makeover not only to differentiate its products, but also to better reflect that growth.
WASHINGTON, D.C. (December 15, 2015)—As consumers count down to the December 15 enrollment deadline for January 1 coverage, the Centers for Medicare & Medicaid Services (CMS) announced today that new HealthCare.gov consumer decision support features piloted earlier this enrollment season will now be fully deployed to all visitors.
WASHINGTON, D.C. (December 15, 2015)—The Centers for Medicare & Medicaid Services (CMS) is committed to providing current quality performance data that is useful to the consumer. Recently, data was refreshed on both the Physician Compare and Hospital Compare websites to improve these consumer online tools.
Missoula, Mont. (December 14, 2015)—Aqua Creek recently introduced a new generation of spa lifts, designed to provide greater access to residential and commercial pools or spas. The Spa Lift Ultra and Spa Lift Elite feature added clearance capabilities, making them ideal for taller swim and exercise spas—a growing trend in the industry.
LEWISBERRY, PA. (December 14, 2015)—Butler Mobility’s inclined platform wheelchair lift has helped countless customers better navigate their homes. Installing a lift for customers who have never been able to move from one floor of their home to another allows them to now move easily and freely between multiple floors. These lifts help restore quality of life and mobility.
WATERLOO, IOWA (December 10, 2015)—Medicare beneficiaries, individuals with disabilities and veterans in rural states will have to drive farther to obtain prescribed home medical equipment beginning January 1, 2016.
A recent study completed by the GeoTree Center at the University of Northern Iowa, Cedar Falls, concluded the rural residents in Montana, North Dakota, Oregon, Washington, West Virginia and Wisconsin will now have to travel further to reach an HME supplier.
The study was the continuation of an earlier study in August that showed similar outcomes for five other rural states. The table of information below derived from both studies summarizes the details of HME coverage following the reimbursement cuts.
The release of the study comes just as members of the U.S. Senate and House weigh legislation that would grant relief to hundreds of providers in rural areas expecting reimbursement cuts of up to 45 percent on January 1. The cuts scheduled are the continuation of the phased Medicare DMEPOS Competitive Bidding program that has been criticized widely for using flawed bidding procedures, resulting in widespread business closures since 2007. In this phase, competitively bid rates in urban areas will be expanded to rural ones.
“HME suppliers in rural areas contend with different business challenges such as the cost of delivery and smaller patient volume that are not accounted for in this across the board cut,” said John Gallagher, vice president-government relations, for VGM Group, Inc., which commissioned the study. “Businesses will be put in dire situations, forcing coverage reduction or even closures. Naturally, when there are fewer providers, patient access suffers, hospital discharges are delayed, which costs the government more money.”
In the past six years, there has been a 17 percent reduction of suppliers throughout the U.S., a direct result of the competitive bidding program.
Medicare beneficiaries and their HME suppliers are holding out that S. 2312, the DME Access and Stabilization Act of 2015 and H.R. 4185, the Protecting Access through Competitive Pricing Transition Act of 2015 will be included in the 2015 Omnibus Spending packages, set for vote next week.
“It’s urgent that people in rural states speak out to their elected officials to stop the expansion of the Medicare competitive bidding program that will devastate rural health care,” said Gallagher.
See graphics below.
CHARLOTTE, N.C. (December 11, 2015)—Griffin Home Health Care, Inc. announced that it is relocating its Charlotte business.
Provider Web Capital is pleased to report continued growth in monthly originations and increased customer satisfaction as the firm heads into the final month of 2015. Some notable transactions are highlighted below: